As the uterus expands during pregnancy, the abdominals stretch to accommodate its growth and often separate, which results in a condition called diastasis recti (DR). Postpartum, the walls slowly come back together. Or, rather, they should.
For many women, the gap remains into the fourth trimester and beyond. In addition to a lower-belly “pooch” that just won’t go away can impact a woman’s self-image. DR can be a factor in pelvic pain, incontinence, back pain, constipation and labored breathing and movement.
While the condition is disheartening, it’s not hopeless. We reached out to author and Tune Up Fitness Worldwide founder Jill Miller for some DR guidance. Her self-care fitness programs meld yoga, self-massage, mindset and pain management. Plus—perhaps most important for this topic—she’s a mom herself.
Miller breaks down the when and why, do’s and don’ts, and ups and downs of this often-overlooked but common ailment.
Q: When and why did you begin practicing yoga?
Jill Miller: I started practicing yoga at age 12 with the Raquel Welch yoga video while growing up in an off-the-grid solar home in Santa Fe, New Mexico. Yoga gave me a place to self-soothe, look inward, and get to know my mind and body. It provided a laboratory for exploration of my motions and emotions.
Q: When did you begin to incorporate physical therapy into your yoga instruction?
JM: I am not a physical therapist. Many people think I am. However, since my early 20s, I have integrated massage and corrective exercise into my yoga practice. I learned the bulk of my yoga practice from a yogi named Glenn Black who was a skilled orthopedic medical massage therapist. He was the protégé of a physical therapist from Russia named Shmuel Tatz. Shmuel trademarked his approach to physical therapy as Body Tuning, and my Yoga Tune Up® program utilizes the word “tune” to pay homage to the therapeutic lineage that I studied.
Q: What are the most common complaints from your pregnant and postpartum clients?
JM: The majority of pregnant and postpartum women seek me out for stress relief and the ability to self-manage their own aches and pains. These fall into a few categories: lower-back pain, upper-back pain, shoulder pain, neck pain, hand/wrist pain and elbow pain. No matter which challenge they are dealing with, we always incorporate breath work so that they can learn to see and adjust their stress.
Q: How has becoming a mom changed your approach to prenatal and postpartum care?
JM: On a physical level, I feel great about my approach to prenatal and postpartum care. For me, the biggest challenges have been to my emotional resilience. I am way more emotional than I have ever been. Everything makes me cry, and I also get triggered by things that didn’t used to affect me.
So for me, this translates into making sure I take time to do things that I enjoy alone, away from my family. When I give myself my own version of a play date, I am a much better mom, wife and human. I encourage my clients to work this “me” time into their regular self-care.
Q: What is diastasis recti, in your own words?
JM: It’s a profound shift in the connective tissue seam that laces the abdominal layers together. If these fascial zones are under- or over-mobilized, your fascia may not be able to withstand the significant internal pressure shifts that occur during pregnancy.
Under-mobilization occurs because your abs aren’t using a full range of motion, a scar has inhibited and “glued” layers together, or you are chronically toning the muscles without adequate tissue recovery. Over-mobilization is usually because you stretch a lot but don’t strengthen, as well.
Q: How common is DR? Is it more likely with a C-section birth?
JM: Sixty-six percent of women have DR by the third trimester. C-sections don’t have any correlation with DR. If a woman had a C-section and a DR, she likely had the DR before she had the C-section. DR begins to form early in pregnancy, often around the 20-week mark.
Q: Are there preventative steps to take during, or even before, pregnancy?
JM: The American College of Obstetrics and Gynecology wants you to exercise and do core-strengthening moves throughout pregnancy, but they are not specific about core training. Most DR exercise programs will agree to avoid planks, crunches, push-ups and deep backbends, as these all place excessive strains on the midline.
My main recommendation during pregnancy is to train your inner baby carriage, which are your deepest postural muscles. These muscles are also your primary breathing muscles. My Roll Model Mama program breaks down prenatal breath and self-massage strategies in elaborate detail. It’s the most cost-effective way to regularly receive a massage, remind your body of its worth, and learn about the fascinating anatomical changes throughout the whole pregnancy journey.
Also, keep in mind that your body is at the whim of relaxin, which loosens all your body’s connective tissues. This loosening needs to be respected as the pregnancy progresses, and it’s important to adapt your personal practice accordingly. Respect your joints and connective tissue now so that you can be maximally functional for the days and nights of new motherhood lying ahead.
Q: How can postpartum women safely regain core strength?
JM: The rehab begins with breathing. You must be able to sense the respiratory muscles and how they contribute to tension across the midline. Then you should learn to maintain that tension correctly during workouts and everyday activities. I teach many exercises with the Coregeous ball to help stimulate the multiple muscle layers that [make up] the core.
If you think you may have DR, check out my self-assessment video. Then I recommend personalized care. Find a qualified women’s health physical therapist with a pelvis specialization for an assessment and plan.
Q: Why don’t health news sources cover DR more?
JM: It’s not a “sexy” thing to photograph for magazine covers. People want to see ripped abs, not ripping abs. But women need to learn that if your abs are in fact ripping, you’re in trouble.
Q: Then why don’t medical professionals talk about it more?
JM: I think it’s a condition that has been mostly relegated to plastic surgeons. There are many capable women’s health physical therapists who can help with the condition. Just because the tissues have drifted apart doesn’t mean that they are dysfunctional. If you can transfer tension from one side of the abdomen to the other, your core is still effective and efficient. The challenge for many women is that the aesthetic of the abdomen is altered, and this shape change can be a mismatch for their body image. This is why many jump to plastic surgery.
Q: Will DR ever become part of the standard postpartum vocab?
JM: The health of a woman’s whole body postpartum has just been elevated thanks to the American Council of Obstetrics and Gynecology’s new recommendations for more maternal health evaluations during the fourth trimester. This includes mental, sexual AND structural health.
Follow Jill Miller @yogatuneup and buy her book “The Roll Model: A Step-by-Step Guide to Erase Pain, Improve Mobility, and Live Better in Your Body.”
Photo credit: Todd Cribari, inspirostudio.com; courtesy of Jill Miller