Yoga and Diastasis Recti

Many of the challenges facing new moms are well known, but you might not be familiar this one: diastasis recti.
 
Sometimes called rectus diastasis, it is a separation of the two halves of your six-pack muscle, (rectus abdominus) along the vertical groove from the lower part of the sternum to the pubic symphysis (the pubic bone) — though rarely does it open the full length.
 

rectus diastasis image

Although not every new mother has to face this abdominal gap, it’s pretty easy for a healthy, growing, squirming happy baby to push this central sheath of fascia (the linea alba, which separates the two sides) apart from the inside out. Therefore it is common. Depending on the severity of the opening or diastasis, it could be permanent.

 
Recently, a dedicated yoga practitioner asked me if I agreed with her doctor that it is safe to return to yoga 10 weeks post-partum with a rectus diastasis. And I thought I’d share my suggestions here for those of you who are facing the same concerns. 
The real answer depends very much on both the style and actions of “yoga” (a vast spectrum of possibility) as well as the size (often measured in finger widths) and intensity of the diastasis, but my general advice: I’d say not yet. (Especially if you are breastfeeding: the hormone relaxin is continuing to keep your ligaments slack). 
 
Diastasis recti may fall somewhere on this spectrum: a small sacrifice (among many) that mommies make to birth new life and perhaps have forever – or – something that can and — for long term health — should be returned to its pre-baby state as much and as soon as possible.
 
As a yogini you will have much more access to and awareness of your body and you can absolutely heal a relatively small diastasis (or make major improvements if it is larger). Know that your body is the most pliable after trauma (childbirth) in the first few weeks, particularly the first 6-12 weeks (same time frame as those who break a weight bearing bone tend to need to wear casts).
 
Now is the time to nurture and care for your core, and do all that is within your power to shrink the diastasis. The purpose isn’t cosmetic: a diastasis reduces the stability in your core for as long as it exists (and it will persist if not addressed).
 
New moms, please don’t “go back to yoga” until you have received hands-on, skilled treatment for your rectus diastasis, preferably from a physical therapist or massage-trained midwife. Full physical therapy treatment might be 1 session or 10, so I am asking you to be patient and dedicated.
 
(As a side note, your OB probably didn’t touch you very much. If your physical therapist doesn’t touch you, find a new one ASAP. Palpation is sadly somewhat of a lost art in medicine, but it reveals so much, and it will help the therapist know when your tissues feel healthy enough to ease back in to your previous yoga practice).
 
Do follow your home exercises and create a gentle home yoga routine that adheres to your therapist’s guidelines. Know that if you are breastfeeding, you are also more vulnerable to injury because relaxin is still traveling through your system (but that’s a different post for a different day).
 

Here’s why you don’t go back: yoga class tend to be well rounded. During the time you are focusing on healing rectus diastasis, you will want to avoid:

  • backbends,
  • crunches or curls
  • poses like downward facing dog and table where your abdominal organs should hang in the anterior fascia of the abdomen.

Even lifting your head straight up off the floor while lying on your back can exacerbate the diastasis.

Hence, no group yoga classes.

When you go to a physical therapist, the best of the best for would be one who has specialized training in women’s health. A women’s health physical therapist (sometimes generally lumped in with pelvic floor PT) regularly sees pre- and post-natal clients, including those with rectus diastasis. It might be more challenging to get appointments with a women’s health PT, but there’s a reasonable chance they will get you better faster than just any regular outpatient orthopedic PT. (There are three womens health PTs where I work at Georgetown University Hospital!).
 
Another great option is to find someone – a physical therapist ideally, but many bodyworkers and massage therapists will have similar skills – who is trained in treating fascial layers. A therapist skilled in myofascial release will be able to separate any adhesions between rectus abdominus and the tissues below and help to repattern the fibers of the linea alba. (My myofascial release training is in the school of Tom Myers, author of Anatomy Trains, and the Institute of Physical Art as well as ongoing mentorship from some of their Certified Functional Manual Therapists on staff with me at Georgetown). 
 
In the meanwhile, investigate some of the books and readings out there on this condition, and see if one of them seems to help you as you prep for your appointment. One popular method for treating rectus diastasis is the Tupler Method. It might be something to familiarize yourself with between now and your appointment. The technique isn’t without flaws, and I am not endorsing the purchase of any patented abdominal braces or other items, but I know women who swear by it.
 
More important than any of this: congratulations on the beautiful new life you have birthed. Take care of yourself so you can take care of the little one for years and years to come. 
~
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(Please be aware that this blog post is not medical advice, nor is it a substitute for medical advice.)