Healing Diastasis Recti with gentle birthlight yoga

by Kirsteen Ruffell and Françoise Freedman

There seems a great lack of awareness and knowledge among health professionals and postnatal women about the impact that diastasis recti (‘split’ rectus abdominis muscle) has on women’s bodies. Many women arrive in our classes (Postnatal yoga, Prenatal yoga for second-time mums, Baby Massage & Nurture, Baby Yoga, Toddler Yoga, and WellWoman Yoga) unaware that they have one and even unaware what diastasis recti is. It seems to be rarely checked. It also seems to have increased a great deal in the last two decades. Fitness exercises including some forms of dynamic yoga do not appear to aid in preventing DR and, on the contrary, they might contribute to it.

Diastasis Recti most commonly occur in the third trimester of first pregnancies. The linea alba, the line of connective tissue between the left and right packs of the rectus abdominis, does a great job of stretching longitudinally and to some extent laterally to accommodate the growing baby- and it is a big job to do as intra-abdominal pressure rises.

This tissue can thin and lose its springiness laterally often around the umbilicus, and above and below. Most often there is no actual split or tear as such. If there is a hole in the linea alba then the tissues beneath may poke through especially in a sit up- this is an epigastric hernia and it may require surgery, but this is rare. Common forms of Diastasis Recti can be successfully repaired with gentle therapeutic yoga using the breath together with relaxed stretches and gentle twists. At Birthlight we use an integrative approach that, following the principles of yoga and Ayurveda, “supports the supporting structures” around a problem area: lower back strength, pelvic floor tone and organ function are all improved while the Diastasis Recti is being repaired. We have always focused on the Do’s rather than on the Don’ts in our teaching of prenatal and postnatal yoga and the same applies to therapeutic yoga. Yes, some Asanas must be avoided and some women may have to be shown why. But more importantly we offer a wide range of yoga-based simple practices, including new micro-movements, that are accessible to most women for use both “on and off” yoga mats, before and after childbirth. These micro-movements are based on an exploration of adaptations of Asanas in light of recent anatomy and physiology research that goes beyond some received ideas about fitness and how muscle and connective tissue impairments are best repaired.

The Birthlight approach to postpartum closure of Diasastis Recti as part of early postnatal recovery

The greatest window of opportunity for assisting the closure of diastasis is during the first 6-8 weeks after birth as the practices work with the body’s own closing-after-birth processes. Yoga breathing practices, combined with our original postnatal micro-movements, work well if the new mum has not started activity/a fitness regime that does not respect the time needed to re-stabilise the pelvis, realign the spine, and re-tone the deepest abdominal muscle: this is the transverse abdominis (or “baby blanket”) that attaches to the back muscles on both sides and supports the rectus abdominis (the “baby hammock”). We need to reconnect to the breath after whatever happened during labour and birth. Using gentle extended exhalations, the pelvic floor naturally draws up and re-activates the fibres of the first pack of the six packs of the rectus, interwoven with the attachment of the transverse to the pubic bone (remember the “Kangaroo pocket” of the rectus if you have attended a birthlight perinatal course?). The base attachments of the transversus, rectus and both internal and external oblique abdominal muscles are the best “maternity belt” women can use for inner support. Then, with easy stretches, we can wake up again the fibres of the very top pack of the rectus, high in the rib cage over the thoracic diaphragm (Ah, surprise, this abdominal muscle reaches far up! Each breath we take affects it). Then, the middle packs are gently brought together as the top and bottom packs come more alive: easy does it with help from muscle friends all around… As Françoise has always said, it is no good papering over the crack, if we ‘fill’ the hole first (the yoga breathing is like using polyfilla to get the fascia together again) then we do the proper lasting work of closing the body. We need to explain to women that it is well worth putting the time and effort in to recover on the deeper level for their long term heath and function before rushing into certain types of exercise.

Do’s

  • Review the 5 Steps for Postnatal Recovery with yoga breathing (you can find leaflets on the Birthlight Training Website or get a Postnatal Yoga Handbook) to help new mothers close their body
  • Show new mums anatomy images to convince them that the name of the game is elasticity, not tone, and that working on the top and base attachments of the abdominal muscles is the best way to ensure a strong and resilient middle part long term. Once a new mum has closed a DR well after a first birth, it is far less likely that it will re-occur in the next pregnancy. Having an elastic transverse abdominis will be a source of long-term health and wellbeing due to all organs being well supported after childbirth
  • Use birthlight micro-movements in supine poses and chair-based stretches to tone safely while stabilising the alignment of pelvis and lower spine
  • Use a rebozo (wrap shawl) or a pelvic belt for additional support when carrying your baby, particularly in the evenings
  • Spiral hold to lift baby up and put her down.

Don’ts:

  • Resume impact exercises before the DR is completely healed
  • Practise postnatal exercises involving sit ups or any kind of midline abdominal doming
  • Resume double leg lifts while lying on your back until the DR is healed
  • Start your pre-pregnancy favourite yoga routine involving dynamic sun salutations until the DR is healed
  • Lift heavy weights such as baby car seats on a retained in-breath

Repairing postnatal Diastasis Recti in the first two years after a baby’s birth

In the case of a second pregnancy when a DR has been left unattended, the early postnatal practices can work well until the middle of the third trimester. The repair of the Linea Alba can also be helped by pregnancy hormones such as Relaxin.

