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When I first got pregnant, I had a lot to learn. Not only did I need to adjust my physical yoga practice, diet, and sleeping positions, but there was an entirely new vernacular I had to get familiar with rather quickly.
Thankfully, my anatomy training as a yoga teacher helped me understand some of what my doctor meant when she said things like, “Your back hurts because you have an excessive anterior tilt of your pelvis” (that means I was overarching my lower back) or when the ultrasound tech showed me the “sagittal” view of the baby (this is just the technical term for the typical profile view of the baby).
When it came to other pregnancy-specific terms (that are oddly difficult to pronounce), my knowledge was quite limited. Like hyperemesis gravidarum, which is severe nausea and vomiting that can occur throughout pregnancy. Amy Schumer experienced this with her son and documented it quite rawly in her HBO Max Series, Expecting Amy.
The tongue twister that I worked hard to pronounce—and even harder to try to avoid—is diastasis recti (pronounced dai uh STAY suhs REK tai), also known as abdominal separation. Or the much less scientific—and honestly, kind of offensive—“mummy tummy.”
How do I know if I have diastasis recti?
The muscles on the right and left sides of our abdomen are divided by a thin line of connective tissue in the center called the linea alba. This runs from your xiphoid process (bottom of your sternum) to your pubic symphysis. Diastasis recti occurs when the linea albea separates between the two sides of the rectus abdominus.
This separation actually happens in all pregnancies as the abdomen changes shape to accommodate the growing uterus. Sometimes the separation happens so widely that there is a visible bulge. Other times it is more subtle and its presence needs to be determined by your doctor or a physical therapist. It becomes a diagnosable condition is when your muscles do not recoil back to a maximum distance of 2.7 cm.
Diastasis recti is not just linked to pregnancy. It can also occur from overdoing flexion-based core work (as if we need another reason to ditch the crunches), lifting something that’s too heavy, and excessive weight gain. It can also occur in men. Sometimes babies are born with this separation.
When left untreated, diastasis recti can lead to back pain, weakness in the core, pelvic floor dysfunction, and, in some extreme cases, hernia.
Why you can’t necessarily prevent diastasis recti
Some experts say people who are more athletic run a higher risk of getting diastasis recti because their muscles are too tight. Others say those with a lax core and a history of previous pregnancies are more likely to have it.
Alicia Roberts, a women’s health and orthopedic physical therapist in San Francisco’s Bay Area, has been treating patients with diastasis recti for nearly 15 years. Most of her clients are postpartum. Roberts believes it all comes down to our unique tissue structures. She has observed that some bodies with tighter abdominal muscles may be more prone to the separation because the muscles ”don’t stretch as well.” Yet she points out that it’s a bit of a chicken-and-an-egg situation, as it’s also related to the genetics of one’s muscle tissue.
Courtney Satow is a certified birth doula and registered yoga teacher specializing in prenatal and postnatal yoga. In addition to working with clients who are trying to heal their diastasis recti, she has had to deal with it after both of her pregnancies. Satow “did everything right” during both pregnancies, yet it still happened—twice. Despite believing the condition may be inevitable for some body types, Satow still strongly encourages people to modify their practice during pregnancy to mitigate symptoms and prime the body for the separation to come back together more quickly after birth.
Will diastasis recti repair itself?
One of the ways Roberts and other health professionals measure the severity of one’s diastasis recti is by seeing how many fingers they can fit into the person’s gap. For example, if you place your middle and index finger together, that is two fingers width.
Karly Treacy had a four-finger-wide diastasis after the birth of her third child. Yep, that is all four of your fingers together. Her separation was so significant that she was told she would need a tummy tuck to remedy it. This was in addition to a prolapsed bladder, which doctors also told her would need surgery.
For some with a wide gap, surgery is often unavoidable. Also, it’s not just about the width of the gap when determining a prognosis; it’s also about the depth. (Side note: When women need surgery for the condition, it is generally not covered by health insurance, as it’s considered “cosmetic,” although the same surgery is often covered in men, but I digress.)
Using her previous fitness certifications and athletic background, Treacy dedicated herself to studying the pelvic floor. In addition to her self-study, she worked with some of the top pelvic floor PTs in the country. It took time and dedication, but she managed to avoid surgery and her journey ended up being one of the motivations behind creating the KT Method, a pelvic floor reprogramming system aimed to strengthen the body, mind, and spirit, which now helps thousands of women around the world.
Is it OK to do yoga with diastasis recti?
Consider taking additional precautions beyond the standard modifications to your yoga practice during pregnancy if you have diastasis recti or are trying to minimize the likelihood of it—both prenatal and postnatal. Always consult with your physician or physical therapist with any questions.
Avoid big backbends
Most experts recommend avoiding bigger backbends during pregnancy, including Urdhva Dhanurasana (Wheel Pose) and even Urdhva Mukha Svanasana (Upward-Facing Dog). The only backbends that Treacy teaches her expecting clients are Supported Low Cobra and Supported Sphinx (taken with a bolster beneath your thighs). As she points out, pregnant bodies are already in significant spinal extension, and going any further with deep backbends may lead to more separation in the linea alba.
