abdominal separation. Those two words can cause great anxiety and confusion in new moms. While it is a normal part of pregnancy and the body's way of making room for the baby to grow and develop, abdominal blasts or rectal dissections have become a source of much conflicting (and just plain wrong) information. If you're feeling overwhelmed and unsure about how to properly heal your abdominal wall after childbirth, the co-founders ofMotherhood Empowerment Program(Shortcut:https://www.empoweredmother.com.au/) Lyz Evans and Kimberley Smith are here to walk you through the process step by step.
In the video above, Pelvic Health Physiotherapist Lyz Evans explains the four simple steps you can take to treat postpartum abdominal separation - all supported by the latest clinical research and developments.
Understand abdominal separation
Before starting treatment, it is important to understand what an abdominal dissection is and what physiological changes contributed to your rectal dissection. Understanding the physiological changes that have taken place will allow you to assess the healing process and focus on your recovery with confidence.
Why do I still look pregnant? Abdominal wall changes during pregnancy and after childbirth.
Were you surprised that your belly still looked the same after giving birth at six months? We know it comes as a shock to most women.
One of the factors that causes this stretching of the abdominal wall is the fact that the uterus remains enlarged until 6-8 weeks after birth. Before pregnancy, your uterus normally weighs around 70 grams and is about the size of a fist. During the nine months of pregnancy, the uterus expands up to 14 times its normal size and can weigh up to 1 kg and reach the size of a watermelon! Regression is the process by which the uterus shrinks back to its normal size. This process takes 6 to 8 weeks. This heavier and larger uterus can cause the abdominal wall to stretch, especially when that extra weight rests on weakened muscles and connective tissue.
A second factor is that during pregnancy, the collagen fibers that make up the linea alba change from type 1 to type 3. What does this really mean? The linea alba is an extremely strong band of connective tissue that runs along the midline of the abdomen, from the sternum to the pubic bone. One of the functions of the linea alba is to provide an anchor point for the abdominal wall muscles.
Normally, the linea alba is strong, thick and quite rigid. So, before pregnancy, your abdominal muscles, or rectus abdominis, stick together (note that they are still separated by the linea alba, so there is always some degree of abs).
The increase in estrogen during pregnancy causes collagen fibers to change from thick and stiff (type 1) to thin and elastic (type 3). As the pregnancy progresses and the uterus expands, the linea alba thins and widens, and the distance between the two sides of the rectus abdominis increases.
Das ABCDabdominal wall rehabilitation
The thinning and weakening of the abdominal wall combined with changes in the linea alba and an expanding uterus contribute to the extent and depth of abdominal separation you will experience.
With all these changes, it's no wonder that women are confused about what to do to heal their postpartum abdominal wall. The good news is that there's a lot you can do. And we'll break it down for you below with ABCD Abdominal Detox.
Activation + Integration
We mentioned above that the abdominal wall is thinning and weakening and the collagen fibers are changing from thick and stiff to thin and elastic. Your early recovery after childbirth will be optimized when you can work with your body's natural healing process to increase collagen synthesis andmuscle shaping and building.
AgainCollagen synthesis is the process of forming new collagen in the body. This is important for maintaining the health and integrity of collagen tissues.
Collagen remodeling is the process of breaking down old collagen and replacing it with new collagen. This is a natural process that occurs in the body over time and helps keep tissues strong and healthy.
Muscle growth, on the other hand, is the process of increasing muscle tissue strength. This is usually achieved through strength training or other forms of exercise that stress the muscles. When muscles are stressed, minor tears or damage occur, prompting the body to repair and rebuild muscle tissue, resulting in increased strength and size over time.
In short: “Use it or lose it”. Your body's ability to form and build new muscle is an integral part of abdominal wall recovery and is dependent on mechanical stress on the abdominal wall.
Studies show that 4 to 8 weeks of no exercise (not involving any muscle groups) can result in a loss of 20 to 30% of muscle mass. In the early postnatal period, the abdominal muscles may become sluggish and require gentle activation to regain strength.
One effective exercise shown in the video above is the Four Point Knee Core Activation. Once you feel comfortable with this exercise, it's important to incorporate it into your daily routine to ensure you engage your abs in your daily movements.
braces and support garments
During the first 8 to 10 weeks after birth, while the rebuilding process is ongoing, the abdomen is still incredibly weak and enlarged. WincludedCollagen fibers change from type 3 to TType 1 and your body still has excess hormones, it is important to provide stable support to the abdominal wall to reduce stretching and also to provide some sort of sensory feedback to the abdominal wall.
