In light of discovering the gap, Sally
eliminated both the modified plank and curl
up over the ball, and instead focused on
hands and knees single arm reach/alternate
arm/leg reach, with some work in side-lying
and supine to build her deeper core control
and endurance levels. She had no problems
with her pelvic floor.
A month later, when she was 4 months
post-natal,
testing
revealed
Sally’s
abdominal gap to have reduced to 1 ½-finger-
width, with minimal bulging. She continued
to work on these post-natal progressions for
several more months, attending the gym and
working with her trainer to build her strength
and aerobic fitness.
Case study 3: The pregnant PT
Of course, diastasis recti is not only
identified in post-natal clients – it can also
be detected fairly early into a pregnancy. At
12 weeks of pregnancy, Bobbie, a personal
trainer, came in for an abdominal muscle
wall check. It was a surprise to find that she
had a 3-finger-width gap between her rectus
abdominis muscles when measured above
and at the level of the umbilicus.
As a PT, she had worked with some
pregnant and post-natal women during
her career, but she now had to apply her
knowledge in a new way, to herself.
Having previously demonstrated some
post-natal core progression exercises for
some educational materials a year before
her own pregnancy, Bobbie knew she had
a weakness in her lower abdominal wall
compared to her stronger upper abdominal
wall and external obliques. Due to her years
of training predominantly upper rectus
and external obliques, a strong activation
pattern dominated in these muscles and
inhibited some of her transversus abdominis
activation, making them relatively weak in
comparison. Also, when she did her pelvic
floor activation, the effect of the intra-
abdominal pressure created through her
upper and lateral abdominal wall resulted
in activation and then descent initially of
her pelvic floor, when observed on real time
ultrasound.
Focusing on some ‘detraining’ and
retraining, Bobbie learnt to specifically activate
the lower transversus abdominis muscles,
using the pelvic floor muscles to initiate the
action. She included breathing awareness and
took the time to learn the patterns of recruitment
needed to change her focus towards learning
‘pregnancy abdominal bracing’ in preparation
for the lengthening of her abdominal wall with
the uterus expanding. This ‘softer’ approach
was learnt during a training session, to replace
the ‘train hard’ patterns that she was used to.
At 16 weeks of pregnancy, her abdominal
separation had reduced to a 2-finger-width
gap above and at the level of the umbilicus.
Abdominal separation
Her patterns of activation of her deep
abdominal wall had improved, and she was
able to activate around her now-expanding
uterus with less excessive activation of the
upper section of her rectus abdominus and
external obliques. Her pelvic floor technique
was now one of ascent (lifting): there was no
descent and her endurance had improved.
Bobbie volunteered for some filming of
her pregnancy abdominal bracing activation
patterns, enabling regular input to refine this
pattern, which is often needed with clients
as the abdominal wall continues to lengthen.
By observing her patterns and feeling
the abdominal wall activation in different
positions as her pregnancy progressed,
these regular checks and ‘tune ups’ helped
her to refine her technique.
We were able to film Bobbie activating
her abdominal wall using a pregnancy
abdominal bracing action at 40 weeks, with
a good technique. Her level of gap was
maintained at less than 3-fingers-width
during her pregnancy.
So, the question to be asked is, how big
would her gap have been if she hadn’t had
it checked and modified her training at 12
weeks of pregnancy?
It’s never too late – or too early
As the three case studies above show,
starting conversations about the changes that
pregnancy and birth can bring about in the
body is important. Interestingly, some men
can also have abdominal separation, which
could impact upon their core conditioning
training, their back and their pelvic floor.
As Amber’s story illustrates, it’s never
too late to look at changing a gap if one is
identified in a client. Abdominal separation
is something that can be screened for by
PTs, so it is advisable to undertake specific
training that will teach you to identify the way
the abdominal wall is working with the pelvic
floor, and how intra-abdominal pressure
control is occurring. The occurrence of
any bulging or doming during an exercise
indicates that there is strain on the linea
alba, and the exercise should cease.
If an identified gap measures more than
2-fingers-width, the client should be referred
to a physiotherapist working in pelvic health
physiotherapy for an assessment and
management.
Dianne Edmonds
A physiotherapist based in
an obstetric GP clinic, Dianne
is a course creator, Women’s
Health Ambassador for
Australian Fitness Network and
the Director of The Pregnancy
Centre. She has worked in
women’s health and fitness for
25 years and was integral in
the development of the Pelvic
Floor First resources.
NETWORK SUMMER 2019 | 49