The MamasteFit Podcast Episode 147 – Understanding Diastasis Recti

Gina: Welcome to The MamasteFit Podcast. In this episode, we’re going to be talking all about diastasis recti, or diastasis.

Hayley: What do you say?

Gina: I say diastasis.

Hayley: Yeah.

Gina: What do you say?

Hayley: Yeah, diastasis.

Gina: I’ve heard other people say it in other different ways.

There is a lot of fear involved with this normal thinning and spreading of the abdominal muscles known as diastasis, and so in this episode, we’re going to break down some hot takes in addition to, how could we approach healing diastasis in the postpartum? Do you have to even approach it? Could it just heal spontaneously? Does it need to heal? And so we’re going to break this down all in this episode and go way beyond like the standard Instagram post of, “how to heal your diastasis with these five exercises,” ’cause it’s definitely so much more than that.

Welcome to the MamasteFit Podcast. Today I have Hayley Kava here, who is one of our in-house pelvic floor PTs. We have three of them in the gym now. And so one of the things about MamasteFit is we work really closely with other professionals to provide really collaborative care. And I learn a ton from Hayley, I hope that she learns a ton from me and Roxanne, and our kind of like mutual working together really enhances our ability to support our clients in so many different kind of facets of their life.

And so today we’re going to be breaking down diastasis. And this is something that Roxanne and I get tons of DMs about. “Can I do your program? I have diastasis.” Yes, you can do our program. Like you don’t have to not move your body just because you have diastasis. Or, “What exercises can I do during pregnancy to prevent it, to not have it at all?” And so there’s a lot of fear involved with it. We’ll even have folks that are like several months postpartum that are like, “I’ve been doing all of the ab exercises and I still have separation,” and they’re talking about half a finger. Like I can still put my finger between the muscles.

Hayley: Yes.

Gina: And so there’s definitely tons of fear involved with it. So we’re going to break down what is it; what is normal versus when is it maybe not normal and we need some more like deliberate approaches to it; and then also an out of the box approach to diastasis- ’cause it’s more than just do crunches, or do side bends, or breathe, or do this one set of exercises.

Hayley: “Deep core.”.

Gina: Yeah, just deep core exercises. There’s a big approach that we can do for it. And we’re also going to accompany this episode with a workout video that includes some exercises that you can do with our approach to it, ’cause it’s more than just do squats and crunches and this, how we do them can also impact how we heal.

So Hayley, let’s start with, what is diastasis?

Hayley: Alright, so diastasis in Latin, I think, means separation, or like pulling apart. So you can have diastasis of any number of muscles in your body. And so diastasis rectus abdominis, DRA, is the separation of the connection of the two rectus abdominal muscles, which is the six pack- so the one that goes from like your ribs down to your pelvis, again, six pack muscles. And in the middle of those two six pack muscles is connective tissue, so fascia, or there’s just something that holds those two muscles together. And then we have other layers of abdominal muscles. So we have our internal obliques, our external obliques, and our transverse abdominis- which you don’t need to remember, there’s no test- but they all come together behind that rectus, or around that rectus abdominis, and they build up this like line in the middle where they all come together. So this rectus abdominis meets up at the linea alba, which is the, again, the technical term for that line, and it’s adaptable and it’s stretchable. And in pregnancy- actually, this can happen to people who are not pregnant! If you’ve ever seen like this an ultimate dad bod, that’s like with a big distended Santa belly, like those folks probably have diastasis. If you ask them to crunch up, you might see some coating. So this isn’t necessarily exclusive to pregnancy, it’s just very common in pregnancy that as uterus is growing, as baby’s growing, it’s putting pressure out on the entire abdominal wall. We’re seeing changes of the rib cage and we’re seeing changes of the pelvis, which is going to influence tension along that midline, and we can get stretching or thinning of that linea alba. Because that tissue is pretty dense and thick, in order to, again, make room for a baby, it has to stretch and thin. And this is good. And I think that’s really important to reinforce, is that in order for your baby to grow well into that third trimester we’re going to have some separation of that midline.

Gina: And I think it’s a normal adaptation that happens during pregnancy. And so we’ll get folks that’ll DM us, “How do I avoid or prevent diastasis?” And we’re like, it’s actually a normal adaptation that needs to happen during pregnancy. We can be mindful of like how we move so that we’re not like overly stretching it or really damaging it. But ultimately if you cone here and there, it’s probably not that big of a deal.

Hayley: Yeah.

Gina: At all.

Hayley: And I think there’s a lot of different terminology and language when it comes to diastasis recti abdominis, or DRA, is coning, doming, loafing, hard coning, soft coning. And I think the thing that people think of when they’re pregnant is again, when you sit up and you see this like little bulge in the middle of your abs that looks crazy, immediately we start to freak. And I don’t think we need to freak that hard. I think it’s just a little yellow flag that’s waving, that’s going, “Are we adapting to the changes that are happening in our body well? Or are we maybe compensating a little bit?” Does that mean that you’re splitting down the middle, like, alien’s going to rip out of your belly? No.

