Mind The Gap - All you need to know about abdominal muscle separation!
By Taryn Watson, FitRight Physio
It will never cease to amaze that a little human being can grow to full development for nine months in a woman’s belly. One of the inevitable consequences of this, however, is that there has to be a lot of shifting and stretching of the surrounding organs and tissues to allow this to happen!
The “six pack” muscle, or Rectus Abdominis muscle, is actually two muscle bellies with a line of connective tissue down the middle. From about 18 weeks of pregnancy, when the baby starts taking up more space above the pelvis, the midline tissue has to start stretching, and the six pack muscles move apart from each other.
This separation is called ‘Rectus Abdominis Diastasis’, or RAD, and is helped by the fact that pregnant women have a hormone in their body called Relaxin, which allows connective tissue to be stretchier.
MYTH TO BUST – The abdominal muscles do not ‘tear’ or ‘split’, but the connective tissue between them does need to stretch and this is a very normal consequence of pregnancy.
In pregnancy, after the muscles have begun to stretch, it is highly recommended to minimize use of the six pack muscle. This means after approximately 16-20 weeks of pregnancy, avoid anything that causes ‘doming’ or triangling of the abdominal wall during exercise or daily activities. This may include:
- Russian Twists
- Pull ups/chin ups/Muscle ups
- Getting up from the bed/bath/couch
Daily movements can usually be modified to avoid doming, by rolling completely onto your side to get up from a reclined position.
Although it’s recommended not to do certain types of abdominal muscle exercises in the second half of pregnancy, that doesn’t mean that you can’t exercise your abdominal muscles at all.
You can continue to exercise the abdominal wall in a different way, by focusing on the Transverse Abdominis (TA) muscle. There is scientific evidence that this can significantly reduce the rate of RAD after childbirth. The TA is the deepest layer of abdominal muscles and acts like a ‘corset’ to hold in the abdominal contents and give support to the spine. A physiotherapist can show you how to do these exercises correctly.
In the early days or weeks after you have given birth, it is recommended to get your RAD checked by a physiotherapist. This is done with a very simple test of feeling the midline of the muscles above and below the belly button. This will tell the physiotherapist how wide the gap is in finger widths, but more importantly how deep it is, and what happens when it is loaded such as with common abdominal exercises or daily tasks.
Early after birth, if your RAD is diagnosed as being significantly deeper or wider than the norm, it is generally recommended to wear some abdominal support to help the recovery. A physiotherapist may give you an elastic band of material that you step into and wear around your middle, or you may choose to purchase a pair of support shorts that are specifically developed to assist with RAD recovery. This extra support can help to hold the six pack muscles in better alignment while they heal, and is most important in the first two months.
The abdominal muscles don’t always come back to their optimal position after childbirth just because time has passed.
Although abdominal muscle separation will have some natural recovery after childbirth as the uterus and abdominal organs settle back into their pre-pregnancy position, after 8 weeks it has been shown in research that there is often no more natural recovery and you need a specific exercise program get you back to optimal strength.
Learning gradually harder pilates-types exercises from a physiotherapist in this postnatal period can help to fix any ongoing RAD. They will teach you how to ensure that nothing you are doing causes the abdominal wall to ‘dome’ upwards, or the gap to deepen, while you improve your strength.
Many women are focused on ‘closing the gap’, but the width of the gap is not as important as the depth.
Anything up to 1.5-2 finger widths can still be ‘normal’, however this gap should be nice and firm in the midline. It is when the midline tissue is lax and the gap is deep (even if it is quite narrow) that unwanted consequences like hernias can occur.
Being diagnosed with a diastasis that persists after the early postnatal period does not necessarily mean that you have to change your exercise goals.
It doesn’t mean that you’re broken, or weak, or can't exercise your abdominal muscles. It just means that you have to learn how to use your core muscles in a way that prevents 'doming', and monitor what your muscles are doing during loaded abdominal exercise to avoid hurting yourself.
You shouldn’t always have to think about this either - automatic use of the deeper abdominal muscles to prevent doming can be taught. This usually means building up to the higher level exercises and practicing with gradually increasing load through the system.
In summary, it is highly recommended to see a physiotherapist who specializes in obstetrics both during pregnancy and after childbirth, to prevent and manage the inevitable abdominal muscle separation that occurs.
In pregnancy, you should learn how to activate the deep abdominal muscles and how to safely integrate that activation into a gym program and your daily activities.
After birth, you should identify early on if you have a significant separation and wear additional support if you do, and learn correct postnatal exercises to assist the recovery.
You should have it checked again at 6-8 weeks when any natural recovery would have taken place, and if there is any remaining dysfunction at that stage you will be taught a specific exercise program to get it back to it’s optimal strength as soon as possible.
And finally, it’s never too late – even years down the track, improvements can be made to a diastasis if the correct management is undertaken.
Find out more about FitRight Physio at www.fitright.physio