The pregnancy is over, baby is here and you are super eager to get back into your regular yoga or fitness routine but it’s important to understand that your body has gone through significant changes from both pregnancy itself as well as your birth (vaginal or caesarean).
DID YOU KNOW?
New research shows that 100% of women HAVE diastasis recti by 35 weeks and in 40% of women that separation continues postpartum(Lee, 2019)
What is Diastasis Rectus Abdominis?
Diastasis Recti occurs when the connective tissue between your rectus abdominis (six pack muscles) called your linea alba, stretches and thins to allow your belly to grow during pregnancy. Women may have a noticeable bulging or doming along their abdominal wall when performing certain activities that involve either activation of their rectus abdominis (crunches, curl ups, forward folds) or in response to increases in intra-abdominal pressure (coughing, laughing, lifting). In fact, the ability of the abdominal wall and linea alba to respond to intra-abdominal pressure is far more important than the inter-recti distance (distance between either side of the rectus abdominis).
If you experience doming, coning or pain along your abdominal wall with certain movements, it is a sign that you should modify the exercise and consult a pelvic health physiotherapist.
With that said, here are my
TOP 5 TIPS FOR RETURNING TO YOGA AFTER BABY
1. Focus on posture and alignment
Your body goes through a considerable amount of change both in both physiology and anatomy during pregnancy and delivery. As your baby (and your belly grows) you start to hold more weight in the front of your body, naturally your centre of gravity shifts backwards to prevent you from falling over. This tends to cause women to shift their weight onto their heels to compensate and their pelvis tends to tuck underneath them. This tucking of the pelvis tends to put more pressure on your low back and tightening and overactivity in the glutes and hips. Your ribcage and diaphragm also shift backward and expand to make room as the baby grows and can put more pressure and stretch onto your abdominal wall, which may make diastasis more evident. Different postures and compensations can also become apparent here, especially if you have any type of pelvic pain, SI joint pain or low back issues. Most women tend to stay in their newly adopted “pregnancy posture” postpartum. This is the number one thing we need to address for all postpartum women and anyone with pelvic health concerns.
How to Restore Your Posture:
Start at the feet: Start in standing in a relaxed position. Notice where the weight is in your feet. More in your heels or more in your toes? Next, shift your weight onto your heels. You should notice that as you shift back onto your heels, your tailbone tucks underneath you, and your low back muscles flatten out. This is a very typical compensatory strategy during pregnancy. Next, hinge forward from the ankle until you feel your tailbone untuck, and you feel a gentle curve in your low back. You should feel even weight between your midfoot and heel. This should be a small movement, if you feel your low back muscles kick on, you’ve gone too far. Now pay attention to what happened at the rib cage. It should have also shifted forward slightly with your pelvis. You want the bottom of your rib cage, stacked directly over your pelvis. So looking from the side, you should see your ankle, pelvis, ribs, shoulders and ear all in a straight line.
Restoring this posture is foundational to your return to yoga. In order to connect to your deep core muscles and restore balance and function, you need to have a strong foundation. Trying to maintain your pelvis and rib alignment can be challenging as you move through certain poses, especially ones that require arms elevated overhead or require balancing on one leg. Make sure to check in with yourself throughout these poses.
2. Connect to your breath
As your baby grows upwards in your abdominal wall and rib cage, there is less space for your diaphragm (breathing muscle) to lower and draw air into your lungs. This is one of the reasons, you feel more short of breath during pregnancy. Your diaphragm is also a key stabilizer and control muscle of the trunk and core.
Find your breath:
Lay on your back with your knees bent and head relaxed. Start to pay attention to where your breath goes, without forcing it. Are you only breathing into your upper chest? Rest your hands on the outside of your ribcage. Inhale through your mouth and let your breath travel out towards your hands. You should feel your ribcage expand as you breathe in and your belly gently soften. Exhale gently through pursed lips and feel your ribcage and belly close back in. This can take a lot of practice, and can be challenging for many. However, restoring your breath helps reduce tension in the neck and back, improves core function and reduces force and pressure on your pelvic floor.
The most common issue I see is breath holding. Holding your breath is a strategy many women use to brace their core as they move through a challenging exercise or pose. If you hold your breath, you create an increase in intra-abdominal pressure that has nowhere to go, but out towards your abdominal wall and diastasis (which can cause it to bulge or cone) or down towards your pelvic floor (which can worsen symptoms of prolapse or leakage). Exhale as you move and transition through each pose and exercise.
3. Find your transversus abdominis (TVA)
Most people think of their core as their rectus abdominis (six pack muscles), but we’re talking much deeper than that.
Your transversus abdominis (TVA) is your deepest layer of abdominal muscle. It is located underneath the rectus abdominis and obliques and wraps around the trunk horizontally like a corset. It also gets very stretched during pregnancy and can be hard to find postpartum. When activated your TVA restores the tensile strength along the linea alba and works to control changes in intra-abdominal pressure. Being able to find and activate this muscle is the first step to restoring your core and healing your diastasis!
Find Your TVA:
Place your hands on the front of your hip bones and then walk your fingers in towards your navel. Imagine a wire from hip bone to hip bone. Now try to pull that wire to opposite sides of the room. You should feel a gentle tension underneath your fingers and a gentle flattening of your lower abdomen. You should not feel popping out into your hands. Your upper abdominals and hip muscles should stay relaxed.
When moving through any core specific exercises in your yoga class, this muscle should lead the movement. Signs that you are not activating your TVA well or that an exercise is too challenging for the tissue and your diastasis are; doming or bulging along the linea alba (midline of your tummy), feeling your back arch off the floor, or pain in your lowback. Be mindful in exercises that involve curling up or crunching, planks or any exercise that has both legs lifted off the ground.
4. Monitor and modify
One of the most important things when going back to any form of exercise is to monitor your body and how you are feeling. Remember your body has gone through a significant amount of change in a very short period of time. Check in with yourself throughout the exercises or poses and note if you feel any
- pressure or heaviness in your pelvis
- bulging or doming in your abdomen
- hip, back or pelvic pain
- bladder leakage or urgency
If you feel ANY of the above symptoms, it is highly recommended that you modify or stop the exercise and check in with the yoga instructor and your pelvic health physiotherapist.
5. Focus on your own mat
There is no specific timeline that you need to follow. I can assure you, you are never “behind” in the healing and recovery process. It is easy to get caught up in the comparison game, but whether or not susan can hold a plank longer or her diastasis is healing faster has nothing to do with your progress or recovery. Every pregnancy, delivery and recovery is individualized. It’s much more beneficial to you and your system to progress back into your practice or exercise routine slowly and mindfully then to rush and push yourself too hard because your trying to keep up with someone else.
References: Diastasis Rectus Abdominis: A Clinical Guide for Those Who are Split Down the Middle. Diane Lee. Surrey, BC. 2017
Jessica is a pelvic health physiotherapist and a strong advocate for women’s health. She has extensive training in pelvic health, diastasis recti, pelvic floor dysfunction and postpartum exercise. Jessica has received training from international experts in physiotherapy and pelvic health and is on a mission to improve the quality and standards of healthcare for women. You can find Jessica at Core Restore Physiotherapy in Orangeville Ontario.