Postnatal Pilates and diastasis recti
One very common postnatal condition that Pilates instructors deal with every day is diastasis recti. This is where during the pregnancy or perhaps during labour there is a parting of the abdominus rectus muscles along the midline of the body, a bit like if you had unzipped your jeans keeping the top button done up.
It happens because during the pregnancy a hormone called relaxin is produced in order to allow the ligaments and muscles around the pelvis to relax sufficiently to allow delivery of your bundle of joy. The downside is this hormone affects all of your muscles and ligaments and not just those in your pelvis. For this reason many Pilates exercises are progressively modified throughout the trimesters of pregnancy to reduce the risk of this occuring.
What can you do if you have diastasis recti?
If you can feel any depression in the mid line of your abdominal muscles from the ribcage down to the pubic bone it is best to have this checked by a women’s health physio who will be able to offer specific advice based on the degree of separation. If the diastasis is considered low grade then supervised exercise can begin. Before returning to any form of exercises after having your baby you must also have your GP’s approval.
- Loaded flexion or forward bending, for example in a sit up or crunch, is a big no. When the connections of the muscles in the mid-line are weakened the contraction of these muscles will pull them away from each other rather than pulling the ribcage towards the pelvis as intended.
- Rotational movement through the thorax is also to be avoided. The complex interrelation of all these muscles which makes them typically so supportive under normal circumstances now acts against them as this rotation could again pull on the weakened midline.
- Even some static positions need to be avoided, such as the double table top legs as this is too much weight for the abdominal structures to safely support.
- The great news about returning to exercise with a diastasis recti is that unlike for much of your pregnancy exercise lying on your back is once again on the menu. This places minimal stress on many structures but still gives you the opportunity to strengthen your supporting muscles.
- You can exercise your core muscles without even moving. Breathing exercises such as hissing breaths or breathing through pursed lips create resistance for your exhalation and will engage all of the muscles that wrap around your torso plus the roof and floor of this muscular cylinder, the diaphragm and pelvic floor. This “exercise” is a great way to start to work these supporting muscles that have been stretched and compromised for the last few months. You can feel that this affects all the muscles around your body just by placing your hands on your sides or back and stomach and hissing your breath out. Just be ready for some funny looks if you have an audience!
- Do return to exercise with permission of your GP and with someone who has suitable qualifications and experience.
Despite the impression we might get from celebrity magazines etc it takes a long time for your body to return to it’s pre-pregnancy state. Be kind to yourself, your body has gone through many changes to accommodate another living being over nine months and after the baby has arrived this is even more of a rapid change for it to cope with. The cosmetic appearance may also be distressing.
One client in a studio I worked in with the condition was given the option of surgery to knit the muscles back together with mesh. Wanting to keep this as an option she approached the trainers in her gym who had no experience of dealing with diastasis so she stopped exercising. By chance I was talking to her husband who was using up her pre-paid classes and told him she was welcome back in my classes once she had been cleared by a women’s health physio. Once this was done she re-joined my reformer class at beginner level. Nearly every exercise had to be closely monitored and more often than not adapted but over the course of a year we worked together to get her back to taking the class with no adaptions required.
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