Caring for your Belly During Pregnancy-Preventing Diastasis Recti- Part 2

March 27, 2013 in Abdominals, Diastasis Recti, Pregnancy

Part 2-Preventing Diastasis Recti in Pregnancy

Diastasis Recti is a separation of the rectus abdominus muscles that is a common occurrence during pregnancy.   What we do with our bodies during pregnancy can make this separation worse and the recovery process longer.   There are three aspects you need to be aware of to help prevent diastasis recti.   In a previous post we talked about the first aspect of how rib thrusting contributes to the development of diastasis recti.  See this post to review rib thrusting.

The second aspect you need to be aware of to avoid diastasis is to protect your abdominal muscles with all your activities.   Any time the belly protrudes forward forcefully, like when you laugh, cough or sneeze, the abdominal muscles get strained apart.  The more strain the more separation.  If you are in your late second or third trimester and you notice any doming in the midline of your belly, this is the abdominal muscles separating.  You want to avoid this.

The third trimester is the period of time that greatest strain is placed on the abdominal muscles.   The less your belly domes up in the middle the less separation there will be.

How do you stop the doming and separating?

You can stop the separation of the abdominal muscles by pulling the belly button back to the spine before you do any activities that may strain the belly.  So before you cough, laugh or sneeze bringing your belly button into your spine.   Also before you go to lift anything heavy, contract your abdominal muscles back toward your spine.

DON’T DO SIT UPS OR CRUNCHES

Doing a crunch shortens the recti muscles and actually makes any separation worse.  When the muscles shorten they bulge out in the middle.   Crunches also increases pressure in the pelvic bowl area.  This can weaken the pelvic floor muscles and contribute to pelvic organ prolapse.   You don’t want that!

Sit ups should be avoided and are not an exercise I ever recommend to my patients.  There are other more effective ways of doing abdominal strengthening than sit ups.

Best form of Exercises during Pregnancy

If you want to strengthen your abdominal muscles just pulling your belly button back to your spine is the safest and most effective way to do so while pregnant.  Walking is another way to strengthen the abdominal muscles, as they have to work to support the spine.  In my opinion, walking is the best form of exercise you can do while you are pregnant.

So protecting your belly by contracting your belly button back to your spine with everything you do is the second step in avoiding a diastasis recti while pregnant.

In the next post we will cover the third aspect, which is the most common motion we do at least twice a day that can contribute to diastasis recti.   Stay tuned!

If you want to know how to heal Diastasis please check out my video How to Lose the Pooch For Good and Heal Diastasis Recti 

 

Caring for your Belly During Pregnancy-Preventing Diastasis Recti

March 25, 2013 in Abdominals, Diastasis Recti, Pregnancy

Preventing Diastasis Recti in Pregnancy- PART ONE

Congratulations on being pregnant.   There is a lot of changes that will be happening to your body over the next 9 months, the biggest one happening to your belly.  You probably aren’t that concerned about your belly getting huge, because it will!  But you should!  Things you do to your belly during your pregnancy can impact your delivery and recovery.

As the belly gets larger one of your abdominal muscles, the rectus abdominus can get separated.  How you use your body can cause strain on this muscle and separate it more.  But it doesn’t have to.  The larger this muscle separates the less support your abdominal muscles have during labor and the longer it will take to heal afterwards.   It’s important for you to take care of your belly and avoid putting excess strain on the muscles of your abdomen so you can minimize the separation of your rectus abdominus muscle.

HOW TO AVOID STRAINING YOUR RECTUS MUSCLES

There are three important aspects to know about protecting your abdominal muscles during pregnancy.  Since they are each pretty involved this blog will be in three parts so you can better understand each section.  Before we get into those three aspects let’s talk a bit about the abdominal muscles and what we want to prevent.

The rectus abdominus muscle consists of two sets of muscle bellies that run parallel and are held together by a connective tissue called the linea alba.  This muscle runs from the end of the sternum to the pubic bone.  As the uterus expands the muscle bellies can separate and the linea alba stretches thin.  This creates what is called a diastasis recti.  The degree of separation depends on what activities and stresses you put on this muscle while you are pregnant.

13330_1413899876212_1494023040_31037601_6547864_sYou will know if you have this separation if you notice a bulging out or doming in the midline of your abdomen when you do activities.  Any bulging of this tissue can cause the muscles to separate more.

Avoiding any bulging is what we will be talking about in the second part of this blog post but for now lets talk about how to prevent it in the first place.

 

How do you Prevent Diastasis Recti?

The way you hold your ribcage during pregnancy is one of the biggest contributors to development of diastasis recti.

Rib Thrusting

Are you a rib thruster?  Your lower rib cage should be in the same plane as your hipbone.   The way to tell if you are is to check the bottom edge of your ribcage and see where it is in relation to the front of your hipbones.  You know those little bumps on either side of your hips, which professionals call your anterior, superior iliac spine, or ASIS for short.   If you draw a line from your nipples down to the edge of your ribcage place one finger there and then find that little bump on the sides of your ilium and see how these two points line up.  Are your ribs out in front of your hipbone?  If so, then you are a rib thruster!  If they line up in the same plane, as if walking forward to a wall, both boney points would hit at the same time, then you are not a rib thruster.  Good for you!  YOUR RIBCAGE

Thrusting your ribs puts added strain on the abdominal muscles and can separate the recti muscles, especially when you are pregnant!

