Diastasis Recti with Mary McQueen from Baby Bootcamp Oakland

Let’s get right into the Diastasis Recti struggle- firstly, how do we pronounce this word?

Haha, tomayto, tomahto. I have heard people say it both ways - "di-uh-stay-sis" with a long second a and emphasis on the third syllable (which is how I pronounce it), or "di-aa-st-uh-sis" with the emphasis on the second syllable. The Greek prefix Dia- means “through” or “going through” and -stasis means permanent. So, in effect, going through and separating, and then staying that way. Luckily, there are many techniques to modify DR.   

Now that we can discuss Diastasis Recti (DR) like we know what we’re talking about, tell us what it is.

Diastasis recti (DR) is a separation of the connective tissue (linea alba) of our “6-pack” ab muscles (rectus abdominis). If you draw a line from the center of your ribs, down to your pubic bone, directly through your belly button, you are tracing the linea alba. This fibrous band connects all of your abdominal muscles like a corset: your obliques (abs at the sides of your waist, above the hips) and transverse abdominal muscles (our deepest layer of abs, wrapping like a corset).

DR is NOT life-threatening - it is a natural part of pregnancy, delivery, and birth recovery, that is often ignored by the American medical community. Left untreated, DR can seriously impact your quality of life. A severe separation of your abdominal muscles results in a weak pelvic floor, uterine prolapse, inadequate support for your internal organs, and may possibly result in back pain and tight hamstrings. 

How did you learn about DR in the first place?

A couple of years ago, a friend and former Baby Bootcamp instructor got certified in the Tupler Technique. Tupler is another program that works on repairing DRs without surgery. She asked if she could speak to my Baby Boot Camp moms about it and do DR checks for my clients. She checked me, and lo and behold, I had a 3+ finger separation at my belly button, which explains (at least partly), my chronic low back pain! Since then, I have become licensed in Baby Boot Camp’s Core 9 Birth Recovery and Diastasis Recovery programs in an attempt to bring this education to mamas that really need it. 

How can we find out if we have DR and what are the symptoms prenatally, postpartum or even years after birth?

It is easiest if someone else checks you (I check all of the moms that attend my Baby Boot Camp classes), but you can certainly check yourself: 

Lie on your back with your knees bent and feet flat on the ground, one hand behind your head. With the other hand, place your index and middle fingers inside your belly button with your palm facing you. Inhale with your head resting in your hand and then as you exhale, lift your head and shoulders an inch or two off the ground, like the beginning of a mini-crunch.

With your head up, you should feel the rectus abdominis muscles harden around your fingers. You then see how many fingers you can fit between those muscles. You will want to measure at your belly button (if you have a DR, it is usually largest at your belly button). Additionally, measure a couple of inches above your belly button, and a couple of inches below.

When I check moms at Baby Boot Camp, I also look for how far down I can push my fingers. Some moms have very shallow separations, which are not as concerning as deeper DRs. Moms that have a 1-2 finger separation can do most exercises; I modify significantly for 3-finger separations. If you have a separation of 4 or more fingers, you are still able to workout and come to class, but you should also see a physical therapist.

If you find that you have a separation, your goal is to strengthen and correctly engage your transverse abdominis muscles (TVA), which will start to bring the rectus abdominis back together. Do not do work that engages your Rectus Abdominus, or 6-pack muscle, it will only further the separation.

Is there any way to avoid DR during pregnancy?

Stay active during your pregnancy and learn how to engage your Transverse Abdominal muscles (TA).

Never sit straight up from a reclining or flat position. Roll to your left side and then press up to seated with your hand every time you get up from bed or mat-based exercises. This way, you avoid putting additional pressure on your abdominal muscles and connective tissue.

We recommend signing up for our Core9 Birth Recovery program a minimum of six weeks prior to your due date. Core9 Birth Recovery provides specialized support specific to where you are at in your postpartum recovery. It begins with essential movements that you can do at home immediately after delivery.  

There are some specific exercises and movements to avoid if you have a DR. You should not do any twisting movements (for example: Russian twist and bicycle) but you can work your obliques by doing a modified side plank instead. 

Avoid a full plank position until you bring your DR down to at least a 2 finger separation, and this includes push-ups. These should be done with your upper body elevated or with your knees on the floor, and possibly not at all, depending on the severity of your DR. And NO sit-ups!!! Please!

