Diastasis Recti: Part 2

When More Intervention Might Be Needed

In my last Diastasis Recti article, I defined DR and shared how to assess your abdominal tone and strength—a true DR that needs additional treatment is actually not that common. Today, I'm going to talk about those cases, how it feels and looks, and how to treat it, should you be wondering about the state of your abdominal wall. To be clear, in my 20+ years practicing, I have only seen a handful of these cases and they have all been treatable with the following intervention.

For those of us who embark on the journey of motherhood, there’s a lot about it that scares us…all the flipping time! Your body doesn’t have to be one of those things. It can be a refuge for self-connection, self-understanding, stress release, and emotional clarity. 

Here’s how you know, what to do, and where to begin if you think you may need more help with your abdominal recovery post babies…

HOW TO TELL IF YOU NEED FURTHER INTERVENTION

A true DR is when the abdomen is like a pool of thinned and soft belly tissue—there’s almost no response even at the mom’s very best effort. In these cases, I refer moms to a very specialized pelvic PT for manual, visceral manipulation. This is because, the loss of the front core muscles will have also resulted in extreme weakness and tension in the back, pelvic floor, and hip-stabilizing muscles, requiring manual release, visceral movement, and often organ realignment prior to a mom’s ability to begin isolating, feeling, and engaging her transverse abdominals (TVA).

In these cases, there are common symptoms that accompany the DR such as stress incontinence, back pain, hunched shoulders and “stuck ribs.” The term, stuck ribs, is used to explain how a widened diaphragm and ribcage are unresponsive when asked to expand and contract 3-dimensionally. 

THE 411 ON CONING + DOMING

Ever heard of “coning” or “doming?” These terms refer to an abdominal contraction that instead of pulling down and inward, separates and pushes your midline out between the two sides of your 6-pack. 

This separation and outward pressure occurs in a moment when your TVA are not able to engage and so your external abs are disorganized and de-stabilized, like when you’re 9 months pregnant or just gave birth.  

COMMON CONING

Sometimes coning spontaneously and naturally occurs when you sneeze, cough or simply try to sit up after lying down. These short-lived moments are not dangerous and do not ‘cause’ diastasis-recti.  You can try and engage your TVA mindfully before you sneeze or cough (and definitely when rolling up out of bed) and this can help hold things in place in the moment, but it’s ok if you can’t and don’t. You will not make things worse because you are 9-months pregnant or 1-week postpartum and have a moment of coning.

The coning that we want to watch out for is a separation that occurs when you are working out and your abs cannot sustain their engagement through exercise—so, you “cone.” Paying attention to this “lost TVA moment” will allow you to pause your exercise and use breath to re-engage from the inside out, continuing to strengthen your abdominal wall. If ignored, you begin to risk training your abs to pull apart for strength instead of together, which can lead to thinning and weakening of the midline, resulting in a more severe DR.  

HOW TO KNOW YOU NEED MORE HELP

An Easy Way To Test Your Midline: Standing or lying down, simply take a deep breath. If your midline sticks out below your ribs (and your ribs don’t move), this is a sign that you need some help from a pelvic PT. Make an appointment with a specialized PT to help remobilize your ribs and diaphragm. They can also release the back tension that is keeping your TVA from gliding with your breath.  

EXERCISE & “DOMING”

What can exacerbate your abdominal weakness and lead to a widening of the midline is sustained coning and weight-baring core work while the TVA are disengaged. For example, doing a plank while pregnant and the midline is pushing down and out instead of up and “hugging” the baby. If you are working out and noticing that your mid-belly is lax, bulging or can not draw in and together, then you need to pause and go back to your foundational TVA strength.

BELLY BANDS: DOs & DON’Ts

Belly bands are tight, elastic-type corsets that wrap around your back and waist to help hold your belly in. Moms are advised way too frequently to use belly bands and it f’s up their abs! 

Extended or frequent use keeps your muscles deactivated and trains them to become increasingly passive and reliant on the belly band. I have seen this lead to complete atrophy of the majority of your trunk’s core muscle system, requiring months of rehabilitation and recovery.  

I only advise using a belly band in very specific, early postpartum or post-operative situations, where the mom is often needing to care for her older children and or perform standing/walking tasks that are beyond her body’s capacity. In these instances, the band can lend itself to support the mom through a couple hours of activity and then, she takes it off, but I always use them with a plan to stop using them.  

THE SURGICAL OPTION

Surgery is the right choice for you if you and your medical team decide so. No one knows your body and your needs better than you. I have advised women with minimal separations to head into surgery because psychologically, they just needed to see a quicker fix than the rehab fitness was going to yield. Some have gone in because their tissues were so compromised, they likely would never be able to bring elasticity and strength back to the core without it.  

Whatever you choose, I applaud you. 

POST-OP TIPS

Corrective surgery is major undergoing and you will need the same course of muscle reeducation and strength training post-op as you do now. But, the great news is, you’ll have muscles that are aligned where they are meant to be and tissues with enough tension and elasticity to engage and build 3-dimension strength! Remember, surgery will only be an option after you are sure you’re done having children.

So, no matter where you are in your journey, a daily, mind-body core workout that meets you at your fitness level and supports your muscle activation are a must for your long-term health. 

THE PUNCHLINE 

A fit, active lifestyle is key to success. Find a program that inspires you and keeps you moving forward. It should resonate with you and you should feel changes happening as you make your way through the program.

Persistence is the golden rule for maintaining your core strength and function for your entire life, because motherhood is just one chapter in your body’s ever changing needs. 

For more on diastasis-recti and your pre and postnatal muscle education, check out the RM DR Program on our App.
For an exceptional Pelvic PT, check out Beyond Basics with multiple locations located in Manhattan.