Gina: Hopefully not. Hopefully not.

Hayley: Hopefully not. But, likely. No.

Gina: But some of the terminology that we’ve been hearing is there’s a separation. Your abs are splitting. I’ve seen videos where people take scissors and they’re cutting like fabric abs and ripping them apart to demonstrate this separation that’s happening. And the muscles, there is no, like, ripping that is happening. Everything is so connected, it is just thinning and stretching.

Hayley: And I think it’s also important to remember that yes, like where we, where this measurement happens or where a weak, like a soft point in the abdominal wall is stretching, is where it’s obvious is at the midline, but the, it’s like all of the muscles- so all of those deeper core muscles, they’re also lengthening and stretching and so there is stretch through the whole, the whole thing, not just in the middle.

Gina: Yeah. Not just the center.

So one of, some of the common things that we’ll get from people is, “I was laying down…” which, lounging during pregnancy has tons of stigma. Or, “If you slouch, you’ll have a C-section,” is like one quote that I heard that I was like absolutely appalled by. And so then you have people that are afraid to like, sit down and relax. And then they’ll see some sort of what appears to be coning when they lay down. And so for those folks, I usually tell them there’s a difference between coning that’s occurring, which is essentially that pushing out of the center of the abdomen from increased pressure internally that’s pushing out on it, versus this is just how your belly relaxes when you’re in a restorative position. And for me, if it’s just, you’re just lounging, it’s really not that big of a deal. And even if you see coning from exertion and it happens every once in a while, that’s also not really that big of a deal. We’ll also get folks that are like, “I was doing an inversion,” so like a forward-leaning inversion that helps release the lower uterine ligaments, “and I saw coning.” And I’m like, in that one it’s really just how your belly is relaxing, it’s not really a huge deal.

Hayley: Right.

Gina: It would be different if you were like in a handstand pushup where you’re like upside down and you have a lot of core activation. Like, that type of kind of coning maybe from pressure, potentially.

Hayley: Yeah. And so you can, if you, like, are rolling and…. or you’re doing and inversion… okay, maybe not in a forward leaning inversion, be safe, but if you’re sitting up, and you see some of that sort of pushing out of the middle, you can touch it. And I feel like a good test is like if I touch it, does it feel soft? So that would get labeled as like soft coning, versus if I touch it, is it like rock hard? And so it just tells us about how much pressure force is behind that movement. So it’s soft, it means yeah, there’s some, pressure there, but it’s not so much tension that it’s like putting the tissues on stretch. Whereas if it’s a hard cone, like if you were in a hand stand pushup, or like doing something max effort, and you touched it, it would be firm. And I don’t think that we have like definitive research to support that, that’s just a theory in the rehab world, we are like, “okay, there’s some yellow flags, there’s some, red flags.” We would want to maybe avoid more of that, like, super hard, like and continuous loading. ‘Cause I think even if you were to hard cone doing something difficult one time, that’s not comparable to the amount of force.

Gina: Yeah.

Hayley: On your abs, if you were, like just from being pregnant.

Gina: Yeah. Absolutely. Yeah, and we have a whole YouTube video where I break down like different exercises and common ones that can cause more of that hard coning and modifications that we’ll link down in the notes below. So we’re not going to talk in depth on like how to modify your exercises during pregnancy to limit or avoid hard coning with movement, but there are ways that we could modify our workouts so that we’re more comfortable when we’re working out. ‘Cause coning can sometimes be painful. It’s almost like stretching, like pressure sensations to the front that’s usually pretty uncomfortable. And so we’re big fans here of making sure that you guys feel good during your pregnancies, I think it’s reasonable to feel good. And so minimizing coning with exercise can make you more comfortable in addition to potentially decrease the severity of a diastasis in the postpartum. So if you want like specific exercise modifications, if you’re noticing coning with like overhead press, pull-ups, core exercises, head to the notes below, and we have a whole video where I show you how to modify movements that commonly cause coning for us.

So let’s talk about postpartum healing with diastasis, because that’s really when most people are like, yeah, really thinking about it a lot. “What do I do? How do I prevent this? How do I heal it? Can I even exercise? Can I do anything until it’s healed?” So let’s talk about the nuance of what it’s like to heal postpartum, because I think, like I saw one study like years ago that said most people heal just spontaneously in the first six weeks. Like their body is just like wherever it was supposed to go, just goes there on a own, but not for everybody.

Hayley: Why? Not fair!

Gina: Not for everybody.

Hayley: Not fair.

