In women’s health and fitness circles, Julie Wiebe doesn’t need an introduction. She’s a world-renowned sports medicine and women’s health physiotherapist whose passion is helping women return to fitness after giving birth. Julie’s evidence-based approach to post-pregnancy rehabilitation promotes diaphragm and pelvic floor integration, strengthening women’s cores for function in fitness and in life.
Jen: What exercises should women avoid if they have, or are at risk of developing, diastasis recti? What exercises do you promote for rehabilitation?
Julie: I think the primary exercises to avoid are all versions of crunches and twisting. This is because a crunch is an ab-dominated exercise. Heavy use of abs can pull apart the separation because the abdominal muscles are attached to the thinned fascia at the separation.
That being said we do need to retrain the whole abdominal wall to help heal a diastasis. Instead of isolating it, we must learn to recruit from deep to superficial in conjunction with the diaphragm, pelvic floor and the rest of the postural system. So exercises that engage the abdominals as a part of a system of muscles are best.
Jen: One of the main messages women are getting from pregnancy and postpartum exercise circles is to prevent or heal a diastasis we should “engage our transverse abdominis (TVA) muscle!” Is this correct?
Julie: One of my missions is to get people to stop isolating and start integrating. Stop focusing on the strength of one muscle and start focusing on the coordination of all muscles.
The constant engagement of the TVA all day is not actually how that muscle functions. If you engage it all day, this will mess with your breathing pattern and put added pressure on a weak or uncoordinated pelvic floor below. Or the pelvic floor may fight the pressure from above and be hypervigilant all day. This is another example of uncoordinated action between the elements of the deep core and could lead to other issues such as pelvic pain, constipation, painful sex, incontinence, etc. This is similar to our discussion of what happens with the use of an abdominal brace all day.
It is the coordinated action of multiple muscles, your abdominal pressure and your alignment that will assist with resolving post-partum issues such as diastasis recti. This same group of muscles and pressure system also impacts prolapse, incontinence, aches and pains, etc. Over-focus on only one part of the system (such as TVA muscles only for diastasis, or the pelvic floor muscle only for incontinence) misses the boat for both of those issues.
Jen: Can you give us some exercise examples?
Julie: I wish I could. Everyone wants one or two magical exercises. The only problem with giving exercises in this interview format is that without that deep system working well, the exercises won’t be effective and could be damaging. And since I don’t know the physical history of every reader (new mom, still pregnant, first year after delivery, third delivery, kids now in elementary school or beyond?) it’s tricky to recommend an exercise that covers everyone. So I would suggest everyone start at the beginning, start by rebuilding the center. This involves a lot of neuromuscular re-education to get the deep system (Diaphragm, TVA and Pelvic Floor) coordinated again and working together as a team. Then I would build a program on that foundation. This next step might look like squats or side steps or glute work or rows at the beginning. The choice depends on where they find a good challenge that doesn’t overwhelm their ability to use the deep system and maintain their alignment while completing the activity.
Jen: How does body alignment play into diastasis recti rehab?
Julie: The alignment we have during exercises is so important to which muscles are recruited for that movement. This is also important in how we carry ourselves throughout the day. The way we are aligned will determine if we are properly using, underusing, or overusing muscles. I’m less concerned about 2 – 3 crunch-like movements (IE getting out of bed in the middle of the night to go to a crying baby) than I am about the 18 hours a day you stand with poor alignment that exaggerates the opening of your diastasis.
When you meet a challenge, either in fitness or your day-to-day activities, you should have an alignment that encourages diastasis closure as well as have a balanced, coordinated deep core system supporting your movement. Then the challenge reinforces closure. Instead, if you meet a challenge in an alignment that widens the diastasis and use a breath hold to support your center, which creates pressure against the diastasis from the inside, you will reinforce widening the gap. Open fly, and a breath hold every time you lift your baby or briefcase or open a car door means you are maintaining the gap all day. Aligned function can be your friend when it comes to healing a diastasis.
Jen: Can you give us some good alignment cues?
Julie: I think most have heard that ‘neutral’ alignment is best to create optimal muscle activation.. I like to think of that as creating muscle availability or readiness. Your muscles are ready for a challenge when they are in their optimum position. For a long time we have understood neutral only as it pertains to the position of our low back and pelvis. But we’ve missed how important the position of the rib cage and upper quarter are to our alignment
I like to think of the rib cage as a bell ringing off the shoulder girdle. People tend to either have their bell rung up (chest exaggerated upward; military-style) or rung down (slouched)). Here’s a demo video where I explain the concept:
To help women find their “quiet bell,” I use a trick I like to call the “ski jump.” The “ski jump” position causes a shift of the rib cage over top of the pelvis.
My goal is to help patients find their ‘sweet spot’. This is a position in the neutral range in which the ribcage lives over the pelvis and requires the least effort to maintain because the muscles and pressures are balanced.
Jen: How do you approach alignment with your patients?
Julie: I take women step by step through how to optimize their alignment as a component of rebuilding the deep system after giving birth in my new course, available online and by DVD. The course helps everyone ‘start at the beginning’ and get that deep system re-coordinated before they add on layers of strengthening and fitness.
The focus of the online course is on incontinence but, as I have noted, the same system that helps restore the deep core impacts both incontinence and supports diastasis recti. As presented, I would recommend the DVD for women with a gap 3 cm or less. If you have diastasis recti larger than 3 cm wide, a check-in with a pro who can help you work through the information, assess your fascial system and give you more tips would be important.
Check out Julie’s online course:
Julie offers a self-paced video series offering the latest concepts, exercises, movement strategies and body awareness tips for rehabilitating your pelvic floor, minimal to moderate prolapse, diastasis recti, and pelvic pain. The skills learned in this course can easily be integrated into your day.
Time: 1.5 hours, divided into six brief segments.
Price: $29.95 USD
Click here to find out more
Find a physiotherapist in your area:
Subscribe for More!
Our interview was way too long to fit into one blog post so I’ve packaged it into a four part series: ‘Fix My Pregnant Body.’ In our last post Julie and I will be talking about incontinence after pregnancy and pelvic floor issues. Subscribe to my blog (in the right hand side bar or if you’re on mobile, below) so you don’t miss out!
Fix Me After Pregnancy Series
Please share this valuable information with your friends!