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Strong Abs during Pregnancy and for New Mom’s

The staff Doctors of Physical Therapy at EMH specialize in pre and postpartum physical therapy for a healthy pregnancy and a fast recovery after delivery. Preventing Diastasis Recti is one aspect of our expertise.
Please forward to all your pregnant/new mom friends and family!

Diastasis Recti Abdominis (DRA) can occur in up to 66% of pregnant women due to hormones that allow ligaments and joints to relax, the increasing baby size in utero, improper weight lifting (ie heavy food bags, other children, furniture etc), a history of prior C-section or abdominal surgery and repetitive poor mechanics during daily activities and lack of regular exercise.

Men can also develop DRA due to faulty weight lifting mechanics, obesity and chronic medical conditions that result in frequent coughing such as bronchitis.

What is a DRA?

DRA is defined as the separation and thinning of the rectus abdominus muscles (see diagram in green) and stretching of the linea alba (see diagram in blue). The linea alba runs from the xiphoid process (base of sternum) to the symphysis pubis (center of pelvic bone). Both the rectus abdominus muscle and linea alba are the main support for the front of the abdomen, keeping the visceral organs in place and functioning well. They also maintain pelvis stability during walking, lifting, bending and squatting.

What are the symptoms of DRA?

Symptoms may include:

  • Noticeable small or large bulge in the center abdomen
  • Sharp or burning abdominal pain during bending, lifting, standing and walking
  • Lower back pain
  • Feeling like the intestines or stomach may fall out
  • Poor posture
  • Longer term problems of prolonged DRA may include Stress Urinary Incontinence, Fecal Incontinence and Pelvic Organ Prolapse.

How To Measure for a DRA?

The best way to measure is a finger width measurement. Lie on your back, knees bent, head resting on floor/pillow. Place tips of 4 fingers across the body at naval or just above/below the naval per your comfort. Now raise your head and shoulders slightly upward. If your fingers descend inbetween the parallel rectus abdominus muscles on either side of your naval, measure how many fingers move downward. If there is a true split of the linea alba, your finger will fall into a space that feels squishy (your intestines live here!). A positive DRA is one where there more than 2 fingertips (1 inch or 2.5cm width) that lower. We have measured women with 3 to 4 inches ( 8cm) wide and have helped them narrow back to 1 inch (2.5cm) wide.

 

What to Do if you have a DRA?

Best to first consult a pelvic physical therapist for a tailored postural, stabilization and home exercise program targeting the Tranversus Abdominus (deepest and lowest muscle of our abdomen), the pelvic floor muscles and the multifidi muscles (lower back stabilizers). Here are some tips to help you immediately:

  • Avoid positions that may further separate the recti muscles, like doing sit ups, crunches, strong stretches of the abdomen, quick trunk rotation movements
  • Stand and sit symmetrically (not to weight bear more on one side vs the other)
  • During standing, gently unlock your knees and gently pull your stomach inward while breathing normally
  • Self bracing of your stomach with your hands pushing the rectus together when sneezing, coughing or laughing
  • Wear a pelvic and abdominal support product to help maintain erect trunk posture and decrease pain until your muscles are aligned and strong

 

 

Diastasis Recti Abdominis (DRA) or “Split Seams” can be treated by Pelvic Physical Therapy

Diastasis Recti Abdominis (DRA) can occur in up to 66% of pregnant women due to hormones that allow ligaments and joints to relax, the increasing baby size in utero, improper weight lifting (ie heavy food bags, other children, furniture etc), a history of prior C-section or  abdominal surgery and repetitive poor mechanics during daily activities and lack of regular exercise.

Men can also develop DRA due to faulty weight lifting mechanics, obesity and chronic medical conditions that result in frequent coughing such as bronchitis.

What is a DRA?

DRA is defined as the separation and thinning of the rectus abdominus muscles (see diagram in green) and stretching of the linea alba (see diagram in blue).  The linea alba runs from the xiphoid process (base of sternum)  to the symphysis pubis (center of pelvic bone).  Both the rectus abdominus muscle and linea alba are the main support for the front of the abdomen, keeping the visceral organs in place and functioning well.  They are also maintain pelvis stability during walking, lifting, bending and squatting.