Gina: I don’t know exactly what causes it for some people versus others, ’cause we have people that are like exercising throughout their pregnancies that maintain a diastasis, people that are not as into exercise during pregnancy that don’t maintain one. And so I guess let’s talk about like the spectrum of postpartum.

Hayley: Yeah. I’d say, I hate to pile on this community because they struggle with a lot already- our more hypermobile community, so people who have a hypermobility period, or connective tissue concerns, their body is going to respond to stretch differently than someone who maybe doesn’t. Yeah, genetically you just might be lucky, or, not lucky. And I think, yeah, I’d say hypermobility is like a big factor that people who tend to be hypermobile are going to be your highest sort of risk category for something becoming a little bit more difficult to rehab. Not impossible, it’s just we want to be more mindful, than those that aren’t.

Gina: Yeah. So even for Roxanne and I, we have the same parents, we are biological sisters- I don’t maintain a diastasis, like I think by the time I hit my, “all clear point,” like, quotations, it is normal looking. Even though I’ll look at my videos from when I filmed like the postpartum program, like early post or like the first like few months postpartum, and I’m like, I look like I’m postpartum and that’s okay. But for Roxanne, she usually maintains the diastasis for like years. So she’s had the same separation from her first pregnancy into now. We’re both sisters, I think she does my programming…!

Hayley: Yeah. I think that the whiplash on being postpartum and diastasis is so hard because you like, love your belly, and it’s like people are talking about it, and you love it so much, and then all of a sudden it’s, “Alright, you better be gone.” And then to put on that worry of oh, it’s not gone. Like mine, it’s not gone. I have a belly, and I am over a year postpartum now. If you want to put a label on it that says, “Oh yeah, I have diastasis recti and that’s why I don’t have a flat stomach.”

Gina: Yeah.

Hayley: And I think there’s a lot wrapped up into the body image of that, and I think that’s complicated, but I think for people who are seeking support with that’s also valid. It’s also valid to want to look a certain way. It’s also valid for you to want your abs to function a certain way. But I think the reason why there’s so much interest in searching or Googling what’s going on is wrapped up in that, like wanting to look a certain way.

Gina: Yeah. And so even though my abs decided to be closer together than Roxanne’s, I think both of our cores are functionally the same.

Hayley: Right.

Gina: We both have…

Hayley: That’s the thing.

Gina: The same pelvic floor issues, or not pelvic floor issues- like we both suffer from constipation! And so even though like our like abdominal wall looks differently, both Roxanne and I have the same type of function. And I think that’s something that is really important to note as well, kind of from your initial hot take to the episode is, the separation, or the spreading, or the thinning- whatever language feels best for someone to describe it- does not equate to function, or to problems either. And so like our stomachs look different, and it doesn’t mean that like my body is better or works better than Roxanne’s or anybody else’s.

And so I think we could take away some of that pressure to have the muscles right next to each other, or somehow melded together, to a single sheet of muscle. ‘Cause one, that’s not realistic, and two, it doesn’t equate to function either.

Hayley: Yeah. So there was a study that looked at, again, the reference, I have no clue, this is just pulling from the back of my brain. But, they looked at comparing like diastasis and prolapse and what they concluded from the study was that a diastasis was actually protective of a prolapse diagnosis. So, women who had more significant diastasis tended to have less prolapse. I think from a pressure standpoint, that makes sense.

Gina: Yeah.

Hayley: So if you are, there’s a change in pressure in pregnancy and in postpartum, and if you were, like the way you manage that pressure was to increase the stretch on the ab wall, and so you had more significant pressure going outwards, you probably had less pressure going downwards. Whereas if your ab wall did not release some of that pressure the same way, if we’re blocking off the front, there might be more additional pressure down.

Gina: Which makes total sense.

Hayley: And so like from my own body, I feel like after my first, I really hadn’t like postpartum, virtually no diastasis, but had significant prolapse symptoms, and then it flipped where it was like, oh, prolapse symptoms are good now with second pregnancy and third pregnancy, the ab wall has been the thing that’s taken a little bit longer to get functionally better, but the pelvic floor and prolapse symptoms were good. So that’s my one of one sort of experience with that, but I think that’s an interesting sort of pressure take on how the two things interact.

Gina: Which makes tons of sense. So for some of the folks that- I have like very limited experience, ’cause I don’t specifically work with diagnosing or helping people heal from diastasis in a one-on-one standpoint, it’s really only from like our postpartum programs and that’s more just like general postpartum approach- the folks that I’ve seen that have like more severe diastasis, seem to be like higher level athletes, and I almost wonder if it’s because, not that lifting weights equals tighter pelvic floor, but I’m sure there’s a little bit more of a correlation to maybe a little bit tighter, or like a little bit more tension within the pelvic floor, that pressure has to go somewhere, and so maybe that could be contributing towards more severe diastasis. This is not to say that athletes = anything, but just some of the patterns that I’ve noticed. And so it would make total sense if you have a a little bit more tension within your pelvic floor, where it doesn’t move when you breathe, it’s gotta go somewhere, and vice versa as well.

