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BY DEANA GHERI | Physiotherapist | Sum of Us

Can Pilates and Physiotherapy help prevent or heal diastasis recti, and if so, which exercises are most effective?

In this Q&A, discover how Pilates and Physiotherapy can help prevent and heal Diastasis Recti during and after pregnancy. Explore effective exercises, core engagement, and lifestyle factors aiding recovery. Learn about the role of compression garments in enhancing Pilates for DRAM. 

1. What is Diastasis Recti and How Can Pilates & Physiotherapy Help Address It During & After Pregnancy?

Diastis Recti (DRAM) refers to a separation of the connective tissue (the liner alba) down the middle of your abdomen that holds the two sides of your rectus abdominal muscle together. This occurs in 2 out of 3 women during pregnancy due to hormonal changes, rapid weight gain and the increasing size  of the baby and uterus.

Pilates and physiotherapy can reduce Severity, width and incidence of Diastis Recti in the pre and post natal period. Exercises focusing on deep core muscles such as the pelvic floor, Transverses Abdominis and obliques can help build strength, re establishing the connections between your abs and supporting muscles

Abdominal separation between the rectus abdominus musculature

 

2. What Precautions Should Be Taken During Pregnancy When Incorporating Pilates Exercises To Prevent Diastasis Recti?

Signs of potential Diastasis Recti are doming of the abdomen. This is a sign that the load on your tummy is beyond the capability of your Linea Alba and repetitive occurrences of this can result in thinning and weakening of the tissue causing further separation. Exercises that cause this commonly include sit ups or pushing and pulling too much load.

When engaging in pilates any exercises that produce doming should be avoided or modified. Often focusing on activating the deep lower abdominals and completing the exercise in a smaller range can help prevent doming. Cues to aid in the correct technique can be “drawing bub up and in towards you and bringing your rib cage over the top to make a c-shape.” Or “hugging bub towards the spine”

 Doming of the abdomen

 

3. Are There Specific Pilates Exercises that Can Safely Aid in Preventing Diastasis Recti?

Pilates exercises that involve strengthening the lower deep abdominals, obliques and pelvic floor can safely aid in the prevention of Diastase Recti as they help maintain stability and support of the abdominal area. Examples of these are:

  1.Roll downs + overhead arms, oblique twist, diagonal arms

Roll downs + overhead arms, oblique twist, diagonal arms

   2.Plank

Plank

 3.Bear hover

Bear Hover

4.Side plank 

Side plank

5.Bird dog

Bird Dog

Make sure you always cue hugging bub towards spine to engage the lower abdominals

 

4. For Women Already Experiencing Diastasis Recti, How Can Pilates and Physiotherapy Assist in the Healing Process?

Most of the natural soft tissue healing will occur in the first 6 weeks postpartum where the majority of women will see their DRAM close. 1 in 3 women however will still experience separation beyond this point which is where Pilates and Physiotherapy can assist. Up to approximately 18 weeks postpartum the Diastases Recti can heal through activity modifications and specific core strengthening exercises under the guidance of a physiotherapist. These specific exercises will target the deep abdominal muscles and obliques to give support around the abdominal area and act as a corset to hold the abdominal muscles together and give the fibres of the lines alba an opportunity to realign and knit back together. In addition to this we recommend specific compression garments and give advice around avoiding activities that cause doming and inhibit the healing of the separation.

 

5. Is it Possible to Overdo Pilates Exercises While Recovering from Diastasis Recti? How Can Individuals Strike the Right Balance?

Whilst recovering form Diastase Recti pilates exercises should be guided by a physiotherapist or pilates instructor who is trained in post-natal recovery. This will ensure that the exercises are specific, safe and the correct technique is being used. It is possible to overdo pilates exercises as the core muscles can get over fatigued from frequency and/or the exercises are too challenging which will cause doming. Any exercises that cause doming will prevent the separation from healing by causing repetitive strain on the line alba and increasing the abdominal pressure at level where the deep core muscles are not strong enough yet to control. Striking the right balance can be challenging as each woman will have an individual journey postpartum. Knowing your body and being educated about the correct technique and signs of overloading and overworking the abdominal muscles are key.

 

6. Could You Explain the Role of Core Engagement in Diastasis Recti Recovery and How Pilates Techniques Enhance It?

The deep core muscles and obliques provide stability for the trunk and act as a corset around the abdomen. Engaging these muscles early post-partum assists in bringing the walls of the Rectus Amdominis together encouraging healing of the Linea Alba and separation to reduce. It is particularly important to begin by focusing on the Traverses Abdominis early as it serves as the foundation for higher levels of core control. Once engagement of this muscle is achieved more complex abdominal exercises can be commenced incorporating the use of obliques and then Rectus Abdominis to further provide stability and support.

 

7. Are There Any Specific Lifestyle Factors Beyond Exercises that Can Support Diastasis Recti Healing in Conjunction with Pilates and Physiotherapy?

Avoid excessive strain on the abdominal tissues.

- Avoid sit-up movements

- Roll to the side to get into and out of bed.

- Modify any exercise that causes your DRAM separation to bulge outwards.

Avoid heavy lifting:

  • Avoid heavy housework, heavy cleaning and pushing, pulling or lifting heavy weights at the gym.
  • If you must lift, brace and tighten your deep abdominal and pelvic floor muscles prior to and during lifting.
  • Lift nothing heavier than your baby for at least 6 weeks after delivery. 

Avoid constipation and straining on the toilet:

  • Ensure adequate fluid intake, especially water.
  • Ensure a high fibre diet with lots of fruit, vegetables and whole grains.
  • Adopt an appropriate toileting position  (Knees higher than hips, lean forward with a straight spine and rest your elbows on your knees.
  • Do not strain when opening your bowels.

Avoid constipation and straining on the toilet

 

8. How Can Wearing Compression Garments During Pilates Assist in Preventing and/or Healing Diastasis Recti -  How Do They Work in Conjunction with Pilates and Physiotherapy?

Modifying technique and improving control and stability during pilates is the best way to prevent and/or heal a DRAM. If the separation is significant and limiting your ability to engage in the core strengthening exercises necessary to facilitate healing, compression garments can aid in supporting your abdomen during pilates. The garments work in conjunction with pilates by allowing the abdominal walls to sit closer together and the Transverses Abdominis and Oblique muscles to function effectively and strengthen to facilitate healing of the separation.

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Written by Deana Gheri

Physiotherapist at Sum of Us

Bio: Deana, with a Masters of Physiotherapy, channels her passion for movement-based rehabilitation and injury prevention from her background in dancing and martial arts. She employs a diverse range of hands-on and exercise therapies to treat various conditions and individuals of all ages, incorporating Pilates principles for strength, mobility, and core stability. She runs quarterly prenatal workshops at the Sum of Us studio in Prahran. These workshops are filled with all the knowledge expectant mamas need to know around musculoskeletal conditions, diet, exercise, acupuncture, compression garments and more. 
https://www.sumofusstudio.com.au

Deana Gheri - Physiotherapist

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