Diagnosing a diastasis and what you can do about it

In my last post we spoke about a commonly overlooked reason for a post pregnancy pooch that you cannot seem to lose no matter how much you exercise or diet. This separation of abdominal muscles causing the bulging appearance of the stomach is called diastasis recti. This post will cover how to check for a diastasis and some of the things you need to consider if you have this condition.

A test to determine a diastasis can be done by yourself at home or you can speak to your physiotherapist or gynecologist who will check for it.

Diastasis gaps are typically measured in finger width. So you could be diagnosed as having a diastasis which is 2 fingers wide or 4.5 fingers wide. I will not go into how to self-diagnose as there are many videos and tutorials available online. Here is one that explains it quite clearly: diagnosing a diastasis.

If you have a diastasis there are a few things that you need to know:

1. This does not mean you will never have a taut tummy ever again; you will probably just have to exercise with some modifications and avoid certain exercises altogether.
2. If people around you- your doctor or family and friends try to tell you that this is normal and just the way all women’s tummies look after a baby it is NOT true. A tummy with a wide gap (diastasis) looks distinctly different from just regular flab that accumulates around the tummy.
3. A tummy with a diastasis tends to dome or look like a bump when you either get up from a lying down position or any movement which cause you to jack knife or bend from the hip thigh joint.
4. The traditional Indian post-partum ritual of tying a saree around the tummy may have been dismissed by many as outdated and pointless (I am guilty of saying this as well) however there seems to be some merit in the practice. Providing support to the sagging tummy by splinting helps to provide some support to the weakened stomach muscles and restricts you from bearing down or creating intra-abdominal pressure. However it is important to note that along with splinting it is essential to start strengthening abdominal muscles, otherwise it is of no use and your tummy will continue to pooch out as soon as the splint is removed.
5. All women who have been pregnant have had some degree of muscle separation, for some the gaps reduces naturally, typically for first time mothers, women who have already been exercising prior to getting pregnant while for older moms, second pregnancies, multiples the diastasis may be wider and not heal naturally.
6. If your gap is less than 2 fingers wide this is considered normal after pregnancy and should heal by itself by doing diastasis safe exercises before moving on to regular exercise. If the gap is more than 2 fingers or more following “Tupler technique” will certainly be of help. This is a non-surgical technique developed by Julie Tupler (a registered nurse) which is considered to be the gold standard of diastasis healing throughout the world.
7. Doing exercises that involve jack knifing or rolling up (like when you get out of bed) or any exercises that cause your abdominals to stretch out like back extensions will worsen the conditions.
8. Pilates exercises can be modified to suit conditions like diastasis. More importantly the emphasis on using the pelvic floor muscles in Pilates exercises makes it very suitable for post-partum fitness. However it has to be said that not all Pilates exercises are suitable for people with a diastasis. It therefore becomes very important to find an instructor who understands post-partum anatomy and can guide you through exercises that are safe and suitable.

Whether you are a new mom or someone with an older child it is not too late to try and heal your diastasis. Finding the right instructor who can work with you and who understands the condition is important. Enjoy your baby and work your way back to a fit body slowly and safely!

Can’t lose the mummy tummy? You could have a diastasis recti.

In my last post I wrote about easing back into a realistic doable fitness routine post pregnancy. One of the things that I had mentioned was that it is important to exercise safely. Pregnancy is a time of many physical changes, while it is important to remain physically active during and after pregnancy it is also important to understand these changes and modify or alter your fitness routine accordingly.

During pregnancy your posture tends to change. The increasing weight around your mid-section tends to pull your lower back into a hyper extension that can cause lower back pain both during and after pregnancy. This pain can get worse post pregnancy when your hormones are still in flux and ligaments are still in a relaxed state and now you have the additional task of caring for your baby. Constant bending, lifting during bath times, diaper changes carrying the baby on your hips all contribute to the stress on your lower back.

Pilates helps by strengthening muscles that support not just your back but also your pelvis restoring a more neutral alignment of the spine and thereby alleviating back pain.

One of the most common mistakes new mothers make in a bid to lose the “mummy tummy” is to do endless crunches or sit ups.  Not only can traditional sit ups hurt your already weak lower back but it can actually make your tummy pooch out even further.

This is due to a condition called diastasis recti.

Your abdominal muscles are layered with the transversus abdominis being the deepest or inner most followed by the external and internal oblique muscles and the rectus abdominis or the 6 pack forming the outermost layer.