Hayley: Yeah, and we see that there isn’t a huge correlation between diastasis and back pain or diastasis and hip pain, or diastasis and function. And so I think it is important to remember, “Hey, that number on the measurement, yeah, doesn’t mean you can’t do X, Y, Z,” because there are plenty of cases where people have either more significant diastasis or a relatively small or non-existent and can still have functional issues. So, we gotta look at the big picture.

Gina: Yeah. So what are the approaches that you may have with somebody that comes to you and they want support with their diastasis, regardless of the severity or, the gap? What are some like approaches that you normally take to help them feel like good about their body and how to functionally improve whatever issues they may be dealing with?

Hayley: Yeah, I think if the reason someone’s coming in is specifically for diastasis concerns, then we want to address those concerns. And that’s something that I work on as a PT because my perspective is we want this whole, we want the whole thing to work together better. So sometimes I have a tendency to be like, we’ll worry about the abs as it all comes together. But I think as I’ve matured as a therapist, I go, oh, this is this thing that’s really important to you. I want to make sure that you understand how we’re looping this in together with the big picture.

So number one, with any muscle, when rehabbing any muscle in the body, we want to think about where that muscle starts and where that muscle ends, and then the function of, the role of that muscle. What does that muscle do? The action, right? So origin, insertion, action. When it comes to our core muscles, the origin, right, is up on the rib cage. And it actually, it’s not just in the front. So the rectus abdominis is just in the middle, but the rest of our abs attach all along our rib cage, even into the back. And then the insertion is all the way down on the pelvis, so like on your hip bones all the way across the pelvis, and then they connect in the midline. And then the action of our rectus, or our six pack muscles, is it helps our core flex. But our internal obliques, our external obliques, and our transverses abdominus are all muscles of respiration, right? They also help with flexion of the core and side bending of the core. But their major role is to oppose the diaphragm to help us breathe better. So we better start with breathing, right?

Gina: Yeah.

Hayley: We better start to teach these muscles how to do their job well in order to improve their function. And so we want to look at like, how are we breathing? What strategies are we giving? If we’re in person, get hands on with that individual and get a sense of how well do those ribs move, right? We know the rib cage changes in pregnancy. Most people go up a couple bra sizes just from width of the ribcage changing. So that’s going to change how we breathe, it’s going to change how the origin of those core muscles functions, and then it’s going to change how well the diaphragm is able to move up and down, period. Again, we want to look at that from the top down, and then we want to look at the pelvis and how the orientation of our pelvis has changed throughout pregnancy. Again, normal changes that happen in order to be able to carry a baby in there! But some people, snaps back postpartum, and some people, it doesn’t. I’d say most people it doesn’t. And so we want to understand that distal attachment, so where those ab muscles attach on the bottom, and how are we able to move and control that from the bottom?

Then we want to be able to put them together so that now the top and the bottom can interact in all the ways that they might need to interact: via flexion, extension, side bending and rotation, all the different angles, all the different ways. Because those layers of muscle work at different angles, they all are going to have times where they’re working better and more efficiently than others. So we can’t just isolate- like one of my biggest frustrations with the diastasis rehab is like all the focus on just transverse abdominis only, and like, isolating the TA.” It’s like, that’s one of four muscles.

Gina: Yeah.

Hayley: And the tightening, the tensing of that muscle, is just one action that muscle can do. That muscle needs to be able to tighten, right? So if we think about that, like an isometric hold, right? And you need to be able to hold it still, but you also need to be able to shorten it. You also need to be able to lengthen it, and then rotate it and, use it in multiple directions. And so if we’re stuck in isolation land, or we’re struggling to isolate- I think I see that a lot. It’s like I’m laying on the table. I’m having a hard time feeling those TA muscles contract. No wonder! Because if we are not looking at where does that muscle start, where does that muscle end, and that’s off, you’re going to struggle. It’s going to be frustrating to lay there on the ground and try to get those muscles to contract.

Gina: Yeah.

Hayley: So, maybe to bring it back around where I’d start is addressing what’s going on above, what’s going on below, and then let the abs do what abs do, which is just function.

Gina: Yeah. So it sounds like rib cage positioning, pelvic positioning, paying attention to what this, what the pattern is before we approach exercises- like what position does someone like to be in all the time? Do they have a little bit more flared ribs? Maybe pelvis is a little tilted it more, which is probably normal.

Hayley: And would just in general. I would even back up and say like another kind of like hot take is does rib flare matter?

