Diastasis Recti, Pregnancy Pelvic Girdle Pain, Symphysis Pubis Dysfunction, Rectus Distension… What Does It All Mean?

Diastasis Recti is one of the causes of your mummy tummy, Symphysis Pubis Dysfunction means you can’t get out the car comfortably when pregnant… and then there’s the acronyms for all these pregnancy & postnatal aches & pains: SPD, PSD, PGP, DR, RD. You need a copy of Gray’s Anatomy just to give a name to your sore joints & back ache once you’re pregnant!

Confused? You’re not alone. A few new clients lately have been feeling a little flummoxed by some of the terms being used for whatever it is they’re suffering from…  sometimes midwives, antenatal teachers, doctors, personal trainers or your best friend, don’t use the same language.

So I’ve done a mini glossary of the ones you’re likely to come across or suffer from. Hope it helps, & if you have any others you’d like to know about, do ask!

Diastasis Recti, Rectus Diastasis or Rectus Distension all refer to a very common separation of the rectus muscles at the front of your tummy during pregnancy. I post frequently on this condition & here you can find some instructions on how to test for diastasis recti, which exercises are recommended & which ones you should avoid.

Diastasis Symphysis Pubis (DSP) is not the same as diastasis recti, it is an actual separation of the Symphysis Pubis Joint. This can only be confirmed by diagnostic imaging by a doctor or physiotherapist.

Pregnancy-Related Pelvic Girdle Pain (PGP) & Symphysis Pubis Dysfunction (SPD) refer to the same thing.

Pelvic Girdle Pain is the term more used more nowadays, but both refer to pregnancy-associated pain, instability & dysfunction of the Symphysis Pubis Joint &/or the Sacro-Iliac Joint.

Pain may be a minor discomfort, necessitating some modification of movement… right up the scale to severe pain & disability. Make sure you consult a physiotherapist or professional trainer who specialises in this area, & don’t go to just any generic exercise class or instructor.

The joints affected are the ones at the front & back of the pelvis. You may feel pain over the front of the pubic bone at the front, across your tummy, or across one or both sides of your lower back, or down your legs.

You may feel a clicking or grinding in your pelvis & have difficulty walking, especially up or down stairs. This ’shearing’ movement (one leg in front of the other) or abduction (legs out to the sides) may also hurt, making getting in or out of a car, your bed, or any number of other everyday activities, painful.

Pregnancy-Related Pelvic Girdle Pain affects around 1 in 5 women, at varying degrees of severity. Around 7% of women continue to have problems postnatally.

In general:

You will be advised by your Midwife or doctor to avoid or adapt as many painful movements as possible. So avoid heavy lifting, go carefully & slowly up stairs; keep your knees together as mush as possible when getting on or out of the car; roll over onto your side to get out of bed…but many of these are part of life, & can’t realistically be avoided.

You can however help to alleviate pain with correctly prescribed core strengthening exercises.

The stability of your joints is affected by the pregnancy hormone, relaxin, but also by the strength of the muscles that hold them in place. Do NOT go to a generic class or instructor with PGP, they cannot be expected to accurately prescribe the correct exercises for you. But controlled, guided core strength & lower body resistance work will definitely help to strengthen & stabilise your joints, & reduce pain.

Let me know what else you need on these conditions – I know from my clients that they are  commonly diagnosed, but also often misunderstood pregnancy & postnatal considerations which affect the exercise you can comfortably undertake.

The Mummy Tummy… How Long Can you Blame Your Babies?!

That’s what women often ask when they get in touch or find out what I do for a living… ‘my youngest is 7… but I’m still blaming the mummy tummy (or jelly belly, muffin top, you get the idea) on my babies!’

‘Postnatal’ recovery… how long does the ‘postnatal’ (or postpartum if you’re reading this in the middle of my night) bit last?

Well in my experience (& my clients’), a correctly prescribed postnatal exercise programme will put your body back to where you want to be within a year of having your baby, including tackling the mummy tummy.

BUT… funnily enough… most women don’t actually have the guidance (or possibly the inclination) to really commit to a ‘correctly prescribed  postnatal exercise programme’ for the 12 months after their little miracle arrives.

(Can’t imagine why… anyone would think that first year was hard work, or tiring, or utterly overwhelming or something)

Anyway, point is, most don’t. Which means, that unless you are blessed with REALLY annoying (for the rest of us) genes, then that mummy tummy is going to be obscuring the waistband of your jeans for some months or years to come.

I have good news though! It’s never to late to start knocking those wobbly bits back into shape.

I can already hear your ‘I’m the exception to the rule!’ cries: ‘but my stomach muscles split!’ / ‘I’ve had 3 c-sections’ / ‘big bones’ or ‘my mother never lost hers either’.

Honest. Something can be done dear fellow knackered mum. Something CAN be done.

