CLOSING THE GAP: TALKING DIASTASIS RECTI WITH PILATES INSTRUCTOR MARY JANE STOESS
Countless women suffer from the all too common problem of abdominal muscle separation, Diastasis Recti (DR) after giving birth. Just as common is the lack of guidance from OB/GYN physicians in postpartum check ups for how to heal the separation or prevent it from worsening. Symptoms and side affects of the diagnosis can include back injury and pain (from compensating for weak abdominal muscles), loss of bladder control, bladder prolapse and umbilical hernia. Mary Jane Stoess, a Louisville, KY based Certified Pilates instructor and mother of two, teaches workshops at Core Pilates and Yoga Studio of Louisville, working to help moms find safe interventions of exercise and diet to reverse the effects of DR. She endured abdominal separation herself after the birth of her second child and was kind enough to share her personal story, expertise and tips in an interview today. If you’re in Louisville, don’t miss the chance to register online for her next workshop November 12: www.trypilates.com.
Natalie Westbrook: Can you tell us about your training and background?
Mary Jane Stoess: I was first introduced to Pilates when I was in college, and training to be a professional dancer. Pilates is tremendous cross training for dancers, it's a really compatible form of exercise and helps tease out the imbalances in your body, and strengthen the inner most muscles of the core. I liked the challenge and it felt really athletic. Eventually I wanted to move on from dancing professionally and felt intrigued by the element of mindfulness in Pilates. I trained under physical therapist Kristen Veltkamp with Integrated Balance. My training included in depth study anatomy and emphasis on keeping clients safe while working within the limitations of each individual's body. For nine years I've been fortunate to be based at a great studio where the owner prioritizes keeping the clients safe and helping them to get out of pain. Most of my clients are the complete opposite of the athletic dancer types. They have neurological conditions, injuries, or are mothers- both young and old- that are still dealing with issues from their pregnancies and child birth. This includes mothers from 4 months postpartum to 25 years postpartum.
NW: You see a lot of clients dealing with diastasis recti and pelvic health issues, why did you become interested in this?
MJS: I'm a mom to two young daughters. I was in great shape and practiced Pilates before and during my first pregnancy, but was blissfully unaware of what kind of toll pregnancy and childbirth take on the body. After I had my second child, I realized something wasn't right with my belly and started doing independent research after realizing I had a pretty significant separation of my abs. I naively thought I could figure it out and fix it on my own. Quickly I realized it was a complicated, complex issue to solve. I so desperately wanted to understand how to close the gap, and eventually sought help from a reputable pelvic health physical therapist who helped me for months to work on it. I was so surprised at how much I had to completely start from the basics, and build my strength doing tedious very small movement exercises. The dancer and athlete in me was chomping at the bit to do more, but I remained patient and stuck to the humbling process. I've learned so much on my own journey about what exercises are safe, what to avoid and, most importantly, realizing I'm certainly not alone. I've met lots of moms that are struggling with this, even some not aware that it's a problem. Unfortunately, a lot of women don't know that they should probably see a physical therapist who specializes in pelvic health, during and after pregnancy. There are so many issues that are likely going on that need to be addressed that go unchecked, such as pelvic floor dysfunction, diastis recti, SI joint pain, and prolapse.
NW: What is diastasis recti exactly? And what are the signs you might have it?
MJS: Diastis recti is the separation of your rectus abdominus into right and left halves. It can occur in infants, but usually closes on its own. It occurs in pregnant women because of the growing uterus pushing on the abdominal wall, and the linea alba, which holds the two sides together, gets over stretched. DR is also common in overweight individuals. Usually, people who have DR will notice back pain and their abs not functioning to support their spine. They may still look pregnant even though it's been months or years since giving birth. A person with diastasis recti will lay on the floor supine, and notice a "french loaf" or a dome, and in a lot of cases, you can see your intestinal tract, moving around in this gap.
NW: Are all moms at risk for developing the separation? Is there greater likelihood depending on whether a birth was a vaginal delivery or cesarean, and is there anything that can be done preventatively during pregnancy?
MJS: There is a risk for everyone to get it. I have lots of mom friends who have it, and a few who are so fortunate to not have it at all. I think it really depends on a lot of factors, and the luck of the draw. Moms who carry their babies straight out to the front, almost like a "torpedo" baby bump are more likely to get it, versus a mom who carries her baby wide with a more evenly distributed baby bump. Moms who have a small frame and birth very large babies in proportion to her body, are likely to deal with it, as well as moms who have multiples, and multiple pregnancies. Age as well as preexisting issues such as weakness and pelvic floor dysfunction can contribute as well. I don't think it matters what way you give birth, because most of the damage of diastis recti occurs during pregnancy, and can also become worse postpartum if not monitored. Preventatively, during pregnancy, you can do some things to help, but for some of us, it's going to be our fate no matter what precautions we take. Avoid exercise where there is a lot of intra-abdominal pressure, for example crunches, or being in a quadruped or plank position and letting your belly hang. The weight of the baby strains and stretches those abdominals if not supported properly. Try to get up from lying down by rolling into your side, instead of trying to perform a sit up. It's also important to consider your posture while sitting and standing, really letting your pelvis dump forward into an anterior tilt is hard on your spine and presses into the abs.
NW: How do you assess whether a client has diastisis recti and how severe their particular separation might be?
MJS: There is a really simple test everyone can do to test themselves for diastasis recti. I think it's helpful to learn how, but I also highly recommend seeing a pelvic health physical therapist if you haven't already. To test yourself, you lay supine, with your feet flat and knees bent. Take your fingers and lay them above your belly button, and curl you head off the ground. If you have a separation, you will be able to fit your fingers width wise into the gap. You can test above, and below your navel and it might vary in the width in each location. 1-2 fingers is usually considered normal, and 2 or more you should definitely seek help from a physical therapist. It's also important to note that pelvic floor dysfunction goes hand in hand with diastasis recti, and a physical therapist can use equipment such as an ultrasound to see if you're able to contract your pelvic floor muscles and contract it properly.