Gina: I don’t know, does it?

Hayley: Because when, you start looking at like ab walls of people who have had kids and who haven’t had kids, it’s not like these rib flares just like magically pop out of nowhere. Often these are changes in the structure of someone’s body that have existed since they were…

Gina: I feel like I have always had a left-sided rib flare, and I’ve always had…

Hayley: Absolutely.

Gina: Like whenever I did a yoga class, it was always so much easier to go into more externally rotated positions on my left versus my right.

Hayley: Yeah. Does that mean that you are not going to be able to rehab your ab wall?

Gina: Yeah.

Hayley: Or do you have to fix your rib flare before your abs will work better? No.

Gina: Yeah, ’cause our diaphragm is not the same on both sides. So why would my rib cage look exactly the same on both sides as well?

Hayley: Correct. Do we want to keep these things in mind? Sure. But I think a lot of times those types of terms, that type of terminology, “Oh, fix your rib flare!” “Fix your diastasis!” is it like, puts the brakes on recovery, puts the brakes on just doing exercise in general. ‘Cause we’re like, “Oh, I can’t. I can’t do any core work until I fix that left rib flare. Let me go, let me pull up my Instagram page and find a post that gives me three things that…” it’s like, come on.

Gina: I also, when I was first getting into this space, back in, what, 2017? Rib flare was definitely a huge thing, and I was like hyper-focused on my form with like my lifts. Like, I wanted my squats to be like perfection, and it ended up holding me back, ’cause I like could not accept like any deviation from perfect form, because if I didn’t do perfect form, I was hurting myself. That was like like the messaging that I was telling myself, even though I accepted. Imperfections in other people. I was like, “No, I need to have perfect form.” And I ended up essentially just not lifting as heavy as I needed to, and was like physically holding myself back because I needed this to look this very specific way. “Oh, I’m having some rib flare. I can’t do that exercise until I fix that rib flare, ’cause I’m going to hurt myself if I don’t.”

And now I have a different approach to things. But I think like that kind of feeling creates a lot of fear of, “I cannot do X, Y, or Z until I fix this problem.” But is it actually a problem? Is having some sort of gap in your abdominal wall a problem? Is having a rib flare a problem?

Hayley: And if you are having pain, or you’re having pressure, or you’re not able to do the things you want to do, then we can talk about it. But I think it’s yeah, we get just so far into our head about our body in a time period where we’re already concerned about, yeah, our body, and how it looks.

Gina: Yeah. So for the things that have helped me in my past few postpartums to feel comfortable- because postpartum is hard, it’s a little uncomfortable just in general, right? There’s a lot going on. I found breathing into my backside, like doing back expansion, breathing, even now, if I’m having like lower back pain or discomfort from carrying my kids all day, like back expansion breathing helps me feel so much better. If I’m having SI joint pain, if I’m having any pubic pain, if I’m having lower back pain just breathing into the backside of my body, it’s like a game changer for me. Either standing, all fours, like curled up in a little ball like smushing stuff, like as I like, squeeze and round was like super helpful early postpartum for me.

Hayley: And that’s helping us with orientation of the thorax and the pelvis, that’s helping us with approximating ab muscles that have been elongated throughout pregnancy. That is also huge for nervous system regulation. So the expansion of our back body helps us turn into parasympathetics, helps us relax, which I think is a huge part of postpartum recovery- equally as important as like bringing our abs together.

Gina: Yeah, absolutely. I also found thoracic mobility to be really helpful for feeling good within my body. I think it’s very helpful if you were looking to approach healing diastasis, if you need to even heal it postpartum, like having a rib cage that could move, that isn’t just stuck in one position, which I think is really easy to happen. Like we’re holding this cute little baby and we’re just feeding them, and then you get like nap trapped and you’re like, “I’ll just hang out here and play on my phone,” and then you’re like, “Oh, my back hurts.” So adding in the thoracic mobility was something that I found really helpful to help me feel good in my body. And when I feel good in my body, it’s easier to then do exercises and movements to help strengthen my body postpartum. And then I was incorporating a lot of… not a LOT, in early postpartum, but more of like the hip shifts and like groin releases as it felt better for me to separate my legs a little bit more. I know there’s some fear with spreading your legs after you give birth, especially if you had any sort of tearing, just to add a little bit of like pelvic mobility.

And so looking at the rib cage, looking at the pelvis, and then rounding, were all things that helped me to feel much better within my body. And then once I was like outside of that first month, first six weeks postpartum, and I wanted to start loading the tissue again, that’s when I really felt like my core was like really reconnecting to itself.

Hayley: Yeah.