This is where abdominal support garments like the SRC Recovery Pants are so important to your postpartum recovery, and the research backs it up.
There is a body of research showing that core exercises combined with wearing abdominal support clothing for an average of 8 hours a day result in:
- greater reduction of the distance between the rectums.
- Increased trunk flexion strength through the abdominal wall (in a crunching motion pattern). AND
- improves muscle endurance,
compared to just doing core exercises.*
Interestingly, a SRC laboratory study showed that when wearing pantyhose, the ultrasound showed that the space between the rectus muscles decreased and the thickness and tone of the rectus abdominis muscle increased!
Crunch e Curl-Ups
From about 6 weeks after birth, you need to start putting weight on your abdominal wall. One of the main types of abdominal movement is flexing your torso in a curling motion!
For a long time there was a lot of uncertainty whether strumming was safe or not. However, when we want to stress connective tissue and rebuild muscle mass, doing crunches or pull-ups correctly can help rather than hurt.
Our daily lives require us to bend the upper body, such as when getting out of bed or rising from a chair. This undulating pattern of movement repeats itself hundreds of times a day. At EMP, it's very important to us that you not only heal your body safely, but also prepare it for all the movements you need to have on a daily basis.
Research also confirms this. If we compare a group of women doing core exercises combined with push-ups to another group doing core exercises combined with planks - the group that did thisThe group that did sit-ups outside of the program had much greater improvements in rectal distance.**
Dynamic + progressive loading
This is an error that we see frequently. Women cannot go beyond the first postpartum exercises, and therefore constantly feel stuck after giving birth.
The abdominal wall needs to flex, stabilize, twist and stretch - and if we never get off the ground or challenge the muscles, it will never regain its full strength. Progressive overload is the main principle of muscle growth. So it's important to keep challenging the muscle in terms of movement patterns, endurance and strength if we want it to keep growing.
All of your body's natural healing is completed in 8 -10 weeks postpartum, so further improvements will take some work. Ensuring you continue to progress safely and challenge your abdominal wall will ensure you continue to heal and return to your pre-pregnancy strength (or beyond!).
Antonio (2017) SRC Recovery Shorts, Research Laboratory Analysis of Functional Outcome: A Single Case Study. Cuesta-Vargus, Department of Physiotherapy, University of Malaga, Andalusia, Spain.
Depledge J, McNair P, Ellis R. (2021) Exercise, tube and tape: can they reduce the dimension of the rectus abdominis measured three weeks after birth? Practice of Musculoskeletal Sciences; 53:102
Keshwani et al. 2019. The effect of exercise therapy and abdominal binding in the treatment of the rectus abdominis in the early postpartum period: a randomized controlled pilot study. Theory and Practice of Physical Therapy 25:1-6
Lee (2017) Diastasis Rectus Abdominus: A Clinical Guide for People with Midsections. Learn publications. Surrey BC Canada.
Saleem, Khann, Farooqui, Yasmeen, Rizvi (2021) Effect of Exercise on IR Distance and Associated Back Pain in Postpartum Women: A Randomized Controlled Trial. J Family Reprod Health Set: 15 (3) 202-209
Szkwara M, Egwuagu C, Topping M & Schutt-Aine J (2020). A prospective, quasi-experimental, controlled study to evaluate the use of dynamic fabric elastomeric orthoses for the treatment of common postpartum conditions in postnatal care. Journal of Women's Health Physical Therapy, 44(1), 24-34.
Walton, Costa, Lavanture, McLarth, and Stebbins 2016 The effects of a 6-week dynamic plank training program compared to a traditional rectus abdominis back stability program in the supine position, pain, Owestry Disability Index (ODI) and Pelvic Floor Disability Index scores. Physiotherapy and Rehabilitation Volume 3: 3.
Lyz Evans and Kimberley Smith are the co-founders ofMotherhood Empowerment Program(Shortcut:https://www.empoweredmother.com.au/), the award-winning online program and mobile app that combines physical activity with expert training for all stages of pregnancy, childbirth and postpartum. Lyz is a Pelvic Health Physical Therapist and mother of three. Kimberley is a pregnancy and postpartum exercise expert and mother of three.
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