During pregnancy the increasing load around your tummy puts pressure on your abdominal muscles from the inside (intra-abdominal pressure) and this causes the thin connective tissue running vertically down the center of your torso from the sternum to your pubic bone to stretch out and the rectus abdominis muscles to separate this leaves the contents of the abdomen unsupported with very little to hold them in. This is what causes the permanently 5 months pregnant pooch that some women face many months and years after the baby.

(It is important to note here that a diastasis is possible even among men and infants. For men the reason is typically very weak core muscles made worse by heavy lifting and doing traditional sit ups or after surgery.)

The diastasis post pregnancy normally tends to shrink on its own but doesn’t in many cases.

In the next post I will be talking about how you diagnose if you have this condition and what you can do to heal it.

Post Natal Fitness and Pilates

So you’ve survived the roller coaster that is pregnancy, welcomed your precious bundle of joy into the world and are slowly beginning to wonder when you are going get your body back into pre-pregnancy shape or any recognizable shape for that matter!

First off enjoy your baby and the time that you spend with him/her, these are important moments in both your life and your baby’s life that you will never get back.

In today’s world with all the bombardment of social media and celebrity pre and post baby three week “miracle” transformations from flab to fab it’s easy to start thinking that this is the norm and all new mothers will (and should) snap back into their old bodies in the blink of an eye. This is not so and it is not necessary either.

A few things that are important to remember as you attempt to ease back into a fitness routine:

1. You NEED to get a doctor’s OK to start exercising- your gynecologist is the right person to give you this advice. They have seen you through your pregnancy and will be able to advise you when it is the right time for YOU to start exercising. The text book 4-6 weeks doesn’t apply to everyone. Having said that, simple exercises like Kegels can be done almost immediately after delivery if you are up to it.
2. Each body and each pregnancy is different- what may have worked for your friend or for you in your first pregnancy may not work for you now.
3. Get enough sleep, in the first few years most mothers are sleep deprived and there are days when the last thing you want to do is exercise when you are running on 3 hours of sleep. Sleep is a crucial part of your body’s recovery process.
4. Proper nutrition is vital not just for you but for your baby especially if you are breastfeeding. You can lose up to 500 calories while breastfeeding! Simple home cooked meals that are nutrient rich and low on empty calories are important.  Especially in the Indian context where new moms are regularly faced with wanted and unwanted advice from well-meaning relatives on what foods will increase breast milk supply (This seems to be an obsession with all the older women in most families!). A lot of these home cures are heavy on sugar, fats and are basically desserts in disguise and will take you further away from your efforts to lose weight or stay healthy. It’s also very important to stay hydrated both from a breast feeding point of view and also to avoid constipation.
5. It is also important to understand that your body has undergone some major changes in the last 9 months. Your ligaments (the scaffolding that holds your joints in place) have loosened up to enable the baby to pass through your pelvis. Going straight into high intensity exercise may not be advisable initially as you are likely to injure yourself.
6. Start slowly, listen to your body and know when to stop or alter your exercise intensity.

Pilates is a great choice for new mothers for many reasons

1. Its focus on developing core strength is exactly what you need after pregnancy.
2. It restores a more neutral alignment in your spine
3. It is rehabilitative especially if you have conditions like diastasis recti
4. It’s a great way to reconnect with your own body, many times a difficult labor and delivery leaves women with both physical and mental trauma that leaves them feeling that they are not in control of their own body.
5. Pilates exercises strengthen the pelvic floor muscles which are stretched and weakened during pregnancy and child birth. A weak pelvic floor leaves many women with urinary or fecal incontinence and sometimes more seriously a pelvic organ prolapse.

In the next post we will go into more details on how to engage your pelvic floor muscles, what exactly is a diastasis recti and how to exercise safely without worsening the condition.

The more important thing is to remember that your exercise routine post pregnancy should be something you look forward to and enjoy, something  that doesn’t exhaust you to the point you are unable to rise up to the challenging demands of motherhood!

Pilates for runners

Whether you’re are serious marathon runner or just a casual runner on a treadmill you would obviously be looking at improving your speed or efficiency and the best way to do this is if you can manage to run without pain or injury.