Gina: It was, okay, now I’ve done like the deep core connection with the breathing and the gentle mobility. Now let’s add on some extra stuff. Can I keep my core at its position as my arms and legs do stuff for that core stabilization? Okay, I could do that. Now let’s add some, like a band. Let’s add some resistance with weights, and then to get off the floor. So like we can do all of the deep core exercises on the floor in perfect positions and maintain and then add all the load, but eventually we need to get on our feet ’cause that’s where we live life. We don’t live life on the floor.

Hayley: Yeah, just like with the pelvic floor, right?

Gina: Yeah.

Hayley: We can like we can start to activate those muscles, we can respect the position, and then eventually, we gotta put it to work, and it’s in those more functional movements. We’re not thinking about squeezing it all the time. Like we’re not thinking about, “Okay. All right. Transverse abdominus. Come on.” In the early phases, sure. We might bring some more consciousness in there, but if we’re doing that you don’t have to think about it.

Gina: Yeah.

Hayley: When you’re working out. And I think that’s a big shift for a lot of my clients is, I don’t really want you thinking that hard about your abs when you’re squatting, I just want you to squat. I don’t want you to think that hard about your pelvic floor when you’re doing this thing. I just want you to do it.

Gina: Yeah. It’s mentally fatiguing, too, to like constantly be thinking about it. And so for us in our programming, it’s the core warmup that we do, which is all floor based- I want you to really think about breathing and being like more simple with your movements then. And then once we’ve connected, okay, now let’s stand up and do our movements. And that kind of integration should hopefully still be lingering.

Hayley: Yeah. Kind of prime the system so that neurologically…

Gina: So it’s like hopefully still there for you when you come upright to do your squat, to do your step up, to where we’re still thinking about positioning and breathing. And then by the end of the program, it shouldn’t be something that you have to think about quite as much anymore, ’cause it becomes a little bit more like automatic, which is the goal. but it can be really mentally fatiguing to think about every single rep, every single breath.

Hayley: Yeah. Gosh.

Gina: Every single activation. And then it feels defeating ’cause you’re like, “Oh my God, I’ve done like four reps, and I’m exhausted!”

Hayley: I can’t!

Gina: It’s like, “Oh, God!” But yeah, no. So for me, I found back body breathing, just mobility at first in like the early postpartum was like really helpful for me, in just healing and feeling “good”, quotations, ’cause early postpartum is hard to feel like amazing. And then once I came out of that early postpartum, it was like, all right, now let’s add some loading to it. I’m going to start on the floor to prime the system, to connect with my core, to think about my breath. How do I maintain stabilization? Starting to add some loads. So over the weeks, we add bands and weights and things to make it a little bit more challenging on the floor. But then after we get from the floor, it’s not, “okay, six weeks from now we’ll do a squat.” It’s no, we’re going to be on the floor, we activate, and then we’re going to stand up, in the same workout. Like we’re going to get upright, because it would be a disservice to only do these deep core exercises on the floor, and never at some point come to, okay, how do we take what we’ve learned there to this upright position so that we can integrate and heal?

Hayley: Yeah.

Gina: Postpartum.

Hayley: Right. Use it. Yeah, absolutely.

Gina: I think there’s also a lot of folks that are afraid to advance their exercises if they have a diastasis, but I think there’s a lot of research- or limited research, ’cause there’s probably not a ton of research on this stuff- that loading the tissue can actually help to heal somebody if they’re plateauing in their healing.

Hayley: Yeah, a big one, I feel like, that comes up a lot is like the fear of ever doing like a plank; the fear of ever doing a sit up. And so especially in those cases, I get those people doing like rolling sit ups, so do the thing that scared you the most, with some buildup, and see that you literally… you’re not…

Gina: You didn’t explode.

Hayley: Nothing’s going to pop open.

Gina: Yeah.

Hayley: You’re not going to explode. It actually felt really good. And, then keep going.

Gina: Yeah. We’ll get a lot of questions where folks are like, “How do I know that I’m ready to do, the next movement? How do I know I’m ready to advance?” And that’s usually what I say, I’m like, “Just try it, and see how it feels, and if it doesn’t feel good, regress a little bit.” But that’s really the only way that you’re going to find out, can I do this next movement, is to try it and see how it feels for you. And if it feels good, then advance it again. And if it doesn’t, just come back a little bit. And so I think there’s a lot of power in understanding that a lot of the answers that we’re seeking are already within ourselves. And this applies to birth as well, ’cause we’ll have folks that are like, “How do I know what labor position to do?” And I’m like, try some and see which one feels best for you. And the one that feels best is the best position! And it’s okay if it’s not the one that like mechanically opens the pelvis the most based on where baby is. If it feels best for you, that’s a good position to be in.

And I think this also applies when it comes to approaching fitness or movement in the postpartum is, if you’re trying to figure out like what is like safe for you to do with whichever diagnosis that you have, try it.