NW: What are some of the steps you offer clients in your plan for closing the gap and preventing the separation from worsening?
MJS: I see clients who have diastasis recti and have graduated from their physical therapy, and want to continue their training, but wanting to do it safely. Once you have diastasis recti, you really have to be careful to do safe exercises or else you can reopen the gap. We train to strengthen their transverse abdominus, pelvic floor, mutifidii, and abductors, and also try to teach them functional movement patterns so that they aren't doing things in their daily life that will increase the gap. Pilates is my favorite way to exercise and I've really enjoyed creating my own Pilates workouts that are safe for me to perform, and I'm excited to share with other people in the same boat.
NW: Is it possible to completely close the separation, and if so, how long does it take?
MJS: It really depends on each individuals body. A 1-2 finger separation is considered safe, and really it's more about if the abdominals are functioning properly and are strong rather than how much of a gap you have. It's particularly difficult to close the gap around the belly button- most never do- but if you have a really strong base and are using your pelvic floor and abdominals properly, and your core is functioning correctly, maintaining a separation is simply more of a cosmetic problem.
NW: What sorts of activities should moms with diastisis recti avoid while the abdominal muscles are not yet closed?
MJS: If you haven't seen a physical therapist yet, or just had a baby, and only a few weeks postpartum, be so gentle and patient with your body. Everything is so raw, and tender, and really susceptible to injury during this postpartum period. You can cause a lot of damage to yourself by jumping into an intense exercise program too soon. I see a lot of moms who right after the 6-week all clear fromtheir OB/GYN are jumping into intense boot camps to get their pre-baby body back. Take it slow, gentle and get acquainted with your new body. Most likely, your body has gone through some dramatic changes, and it's important to take some time to get familiar and see if there might be some issues that need to be check out by a professional. Since diastasis recti and pelvic floor dysfunction often go undiagnosed at the OB/GYN, you have to advocate for yourself and ask lots of questions and get a referral for a physical therapist who specializes in these issues. For diastis recti, you can do corrective exercises religiously, but if the rest of the 80% of your day your are doing function wise poor habits, you'll be continually starting from square one with getting rid of gap. As far as exercises goes, avoid abdominal exercises such as sit ups, extension of the spine, and any movements that involve your hips over your head in a jack knife position. Twisting, to work the obliques, can cause a lot of shearing as well. Burpees, push ups and crunches are really only going to make your ab separation much worse. It's counter intuitive, you would think 'I just really need to work my abs,' but it can make it significantly worse. It's important to note that there are plenty of Pilates exercises that are contraindicated for diastis recti, so you definitely don't want to blindly hop into a mat class to tone your abs to get rid of the 'mummy tummy.' You want to find an instructor familiar with diastasis and train one-on-one so you can make sure you are training safely.
NW: How do you feel about the compression garments called belly binders?
MJS: That's a very heated debate- there are really two different schools of thought. Some therapist swear by belly binding, such as the Tupler Method. The philosophy is that it helps give the separated muscles some proprioception back and encourage those muscles to go back to where they should be. Other therapists say this is outdated and can cause intra-abdominal pressure, squeezing your organs to places your organs shouldn't be. I, personally, wore a Bellefit girdle when I was healing abdominals. I felt like I really needed the extra support, since my circuits were completely shut off. Plus, every day I was lifting and carrying two kids. It's really up to you and your therapist as to what is best for your body.
NW: Were you able to completely close your own abdominal separation?
MJS: Yes and no. I began with a 3.5 finger gap, and after therapy, was able to get it down to a 1 above and below my navel, and around my belly button it is still a 3 finger gap. It's definitely a huge improvement, and I have a really strong base to my abdominals, so I feel they are strong and functional. However, I attended a free seminar at our studio and was lucky enough to get an ultrasound done and was surprised to discover I'm not contracting my pelvic floor properly. So my journey continues, and I'm going to return to therapy to work on that, and my therapist feels confident I can close the 3 finger gap at least another finger. I've been reaching out to all my mom friends and telling them they need to go get checked out, you really never know what could be going on in your body. I'm so happy I've been on this journey, it's been fascinating for me to learn about all these issues, and I am thrilled to share with others.
NW: How does diet play a role in diastisis recti?
MJS: It can definitely contribute. If you're eating foods that cause belly bloat and gas, it can make your belly expand, and continue to stretch and strain those abdominals. Diet is so personal to everyone, but I recommend eating a clean whole food diet, rich in vitamins that will help rebuild that elasticity in the muscles and ligaments. It's equally important to eat often enough that you don't rely on filling up on one or two big meals. Eating lots of small meals helps to avoid the belly bloat.
NW: Do you have a recipe you could share with us?
MJS: Absolutely! Butternut squash is one of my all time favorite foods this time of year, and I love pairing it with sage. For some reason the combination is magic for my taste buds! Enjoy!
Roasted Butternut Squash Pasta with Sage
1 Tbsp Good quality Extra Virgin Olive Oil
1-2 cubed butternut squash
2 cloves of garlic
A handful of fresh spinach
A small yellow onion chopped
1 package of sliced button mushrooms
Penne pasta or pasta of your choice
A pinch of dried sage
Bring a pot of water to a rolling boil and cook the pasta to desired tenderness.
Sauté onion until translucent in olive oil. Add garlic. Add butternut squash. Cool for 3-5 min then add in mushrooms, spinach, and sage. Stir in cooked pasta.
Optional: Serve with turkey meatballs or chicken.