Do’s

  • Progressive sequences (depending on the degree of the DR integrating the lower back muscles and the four abdominal muscles in conjunction: they like working together and supporting one another! The transverse supports the overstretched or split mid packs of the rectus from underneath and the two transverse muscles help bring the packs together diagonally, each in their own way
  • Slow open twists
  • Kneeling stretches
  • Yoga walks with breathing awareness
  • Return to “safe transitions” (Birthlight rolls) from standing to kneeling, kneeling to sitting and lying and from the floor to standing up again (with knees together if not pregnant, in neutral stance (distance between your knees same as the length of your thighs) if pregnant
  • “Spiral lift” your baby as much as possible rather than bending forward for picking him or her up from the floor.

Don’ts

Some yoga poses are not compatible with trying to heal a DR:

  • Chatturanga (plank pose) in dynamic Sun Salutations
  • Chatturanga dandasana
  • Sustained Adho Mukhasana (dog pose head down) with leg up
  • Navasana (boat pose)
  • Standing poses in a very wide stance
  • Any sit up type movement or asana
  • Full Cobra
  • Bridge pose and wheel pose

Repair of Diastasis Recti left unattended for several years after childbirth

It is sad but not uncommon that some women live for many years with DR as if it was something they must put up with because there is no remedy other than surgery, if the condition is severe enough. DR, often associated with a weak pelvic floor, is something that Well Woman Yoga can help with. The later this dual condition is addressed, the longer it may take to see improvements but then the results are long-lasting with additional positive impact in women’s overall health and energy levels.

Working with yoga on long-standing DR involves an in-depth re-toning of core muscles and the use of “relaxed stretches” to regain elasticity along the lines of Tom Myers’ “muscle trains”. When we start toning the abdominals after a long-standing DR, we want to work with relaxed muscles – including the thoracic and pelvic diaphragms, as these muscles may have been tense and held in protective patterns for years. This is a more skilled type of yoga practice that is offered in Birthlight Well Woman Yoga courses. It is well worth doing CPD days such as Yoga for Pelvic Health, Advanced Pelvic Floor Practices with Yoga Breathing, Yoga for PGP and Yoga for Diastasis Recti to gain familiarity with the new practices, even if you do not wish to take on the full Well Woman Yoga training.

Do’s

  • Recuperative poses with “relaxed stretches” of the attachments of all abdominal muscles
  • Progressively learn the use of bandhas
  • Work slowly on extended full body twists (supine)
  • Extend exhalations in sitting postures with back support or using chairs
  • Use rebozo (wrap shawls) to enhance breathing awareness
  • Use pressure in selected practices (used in birthlight micro-movements) to tone the deepest layers of muscles and re-connect the abdominal fascia

Don’ts

All the Don’ts in the two previous sections apply, to which can be added the following:

  • Sit down for long periods with incorrect spinal alignment
  • Lounge on soft furniture without adequate back support
  • Collapse the upper part of the thoracic spine by rounding the upper back: this weakens the top pack and the upper attachments of the two sides of the rectus
  • Allow a collapse of inner feet arches when walking

A “key” Birthlight Yoga practice for toning the transverse abdominis in support of the split middle packs of the rectus abdominis.

Postnatal practices begin with Postnatal breathing 1 in supine recovery position with knees bent, set up carefully with zero balance, and correct use of props to support the head and pelvis. We want to tone the abdominals from the deepest layer: the transverse abdominis.

  1. Using the safe transition to the floor, roll onto the back and find zero balance. Align the neck and head with slow rolls of the head to each side. With fingertips lightly on shoulders, stretch the elbows alternately up and down alongside the ears. If your arms extend easily to the floor as you stretch them back alternately stretch each arm with the flow of your breath, extending further at the end of your exhalation and keeping the whole body relaxed.

  1. Cross the arms, hands to opposite shoulders and draw the shoulder blades and shoulders down towards the feet, soften on the inhalation and repeat a few more times. This helps realign the lower ribs that were pushed up and out to the sides in late pregnancy (in some cases the ribs may still be out twenty years later!).  Continue aligning the ribs by placing the hands around this area of the ribs and as you exhale gently push them in to the midline and slightly down at the same time. Inhaling releasing and repeating a few times.

  1. Then, really get the breathing flowing, let it grow in depth and length organically and slowly, allowing the movement of the breath to gradually spread up and down the torso to the lowest abdominals and up to the collar bones… Give yourself time to find a pleasant rhythmic breath that softens in the chest and abdomen all the way to the end of the exhalations. This opens the door to the parasympathetic mode of the nervous system and induces a feeling of relaxation and peace.

  1. When the breath has a lengthened exhalation, we already see the toning effect of the breath as the belly is drawn down towards the spine with gravity aiding. Then we can add a gentle deliberate drawing down of the abdominals on each extended exhalation. A Birthlight “wisdom nugget” about yoga is that in breath and asana combined (bandha or mudra can also be added), “the back always supports the front”.


Ultimately, healing a DR using yoga results in a healthier lower back and pelvic floor, adding wellness to repair.

Birthlight offers acclaimed innovative adaptations of classic yoga poses for pregnancy, birth and the postnatal period, and is a leading provider of therapeutic gentle yoga moves to both prevent and repair common complaints of pregnancy and the postnatal period.

We currently have two Birthlight Yoga for the Repair and Prevention of Diastasis Recti courses scheduled, details as below...


Birthlight Yoga for the Repair and Prevention of Diastasis Recti
7 July 2017
Venue: effraspace, London UK

More info>


Birthlight Yoga for the Repair and Prevention of Diastasis Recti
8 September 2017
Venue: Birthlight Zurich, Switzerland

More info>


 

 

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