Hayley: Yeah. There’s very few activities… Like, unless you’re swinging a knife around…

Gina: Yeah.

Hayley: It’s probably safe. If you’re like, Hey Hayley, I really want to swing these knives around while I do this exercise,” that’s probably the only time I’d say…

Gina: Yeah.

Hayley: I would say, “Is this safe?”

Gina: If there’s a really big fall risk, like if we’re going, I’ve seen these like crazy videos…

Hayley: If you’re balancing on like a exercise ball on a concrete floor or something.

Gina: Yeah, doing a barbell squat, like that’s probably a bad idea. That’s probably a dangerous exercise.

Hayley: Depending on your skill level. It may be perfectly safe, but yeah, like the terms like, “safety” or, “am I allowed,” or, “is this safe?” it’s again, it is very unlikely that the movement that you can do with your body is going to harm you at all.

Gina: Yeah.

Hayley: Again, unless you’re going to faceplant into the floor.

But so it’s, yeah, try it. And I think though, sometimes that’s like what pelvic floor therapy is good for, is like to have someone be able to stand next to you as you try the thing that you’re afraid to try and be like…

Gina: “See! It worked!”

Hayley: “It was amazing! Great job!” And I mean, that’s one of the my favorite things to do, yeah. Makes my job easy.

But, so often people’s experience in rehab is the opposite of that. And that pisses me off, when they’re like, “Oh, I, yeah, I can’t do that. I can’t do that.” I’m like, “Did you try it in the office? Did you try it in the office, and it was clear that you were coning or you had a lot of pain when you did that?” “Oh, no, I didn’t try it in the office. They just told me, because I have still have a three finger diastasis, I can’t do that.” It’s infuriating.

Gina: Yeah, so it’s not like the patient that’s I can’t do that because I have this, it’s someone else told them, in some capacity, that it was like “unsafe” for them to do this exercise because the type of gap that they have, which is super irritating. Like we’ll get folks that are like, “I really want to get back into running, but I still have a diastasis.” And I’m like, “Why couldn’t you run?”

Hayley: Right.

Gina: “Are you leaking a ton? Are you having tons of pain when you run? What’s going on that is impacting your ability to run? It’s, “Oh, I just have this diagnosis.” And I’m like, “Oh, that by itself doesn’t mean that you can’t.” Like if you are like obviously in tons of pain when you’re running, like it’s really uncomfortable, you’re like peeing yourself constantly, okay, maybe we need to find a different cardio activity while we do exercises to help strengthen yourself to get back to running. But just having a three finger separation doesn’t mean you can never run again until it’s not. Because it could just be your normal, just normal for you. Roxanne still has a few finger separation- right now she just gave birth, so she probably has…

Hayley: Roxanne, get on it!

Gina: Get back, bounce back, Roxanne! But like she maintains separation.

Hayley: Right.

Gina: But can still run and do all of the things.

Hayley: Years ago- it was probably seven, six or seven years ago when you guys were at the other spot- we did like a class, a diastasis class. I don’t know if you remember this, like a long time ago.

Gina: Yeah.

Hayley: And I brought with me one of the students that I had at the clinic. She just wanted to come and watch the workshop that we did. And she had never had any kids before as like this petite little gymnast or something, and everyone’s like feeling and like trying to figure out if they have diastasis or not, and everyone’s like stressed out. I was like, “Oh gosh, this is not the way I want this to go!”

Gina: This is the opposite!

Hayley: This is also like early in like me figuring out this. And I was like, “Hold on. Everyone, come over here.” This is like a, this is a person’s body who, with her permission, who’s never had a kid, let’s all start poking in her abdomen. And she had a two and a half finger wide separation, with like probably an inch, or at least an inch, depth. No problem. That was her normal. That was her baseline. And so it’s, oh, I wish like everyone before they even got pregnant could have a baseline, because then you wouldn’t be so stressed out about it.

Gina: Yeah.

Hayley: After. When, if she had never checked it before, had a baby, and was like, “Oh, I have a two finger separation, it’s one inch deep, this means I have diastasis,” actually, you had that before.

Gina: So this is just normal for you now.

Hayley: This is, you actually are perfect.

Gina: Yeah.

Hayley: And it’s like we don’t, if we don’t have that, we don’t know.

Gina: Yeah.

Hayley: Yeah.

Gina: So diastasis, there’s definitely a lot of fear involved with it. We get folks during pregnancy that are like, “How do I prevent it? Should I never do core exercises? I should never just move my body ’cause I don’t want to make it worse.” And then in the postpartum, it’s the similar sentiment of, “I don’t want to move ’cause I don’t want to make this worse. I don’t want to cone a single time, ’cause then my core will explode.” And I think it’s important to note that diastasis is not just the separate, or the spreading, by itself is not pathological.