Pilates complements running beautifully in that it focuses on strengthening the core muscles of your body namely the muscles around your back, hips and pelvis and the deepest layer of your abdominals called the transversus abdominus or simply (the TA)

Stabilizing the core results in smoother and more efficient movements in the rest of the body  such as your arms and legs.

Most runners  (especially the casual runners) don’t think about how they are running..I mean you put on your shoes and go right? Whats there to think about? Well lots actually…

When you run you are using you hip flexors to lift and pull the top of the front leg forward and the quadriceps to extend the knee joint and muscles around the ankle to flex your foot as you prepare to land on it. You also use the hip extensors (muscles around the back of your legs and your gluteals) to pull the leg back after you land. It is important to ensure that all the while you are maintaining a good posture and neutral alignment of your body; not going into a posterior tilt or an anterior tilt of the pelvis. Its important to keep the shoulders over the hips, open out the chest, keep the legs (femurs) facing forward and not turning in and having the knee, ankle and foot aligned.

When you run incorrectly supporting muscles begin to take over functions that they were not intended to perform resulting in aches and pains, stiffness and eventually injury.

So how does Pilates help?

• Pilates helps create a supple, strong and agile body
• Pilates focuses on creating dynamic stability i.e. stability while your body is in any kind of movement (running)
• Pilates breathing is great for better blood circulation, oxygenation of muscles
• Pilates evens out imbalances created by incorrect form while running which results in over or under utilization of certain muscles
• It works on multiple muscle groups
• Creates better body awareness and posture
• Pilates creates long lean muscles and not bulk – lengthening of muscles that are typically tight in runners (calves, hamstrings, hip flexors)

A good Pilates instructor should be able to retrain your mind (over time) to not just think differently about how you move but actually get you to experience it and therefore use it in your next run!

How does Pilates help with back pain

Many people who have back pain and practice Pilates benefit greatly from it. So what makes Pilates so effective in alleviating back pain?

Pilates exercises target basic structural imbalances in the body that are generally the reason for back pain. Lack of core engagement, pelvic instability, muscular imbalances, poor posture, and lack of body awareness all effect the back; this is exactly what Pilates helps improve.

Deep Core muscles of the trunk
The muscles that support the trunk (abdominals, back, hips and pelvis) are called core muscles. Lack of core muscle strength can be equated with a tree that has a hollow trunk and is trying to support heavy branches! Together the core muscles provide support and stability for the spine. As part of developing core strength Pilates teaches how and when to activate and release muscles.

Pilates focuses on deep muscles like the Pelvic floor muscles (think kegels), transversus abdominus (a built in corset!), deep muscles in the shoulder, and psoas (used when you bend at the hip); while these are not muscles of the back they are important because the prevent undue pressure on the spinal column especially in movement.

Improving posture is essential to a pain free back (other than the fact that you will look taller and slimmer!). Posture is how your body parts are aligned with each other. The ideal points to check for alignment are ankles, knees, hips, shoulders and ears. While standing in one place and keeping good alignment is not not too difficult, the challenge is to maintain good posture as you move around through the day at work or at home. This is what Pilates exercises teach you…maintaining alignment and stability as you move or ‘dynamic stability’ (I just love that phrase!!) .

A man in front of his PC with his cervical spine hyperextended

A simple example is when people do ab crunches I have often heard of complaints that the neck hurts more than the abs! This is because typically the position of the cervical spine (the back of the neck) is not correct and as you lift the shoulders to curl up its the neck that’s doing all the work rather than the abs. Pilates will teach you how to align your neck in this movement so that the abs are targeted instead of the neck.

Pilates increases flexibility. A healthy spine should be able to bend forward, backwards, bend from side to side and twist. The deep supporting muscles once strengthened protect and work along with the spine to allow us not only to increase the range of motion but appreciate the subtle movements that the spine is capable of.

Pilates increases body awareness. What I find the most exciting is that from the first session onwards people walk out with better body awareness. Pilates teaches us to look at our body differently and pay more attention to how we carry ourselves through life. Something as simple as pulling the ears away from the shoulder can diffuse tremendous tension that builds up around the neck and shoulder causing aches pains in the back of the neck and head.

Finally to quote Joseph Pilates “The art of *contrology proves that the only real guide to your true age lies not in years or how you THINK you feel but as you ACTUALLY are as infallibly indicated by the degree of natural and normal flexibility enjoyed by your spine throughout life.”

*Pilates was originally called Contrology.

The man was truly ahead of his time…