I’ve had mums at my Mummy Tummy Masterclass who are really VERY postnatal (17 years…  beat that anyone?), & who are benefitting now from learning how to engage their transverse abdominal muscles, knit those abs back together again, & then lose the fat that would have covered up all their hard work.

So the answer to ‘how long is my postnatal tummy actually postnatal?’

Until either your fairy godmother waves the washboard abs wand, or you give it some help.

If you live in London or Surrey, why not grab 3 or 4 slightly wobbly friends & book a Mummy Tummy Masterclass at your home? A whole world of strong mid sections, no back ache & bikini’s could be waiting for you!!

It Seems There’s a Lot of Not-So Yummy Mummy Tummies Out There!

I have been so delighted with the response to my new Mummy Tummy Masterclass!

Clearly mums are simply not getting the answers they need to restore their tummies to pre-baby (or better!) shape. My clients tell me they are left feeling that this is ‘as good as it gets’, especially when a few babies & a few years have rolled by…

I’m loving meeting you all & hearing your stories (I will NEVER tire of birth & baby stories!), but most of all I’m loving being able to share the secrets of postnatal exercise & fat loss with you. The mummy tummy, the muffin top… whatever you call it, I have answers & strategies you can start using today!

Real, busy mums are finally getting the solutions they need to fit in the correct postnatal exercises for abdominal separation, diastasis recti, core restoration & better posture. Most of all, for a flatter stomach!

Thank-you for your interest & for all your questions. Let me know if you’d like to discuss or book a Mummy Tummy Masterclass for you & your friends!

DIASTASIS RECTI Test, What Works and What To Avoid

Frequently Asked Questions About Exercises to Alleviate Diastasis Recti or Postnatal Abdominal Separation.

Q: How do I test for diastasis recti?

A: Lie on your back with your knees bent & your feet flat on the floor. Relax your head & shoulders & place your fingers (palm facing you) just above your belly button.

Lift your head, neck & shoulders slightly off the floor & press down with your fingertips. If you feel a gap, that’s the diastasis. You will feel the muscles close in around your fingers as you lift your head & neck. Don’t lift your shoulders up too high.

Repeat the test in two other place: directly over the belly button, & a couple of inches below.

A diastasis recti gap is measured in finger width’s. You are aiming for 1-2 finger gap or less, but don’t panic if it’s much bigger at first – up to ten fingers is not unheard of!

Q: Should I use a splint or abdominal wrap to bring the muscles back together? What’s the best exercise for diastasis recti?

A: Many women, & some popular exercise techniques such as the Tupler technique, advocate wrapping or binding the mid-section to draw the split recti muscles back together. Binding has also been traditional practice in parts of the Caribbean, India & Africa for generations.

In my experience, it can be helpful when the gap is wide (4 fingers or more), & certainly helps with awareness of the abs & for lower back support. However don’t use a wrap or splint as a substitute for caution when working the abdominals.

To use a splint (a towel does the same job!) to encourage your muscles to ‘knit’ back together:

Lie on your back with your knees bent & feet flat on the floor. Wrap a towel under your tummy & cross it over your abs, holding onto each end.

Slowly & gently lift your head, neck & shoulders off the floor, whilst drawing your belly button towards your spine & tilting your pelvis. This will activate your transverse abdominal muscle. As you lift, pull the towel tighter around your waist.

Do about 10 reps, building up to 30-40 a day (you don’t have to do them all at once!).

Q: How common is diastasis recti?

Over a third of women will have a gap of two fingers or more after their first baby. After second or subsequent pregnancies, this figure is more like two thirds, especially if the gap wasn’t closed effectively after the first.

Q: What else can I do to help a diastasis close up?

A: Think about the ‘bellybutton to spine’ contraction discussed in this post, with everything you do – not just when you’re specifically exercising your abs. When you sneeze, cough, pick up your baby, do any type of exercise, stand up from a crouching position, or turn around.

Try to get back in touch with your body & be aware of your core muscles doing the work to stabilise you in every day activity.

Q: What if I had my last baby years ago – can I still reduce a diastasis?

A: Yes – activating & engaging your core transverse abdominal muscles at any stage post partum can improve the gap.

If you did a lot of crunches &/or oblique crunches post baby, then you may have developed a ‘cone’ shape on your abdomen where you have worked the muscles hard, but in the wrong direction…  Practice belly breathing, engaging your transverse abdominus & pelvic floor & do the towel exercises explained above.

Persistence will pay off! These exercises might not feel like you’re doing much, but do them daily, as many reps as you can, & you will start to see a difference in 6 weeks.

Q: Which movements or exercises should I avoid?

Crunches, sit-ups, oblique (twists) combined with crunches; anything that involves a ‘jack-knife’ movement such as straight leg lifts or holds from lying on your back; pilates ‘100’s’.