It’s not like a problem, always. There may be other things going on that can be impacting function, but it, by itself, is not really a huge deal. Unless there’s like other things going on.

Hayley: Yeah. Yeah, absolutely.

Gina: And so there’s different approaches that we can take if you’re wanting to help bring the muscles closer together. If you want the tissue to be denser, like we can start by thinking about what our positioning is of the rib cage and the pelvis, like breathing mechanics, which is a huge component of that whole abdominal canister. Like how are we responding to pressure changes within the abdomen, and that can positively or negatively impact different symptoms that we may be feeling.

I typically find how well we can change positions, plays a big role in our comfort. When we’re stuck in positions all the time, this could increase symptoms that we’re feeling. How well we’re breathing and internally managing pressure plays a big role in how we feel. And then after all of that, like how well can we stand upright and transfer movement from upper to lower body? How well can our pelvis respond to our rib cage functionally up and down the chain? And then adding resistance and loading to that.

We don’t want anyone to be afraid to move their bodies during pregnancy or postpartum. There’s a lot of like “safe” and “unsafe” lists. “If you have this, yes. If you don’t, no,” like lists. And they’re… and none of them take a lot of the nuance into consideration, where it’s, “if you have rib flare, never do this ever again,” or, “only do these four exercises.” Like, “top five like exercises to heal whatever.” And all it does, I think, is really like scare people into moving their body when if you’re unsure, if you’re ready to try something, try it. And if it feels good then it’s probably fine. And if it doesn’t feel good- and like truly listen, ’cause I’ll get that a lot where folks are like, “Ah, I feel like garbage when I run during my pregnancy,” and I’m like, “Maybe don’t run. Can we try a different sport?”

Hayley: Right?

Gina: And so explore the movement in your body and know that the best person that can tell you whether something is safe or unsafe, or not even safe or unsafe, whether something feels good for you or not, is yourself. And explore and feel empowered to move your own body during pregnancy and the postpartum, regardless of what diagnosis you may have been officially given or unofficially gave yourself, so.

Hayley: What do the Gen Zs do? They do this?

Gina: Is that like clapping? Yeah.

Hayley: When you’re clapping, yeah.

Gina: I think it’s yeah, like I guess it’s the opposite of the little violin.

Hayley: Like, preach. Yes.

Gina: Absolutely. Thank you so much Hayley, for being here.

Do you have any last advice for somebody that maybe listening and maybe they were hoping for a list of exercises to do and they’re like, now this feels more or less confusing for them. Do you have any advice for our listeners that may or may not be dealing with diastasis, and this is something that they really are wanting to overcome or fix in some capacity.

Hayley: I think it’s like respect that it is a process, a healing process. Respect that five exercises on repeat is not going to fix the problem, and that you need to integrate. So your core needs to integrate within a system, and when that starts to happen, good things are going to happen. And that would be my advice.

Gina: Awesome. We do have a workout video or a video that we’re going over different exercises and applying a lot of these concept to that is accompanying this podcast as well. So if you heard this one and you’re like, “Cool, but what do I do?”

Hayley: Yeah.

Gina: Check out the workout video that we did together where Hayley is going to walk you through different approaches to, how can we feel our core again, how can we manage breathing, and then how do we get it upright and functional again? So if you want more of, okay, thanks for the why, tell me how we’ll break that down for you in the workout video from this week as well.

So thanks so much for listening to this episode with us. If you want more support during your pregnancy or your postpartum, Hayley does offer a pay what you want Pelvic Balance class, which is a virtual class. I think you offer it like once a month.

Hayley: Once a month, just about.

Gina: I think it’s eight classes.

Hayley: It’s, it is four weeks, two classes a week, and they’re 30 minutes each. So quick and easy. And it’s all the foundational pieces and we build on it each week.

Gina: Yeah. And so this pelvic balance class is great for pregnancy, you can do it postpartum, and it’s really just teaching you. How to feel stuff in your own body and to recognize things again. ‘Cause when you can understand your own patterns, it can really help you just feel so much better in your body. And Hayley offers it as a pay as much as you want class so that it’s accessible to all, ’cause we never want finances to be a reason why you can’t seek the care that you need. And she is a pelvic four physical therapist, she does offer one-on-one virtual consults as well, but the pelvic balance series is a great way to work with Hayley if you’re wanting to approach your pelvic health and just feeling good in your body in general, really any phase of life, I’d highly recommend it. I did it during my pregnancy. I did it once postpartum. And working with Hayley as closely as I do has been a huge impact on me, and so I would love everyone else to work with her as well. So we’ll link it down in the notes below, depending on when you listen to this episode. Usually it’s like the beginning of every month, but follow her on Instagram, she usually announces when next one’s coming. But it’s usually like a four week series, and I would definitely check it out. So thanks so much for listening.

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