What are the symptoms of DRA?

Symptoms may include:

Noticeable small or large bulge in the center abdomen

Sharp or burning abdominal pain during bending, lifting, standing and walking

Lower back pain

Feeling like the intestines or stomach may fall out

Poor posture

Longer term problems of prolonged DRA may include Stress Urinary Incontinence, Fecal Incontinence and Pelvic Organ Prolapse.

 

How To Measure for a DRA?

The best way to measure is a finger width measurement.  Lie on your back, knees bent,head resting on floor/pillow. Place tips of 4 fingers across the body at naval or just above/below the naval per your comfort.  Now raise your head and shoulders slightly upward. If your fingers descend inbetween the  parallel rectus abdominus muscles on either side of your naval, measure how many fingers move downward.  If there is a true split of the linea alba, your finger will fall into a space that feels squishy (your intestines live here!).  A positive DRA is one where there more than 2 fingertips (1 inch or 2.5cm width)  that lower.  We have measured women with 3 to 4 inches ( 8cm) wide and have helped them narrow back to 2.5cm width

 

What to Do if you have a DRA?

Best to first consult a pelvic physical therapist for a tailored postural, stabilization and home exercise program targeting the Tranversus Abdominus (deepest and lowest muscle of our abdomen), the pelvic floor muscles and the multifidi muscles (lower back stabilizers).

Here are some tips that you can do immediately:

Avoid positions that may further separate the recti muscles, like doing sit ups, crunches and quick trunk rotation movements.  Avoid being on “all fours”  or on hands and knees for too long during exercise classes.  Assuming the yoga, “cow position” where your belly drops down as your head and hips arch upwards,  puts too much pressure on the already stretched linea alba.  Plus, the yoga position of  “Up dog” and extensive backward bends are not recommended.

Stand and sit symmetrically in good posture  (don’t stand on one leg or sit with crossed legs leaning on one hip for too long)

When you are standing, gently unlock your knees and pull  your stomach inward while breathing normally to give abdominal  support and prevent “hanging out” on your ligaments

When you sneeze, cough or laugh you you can self bracing of your stomach with your hands pushing each side of the rectus abdominal muscles towards the midline, or hold a pillow against your stomach for bracing

Wear a pelvic and/or  abdominal support product to help support the growing baby in uteruo , maintain erect trunk posture and decrease pain until your muscles are stronger by doing core exercises.

By keeping your core toned during pregnancy and taking the steps to prevent further widening of your recti muscles, you can prevent extensive DRA.

 

 

Good Posture is Key to Healthy Body

Good posture is a key factor in preventing many pelvic, hip, lower back, mid back and neck pain.  If we spend most of our day sitting in a slumped position, our knees crossed, our shoulders  rounded forward and our head  jutting in front of our body, and do nothing to counterbalance via exercise or change of pattern, overtime, muscles  become tight, joints lose their flexibility, nerves get pinched, our breathing is compromised, our abdominals become flabby, and off to the doctor we go.  These common problems related to poor posture are treatable with the appropriate lifestyle changes, daily postural exercises taught by a physical therapist and by making ergonomic changes.

TAKE THE PHOTO CHALLENGE:

Let’s tackle some basic lifestyle/ ergonomic issues.   The first step in knowing good posture is to become aware of your postures during work and home.  An easy way is to find out is to have your coworker take some random photos of you throughout the work day (no poses!) The best shots are the side and back views where you can see your spine curves. At home, have a family member take photos of you preparing meals, reading on the couch, etc.  Later you can look at the photos and marvel how upright, centered and how you maintain your natural spine curves throughout the day (probably not!)

Just by looking at your photos, you can figure out some of the changes you need to make.  Good posture is based upon keeping the natural curves of the spine during most activities.  This is called maintaining a “neutral spine” and requires flexible muscles, joints and having strong muscles.   Our body should not be placed in extreme positions for hours at a time. For example a hyperextended position, ie standing with both knees locked can cause lower back tension, conversely, a hyperflexed position , ie sitting in a slumped, rounded posture  can cause back and pelvic pain.