In terms of every day movements, avoid lifting straight up from a horizontal lying position – always roll to your side & push up from there; be careful when twisting & turning from the waist, keep thinking ‘core’ & pull belly button through to spine whenever you lift, twist or get up from lying, bending or crouching.

Diastasis Recti & a Mummy Tummy: What Works?

I am asked all the time: ‘HOW do I get rid of my Mummy Tummy?’ & ‘Is it due to Diastasi Recti?’

Well, partly, yes it is. Diastasis Recti is ONE cause of a mummy tummy, & you definitely need to address it for a complete solution.

SO WHAT WORKS?

Cardio? A bit, to lose some extra flab maybe, but it won’t address the root problem.

Pilates? You could certainly borrow a few core & postural principles from pilates … but some moves could even exacerbate the problem.

Yoga? Good for lower back strengthening, which will help relieve back pain & improve posture, but it’s not going to repair the mummy tummy.

Or crunches? NO, NO, NO!!

What is a ‘mummy tummy’?

That saggy, loose, flabby tummy that just doesn’t seem to go away after your baby’s born, & REALLY refuses to go away after you’ve had more than one baby!

Firstly, you need to differentiate between a flabby belly (ie excess fat over your tummy), & the mummy tummy which is partly caused by diastasis recti, a (perfectly natural) separation of the abdominal muscles during pregnancy which makes way for the growing uterus.

Incidentally, you may have a diastasis and a flabby belly, but we will deal with both, so don’t worry!

I’m going to cover the physiological process of diastasis, as well as an easy self test, in another post, but for now, we’re going to look simply at what works, & what doesn’t! Obvious indicators that you have a diastasis, are a bulging, or ‘doming’ above or below your belly button when you contract your abdominals (especially if you attempt a crunch or sit-up type movement).

There are a number of important muscles you need to exercise (in the right way) to repair a diastasis, the most important of which is the transverse abdominus. This is the innermost abdominal muscle which runs right around your middle like a corset. It is attached both in front of, and behind, the rectus muscles (the ones that have split), so if you work the transverse abdominus (TA) correctly, your diastasis (the gap) will reduce, & stay put!

To start identifying & ‘engaging’ your transverse abdominus, you need to ‘belly breathe‘. Sit on a chair or cross-legged on the floor & place your hands on your belly. Breathe in, fill your lungs & let your belly expand. Then exhale, emptying your lungs, whilst drawing your belly button right back towards your spine. Keep your shouders down & your neck relaxed.

Now try doing this from all fours.

There are a number of visualisations which may help, (this is where it can be useful to borrow from pilates & yoga as well as restorative core work) :

Imagine your recti (the vertical muscle we’re trying to put back together) as a string attached to your pubic bone. Now use the string to pull your pubic bone towards your belly button.

Imagine ‘zipping up’ the gap from below the belly button, to above.

Whichever works for you, remember to exhale as you draw your abdomen inwards, & inhale as you allow your tummy to expand & your lungs to fill. Don’t raise & lower your chest (it’s all in the belly), don’t hunch your shoulders, & don’t hold your breath!

You will find that as you do this, your pelvis will naturally tilt forward as you contract the transverse muscle.

OK, now add in your pelvic floor (now we’re really multi-tasking!). As you draw in your transverse abdominus muscle, pull up your pelvic floor. Remember, don’t hold your breath, all these muscles work together best whilst breathing

Ready to get really clever? From the all-fours position, put a pillow between your inner thighs, & as you exhale, draw in your belly button and pull up your pelvic floor, squeeze the pillow between your thighs.

Do this 15 times, every day. (That took, what, 5 minutes??) & you really are on your way to repairing a diastasis recti & losing your mummy tummy, ‘muffin top’ or whatever charming term you refer to it as!

I’ll come back to this with more variations & more detail, but I promise you, identifying & learning to engage your transverse abdominus is the way to go.

Do not, under any circumstances, do crunches or sit-ups post-baby, & certainly not if you know you have abdominal separation.

Any crunching, rolling or jack-knife straining or movement will serve only to widen the gap & make the ‘doming’ or bulging worse. Some pilates moves will fall into this category, so avoid those ones for now. For the same reason, avoid crunches or sit-ups that work the obliques (your waist) in a diagonal direction, until you know you have closed the diastasis gap.

Strengthening your transverse abdominus & working your pelvic floor (because these movements work so well together it’s great way to remember to do your kegels) will repair a diastasis & close the gap. It will also help alleviate back pain, improve posture & increase pelvic floor control!

If there is extra flab as well (which if you’re post-baby, is a distinct possibility ) then in order to see the difference, you will need to address your nutrition, & do some short sharp interval training (circuits) as well.

But your CORE is where you must start – so get belly breathing & ‘zipping up’ & find your pelvic floor… & you have the basis for the post-baby body you’re dreaming of!