 

Rib-thrusting-in-preg-edittedsmallest

Rib-thrusting-corrected-editsmallest-1To correct this rib thrusting, take that point of your ribcage and move it DOWN and back.  This movement happens at the spine and not with your abdominal muscles.  Standing with your back against a wall keep your shoulders and head touching the wall, see if you can get your lower ribcage to make contact with the wall.  If your shoulder muscles are too tight moving your ribcage backwards can cause your shoulders to pull forward.  That’s a whole other post, so stay tuned.

Work on keeping your ribcage down and back with everything you do, especially while walking.  It’s going to take a long time to break this habit.   But every chance you get, remember to bring them down and back and in line with your hipbones.

When your rib cage thrusts forward there is increased pressures in your abdominal cavity.  This increased pressure has to go somewhere.  It can go up into the diaphragm and cause reflex or go down and cause inguinal hernias or force the abdominal muscles to separate.  When you bring the rib cage down and back the pressures even out and decreases the forces in the abdominal cavity, helping everything out.

So your focus for now is to see where your ribcage is hanging out.  Work on bringing them down and back to be in line with your hipbones.

In the second part of this series we will be talking about how different activities you do can contribute to diastasis recti.

If you want to know how to heal Diastasis please check out my video How to Lose the Pooch For Good and Heal Diastasis Recti

What is this thing called our Core?

January 18, 2013 in Abdominals, Diastasis Recti, Exercise, Post Partum

What is this thing called our Core?

Our body is an amazing machine.  What keeps it strong and allows us to move and do all sorts of activities is having strong core muscles.  Core strengthening is all a buzz these days and rightfully so because without good strength in our core muscles our performance can be diminished and can lead to back pains and problems.

So what is our Core?

Our core is made up of 3 groups of muscles, the abdominal, the pelvic floor and the multifidi muscles of the back.  While the other two are important I’m going to focus in on the abdominals and how certain things can really put us in danger of weakening these muscles.

The abdominal muscles 

The abdominal muscles are responsible for all of the movements in our trunk and consist of three muscle layers, the rectus, obliques and the transverse. The most superficial layer, the Rectus abdominus, otherwise known as the “Six-pack” muscle, helps us to bend forward or sit up from lying down. The middle layer of the abdominal muscles includes the Internal and External Obliques which helps us to twist.   The deepest and most important layer, the Transverse abdominus, helps to compress the abdomen in and is part of our core muscles to stabilize the spine and pelvis.

Do you ever see a bulge in your abdomen when you go to sit up from lying?  

If you do, then you have a Diastasis Recti.  That is a separation of the six pack abdominal muscle known as the Rectus abdominus.  The rectus abdominus muscle has two sets of muscle fibers that run up and down from the sternum, or chest plate, down to the pubic bone. They are separated by a connective tissue called the linea alba. These muscle bellies can become separated and the connective tissue between them stretched thin with pregnancy, increased pressures in your abdomen or by just having a big belly.   The muscle bellies get forced out to the side with the increased pressures.  Also, activities with forward forceful movements as in coughing, sneezing, laughing, or doing sit ups incorrectly can create a diastasis or make an already existing one worse.

So how do you know if you have a separation of the recti muscles, or a diastasis recti? 

You will know if you have one if you are lying down on your back and you place your fingers perpendicular to the rectus muscles, pointing down toward your spine in your belly button. You need to be pushing down into the tissue and not just have your fingers resting on the belly.  When you lift your head any fingers that fill the space between the two muscle fibers of the rectus abdominus let’s you know you have a separation. One to two fingers width separation is considered normal.  However you also need to address the connective tissue and see how deep you can poke down before you feel the connective tissue. Normal is very shallow.  Anything past your first knuckle needs some attention.  You want to assess this in three places, at the belly button, 2 inches above and then 2 inched below.  It is normal to have different measurements in all three areas.

Also another key sign you have a separation is when you lift your head does anything pop forward in the midline around your belly button?  That bulge is actually your colon protruding out.  There are certain things we do like getting in and out of bed, doing abdominal crunches, and playing golf and tennis that can make this separation worse.

Do you still have a “pooch” from being pregnant?

It doesn’t matter how old your baby is, our stomachs can still be stretched out from carrying the baby.  The transverse muscle runs like a corset from our spine around the front and inserts in the rectus sheath in front.  If you haven’t restrengthened this muscle it will continue to stay stretched out.  Granted, after the baby left your womb the transverse muscle did come back in somewhat but not to where it was prior to pregnancy.  There are some exercises you need to learn to help restrengthen this transverse muscle and we can show you how.  Regular sit-ups, Pilates and yoga do not address this muscle like it needs to be to help you lose your “pooch” for good.

At Intuitive Hands Physical Therapy we teach classes in the Boulder/Denver area and also have a video you can purchase that addresses all the issues with your abdomen.  You can lose inches and have a flatter belly by learning how to do two simple abdominal exercises that you can do anytime and anywhere.  There is a 4 step program that helps heal your diastasis recti so you can keep your organs in place and protect your back from injury.  We can also teach this class online via Skype.  For more information and to register for a class or purchase the video, click here.

 

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