GOOD SITTING POSTURE – Detailed

Sitting is what we do most of our day – to work, eat, learn, watch TV, read and  mostly sit during transportation.  Over time, poor sitting positions causes muscle tension, joint restrictions, strength deficits and pain that physiatrists diagnose and physical therapists treat every day.

Set up your computer/reading/art /work space to fit your body, to help support and maintain your natural spine curves instead of having your body adjust to the space.  The chair seat should be at a comfortable height, so that both feet (heels and toes) can touch the floor. Feet that are unsupported create tension in hips/legs/lumbar spine.  If your body is more of a petite size, so your feet do not touch the floor, use a footrest.

When sitting, the two bones at the bottom of the pelvis where your hamstrings attach, called Ischial Tuberosities  (IT’s), and the center of your pelvis inbetween the IT’s should be in contact with the chair seat.  Your lower back should rest against a lumbar cushion, either already built into your chair back, or purchased separately and strapped around the chair back. The lumbar cushion gently pushes your lower back forward to maintain its natural inward curve.  You should not slump backward to sit on your tail bone (coccyx) nor should you lean too far forward to bear weight on your pubic bone. Don’t sit on one side/hip as this creates imbalances at your sacroiliac joint, hip and lumbar spine.  (See photo 250)

With your lower back resting against the back of your chair against a lumbar cushion, this frees the thoracic spine , shoulders and neck to stack one on top of another, versus careening forward.  If you find yourself hunching forward to see the computer screen or to reach the keyboard, adjust the placement of this equipment so it is brought closer to you so you do not strain forward.

Lastly, during every hour of sitting, work/read/draw for 50 minutes, then get up for the last 10 minutes to take a brief walk, do a stretch, pet your dog, do something else.  Research shows that 50 min work/ 10 min of change recharges your brain/thinking powers. This timing is a great way to re-evaluate your posture and prevent build up of faulty postural patterns.

POSTURE EXERCISES

A  Upper body lift:  done either in sitting or standing position and has 3 distinct parts

If doing this exercise in sitting, keep your pelvis centered on the seat as described above, your lower back resting against the lumbar cushion. If doing this exercise in standing, keep both knees slightly bent.

1) Think of an invisible string gently lifting your sternum (the bone in front of your chest) upwards    You should feel your upper body move from a rounded upper back to a more elevated posture Hold this as you:

2) Roll your shoulders up towards your ears, then backward, then down.  This opens your front of your shoulders Maintain this position as you finally:

3) Gently tuck your chin towards your neck (think of creating a double chin position)

Hold all three positions together for a count of 20 seconds up to one minute.  Make sure to breathe slowly while holding the position   Repeat.  Do three times a day.

B  Thoracic twist combined with deep hip rotator stretch

While working at a computer we tend to get into a rounded upper back and forward head position. Our midspine, called the thoracic spine can become restricted as well as our hip muscles. Here is a simple stretch to open both areas\

R Spine twist:

Sit in a sturdy chair your buttocks slightly away from the chair back, feet comfortably touching the floor or on raised step stool

Cross the R ankle over the L knee

Place L hand on outside of R knee.

Place R hand on the chair seat behind you

Turn your upper body as far as possible to the right while gently pulling the R knee towards your L shoulder. Keep your neck centered over your chest, not to twist your neck too far

You should feel a stretch along your spine and in R buttock/hip region Hold for 10 up to 30 seconds while breathing slowly.

Return to center and repeat once more.  Repeat to the opposite side two times  Do twice a day

 

C Wall Angels

Do you remember making snow angels as a kid?  “Wall angels” are the grown up version of snow angels This exercise increases strength of  your upper back, posterior shoulder to counteract the effects of a forward head, rounded shoulders posture.

1)      Stand knees bent, your buttocks, lower back, upper back and back of your head are against a wall. Tighten your stomach to keep your core stable.  Bend your elbows comfortably by your sides with the back of your hands touching the wall.

2)      Keeping this body position, slowly slide both hands along the wall raising both arms until your hands meet overhead.    Slowly lower. Repeat 10 reps.  If it is difficult to go full range, try ½ or ¼ range.

 

There are more excellent postural exercises, for example keeping your abdominals, pelvic floor and lower back muscles flexible and strong is key.   Consult your local physical therapist to learn a tailored exercise home program  that is right for you.