Backbends you may want to avoid:
Bitilasana (Cow Pose)
Some prenatal teachers instruct holding a neutral (or straight) spine on the inhale when teaching Cat-Cow.
Urdhva Mukha Svanasana (Upward-Facing Dog)
This may not seem like a “big” backbend in your normal body, but when you are growing a tiny human, the shape of Upward-Facing Dog can be a lot on your abdominal wall.
Dhanurasana (Bow Pose)
As soon as you start showing, which varies wildly from pregnancy to pregnancy, it is recommended that you no longer lie on your tummy. Therefore, most belly-based backbends should be avoided, unless you make it supported by putting a bolster under your uppermost thighs.
Urdhva Dhanurasana (Upward Bow or Wheel Pose)
Full disclosure: I haven’t done this pose in two years and it used to be my desert-island pose—as in, I couldn’t live a day without it. The minute I got pregnant, it no longer felt right. Wheel requires tremendous spinal extension and risks your lower back.
Avoid deep spinal flexion (rounding of your back)
Going the opposite direction of backbends—excessively rounding your back—can also exacerbate the gap in your abdominal wall. This is because in a rounded shape the abdominals tend to push forward. This includes shapes like Bakasana (Crow), but also gentler movements, like over-exaggerating Cat. In addition to avoiding rounded shapes and ditching crunches, Roberts recommends paying attention to basic everyday movements, like when you’re getting off the couch or out of bed. Instead of rounding as you get up, Roberts recommends rolling to the side. During pregnancy, it is always recommended to roll to your left.
Poses with spinal flexion that you may want to avoid:
Bitilasana (Cow Pose)
In most healthy pregnancies, this posture is safe, but if you have been diagnosed with diastasis recti, even this rounded shape should be avoided.
Bakasana (Crow Pose)
In addition to the risk of fall, Crow Pose requires significant rounding in your spine and abdominal engagement.
Garudasana Pose (Eagle Pose)
When we bring our Eagle in for a landing, we round the spine. Also, the crossed legs tend to reduce space in the pelvis, when we want to make as much space as possible during pregnancy. If you’re really missing Eagle, try Eagle arms in Utkatasana (Chair Pose).
Modify Plank Pose in all its forms
Satow says that subjecting your body to excessive Plank Poses—which mostly happens during Power or Vinyasa Yoga—can lead to abdominal pressure, which may appear as “coning,” where the tummy protrudes forward in a narrow tent- or dome-like shape, versus its normal flat shape (pre- or postpartum) or even rounded shape when pregnant. Both Satow and Treacy are fans of modifying plank with the knees down or taking Vasisthasana (Side Plank) to reduce pressure on your abdominal muscles.
Poses like Plank Pose that you may want to modify
There can still be too much pressure on the abdominals when on your forearms. As with the other planks, you can put your knees down to modify.
Chaturanga Dandasana (Four-Limbed Staff Pose)
This low-to-the-ground version of plank can become more of a logistical issue as your belly grows, but like the other plank-like shapes, knees down can be a good way to modify.
Avoid deep twists
Deep twists are generally contraindicated for pregnant bodies because of the potential compression. Deep twists can also exacerbate diastasis. Open twists in which your arms are extended wide and straight out to the sides and your torso is not in contact with another body part are suggested, but even those can be overdone.
Deep twists you may want to avoid:
Parivrtta Utkatasana (Twisting Chair)
In a healthy pregnancy, you can usually modify this by being upright and not “closing the twist.” However, if you have been diagnosed with diastasis recti, double-check with your provider about even open twists.
Ardha Matsyendrasana (Lord of the Fishes)
The pelvis in this seated pose is similar to Garudasana (Eagle Pose) in that crossing your legs can compress space. Crossing your arm over your opposite knee compresses your midsection. Best not to even go there.
Jathara Parivartanasana (Supine Twist)
Lying on your back after your second trimester is generally not recommended. Adding in a deep twist can strain your abdominals.
Where to turn for help with diastasis recti
If it feels like your diastasis recti isn’t coming back together, it is strongly recommended that you seek professional guidance and treatment. There are certain movements that can help you heal, although Roberts observes that many people, in addition to needing hands-on treatment of the tissues, would benefit from a trained postpartum professional to assess the function of your muscles to make sure you are doing the exercises appropriately.
This is why programs like the KT Method can be helpful. BIRTHFIT, another online program, focuses on helping clients make sure they are breathing diaphragmatically and teaches them how to “create intra-abdominal pressure during functional movements to strengthen the core and pelvic floor.”
In addition to doing BIRTHFIT, Satow sought out a pelvic floor physical therapist. Currently in her second pregnancy, she is still waiting for her health insurance to approve visits to her pelvic floor physical therapist, something she and most pelvic floor experts feel should be standard pregnancy and postpartum care. In the meantime, she is using her expertise and focusing on her breath and posture at home.
Whether you are able to get professional support or are working to heal on your own at home, the most important thing you can do is not rush back into physical activity and deep core work. Instead, focus on your breath and a well-aligned spine. You want to feel as though you’re finding Tadasana (Mountain Pose) in almost every pose and every moment. That way you are getting the most important support you need—the support from within.
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