If you take one thing away from this interview, mamas, no more sit-ups, no more crunches, no more roll-downs! I never do any of these in Baby Boot Camp classes - they can make your DR worse. We are socially conditioned to do crunches and sit-ups when we hear it is time for “mat work” or “ab work.” Not only is this not the most effective way to work your core, but it can make your DR worse, and all of that flexion and extension can be really harmful for your back. Did you hear that the US Army is phasing out sit-ups because of spine injuries?! 

There’s so much pressure on mamas to get “back into shape” within a couple months of giving birth - how does this impact your clients’ health?  

Sara, I see this all the time, and I completely understand - most of us have a very limited amount of time off of work with our newborns, and our goal is to LOSE THE BABY WEIGHT! I get it! But things take time. Through Baby Boot Camp, I’m really trying to shift the focus more towards long-term health, safety, and longevity. Boot camps can be really great, but there is a danger in throwing yourself back into exercise and not listening to your body’s signals to pull back.

A physical therapist that specializes in pelvic floor issues spoke at the last Baby Boot Camp conference and she said that because of the relaxin still in your body (a joint loosening hormone), you should not run until you have stopped nursing! Now, I understand that sounds a bit extreme, and there would probably be a mutiny if I told my mamas that, so we have compromised and instituted the 6-16 week rule - moms can come to my classes 6 weeks after a vaginal birth and 8 weeks after a c-section, but from 6-16 weeks, we HIGHLY encourage moms to take the low-impact modifications and to power walk instead of run. You will still get a great workout, trust me!

You might feel really great after having your baby (and I hope you do!); but, use me as an example: I felt great and wanted to get back in shape and went back to teaching way too early, and I’m dealing with issues that I can trace back to my compromised core strength almost four years after I had my last baby!

How would you recommend that a new mama ease her way back into health, what’s your ideal plan from birth to 12 weeks?

I love this question!

About a year ago, we created a program called Core9 Birth Recovery. The program involves weekly supportive emails, movements and stretches you can start doing from week one postpartum, easy and nutritious recipes, and in-person Diastasis Recti checks for 0-9 weeks postpartum.  

I would recommend using a postpartum belly binder during exercise and movements. Walking is great if you’re ready for more movement, and the no-impact core movements that are outlined in Core9 Birth Recovery are great for general core strength, but also to aid in repairing a DR.

I also highly recommend coming to Baby Boot Camp classes once you are cleared by your doctor and either 6 weeks postpartum (vaginal birth) or 8 weeks postpartum (c-section). You will get a great workout taught by nationally certified instructors, that are also well-versed in the appropriate postpartum modifications.

Read this great article by one of my colleagues that outlines safe exercises for newly postpartum moms, as well as what to avoid.

Do you have any other resources mamas should know about? 

Indeed! Baby Boot Camp classes are taught by nationally certified fitness professionals. You will get a fantastic one-hour workout that is safe for newly postpartum mamas, all in a fun and supportive environment.

I am also licensed and certified in Core9 Birth Recovery and Core9 Diastasis Repair. Core9 Birth Recovery is for moms 0-9 weeks postpartum and is NOT an in-person program. It consists of weekly emails with safe and effective movements and videos that moms can do at home in the early postpartum weeks, plus two in-person DR checks.

Core9 Diastasis Repair, on the other hand, is an intensive in-person four-week workshop. I run 3-4 workshops per year, and have one coming up in June. We work on repairing DRs through safe and effective movements, while also improving posture and strengthening the pelvic floor.

The Fitness Center on the Baby Boot Camp website also has some great articles on DR, birth recovery, and postpartum exercise, in general.

Here are a couple articles that are particularly relevant to our conversation:

Early Postpartum Birth Recovery
Birth Recovery and Diastasis Recti
Birth Recovery and Running

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MEET MARY MCQUEEN

Mary is mom to Liam (5/07), Sinead (6/10), and Jameson (7/12), and has owned Baby Boot Camp Oakland since April 2009. She has a B.A. in English and French Literature from U.C. San Diego, is an ACSM-certified personal trainer, and certified in Group TRX Suspension Training. You can reach Mary by email or phone at 510-418-8599.