My Split Stomach| March 22, 2017
Why is this a secret? I wondered. Why aren’t obstetric offices plastered with articles about diastasis recti?
B y the time I was 15 years old doing 300 sit-ups a day was just one part of my exercise regimen. As befits a fitness buff my abdominal muscles were as tough as a brick wall.
After my first child was born the brick wall was gone. I tried every ab exercise that exists dieted like crazy biked and walked but with zero success.
After my third child was born things escalated.
“B’shaah tovah!” strangers “congratulated” me on the “impending birth” during those weeks and months postpartum.
“Is this normal?” my husband asked.
“I think you should get it checked out ” a friend said. “This is not normal.”
“Why isn’t my abdomen going back into place?” I Googled every variation of the question I could think of but nothing solid turned up so I turned to my OB.
“Exercise ” she said dismissively.
I had a feeling many women in her practice express the same sentiment — but I really had a problem. I wasn’t just searching for a thin waistline. I didn’t bring it up with my primary care physician but I did go through several OBs and they were all dismissive.
With each subsequent pregnancy the situation exacerbated. It wasn’t just an issue of not looking fit; I felt as if I couldn’t physically support my pregnancy. I took to wearing a thick supportive belt beneath my clothing — a support most other women have naturally. As I’d enter my ninth month I’d daven to Hashem that I should give birth today; I felt as if I couldn’t hold the load any longer.
By the time I had four children I looked more pregnant months after birth than my neighbor did immediately before she had her twins. The difference was that I wasn’t carrying anything besides a bloated stomach.
Refusing to give up the search I finally stumbled upon my eureka diagnosis: diastasis recti. This condition isn’t just extra pounds put on during pregnancy; it occurs when organs bulge onto the connective tissue between two stomach muscles known as rectus abdominis. The larger the gap between the muscles the less power the connective tissue has to hold the organs in their proper places. As the organs push out the connective tissue the stomach appears larger. Furthermore the exercises everyone told me to do were the very exercises to be avoided!
I did a quick self-check and found that I could fit my entire fist in the gap between the rectus abdominis muscles!
“I think I have diastasis recti ” I told my OB at the postpartum visit.
“I don’t think so ” she said.
“Can you check?”
She did — and then admitted that I did have the condition. “But you can’t do anything about it anyway ” she said.
Upset and discouraged I left the office. Where was the cure I was hoping for?
Now that I knew what I was looking for I could finally do a targeted search. The solution Google sent my way? Get an abdominoplasty (commonly known as a tummy tuck) a procedure involving removing excess skin and fat plus sewing together the recti muscle (sometimes two separate procedures). Not for me.
In addition to the hefty price tag (upward of $10 000 and since it’s viewed as cosmetic surgery and performed by a plastic surgeon insurance companies may not cover the cost) pregnancies are discouraged after tummy tucks and I was hoping my family would still grow. Additionally I couldn’t imagine the difficult prolonged recovery.
I continued with my research. And hit the jackpot with my discovery of the Tupler Technique — an exercise program created to close a diastasis.
I read scores of reviews from experts unaffiliated with the Tupler Technique and a slew of testimonials.
I even learned that coaches who walked people through the tummy-tuck procedure recommended the Tupler Technique first; Tupler was everywhere. Since it involved an outlay of only $150 for their stomach splint and exercise DVD I felt comfortable giving it a try.
The splint is meant to hold the muscles in proper position while the exercises ensure that the transverse (innermost) muscles are used for everyday activities. This prevents the weakened connective tissue from becoming overtaxed and allows it to regain its strength to bring the muscles back together and close the gap.
I’d been through the gamut of exercise options; Tupler was a breeze compared to all that. Ironically more difficult was learning and remembering what not to do as well as how to go about daily activities. I’d been doing sit-ups since I was a little kid; now I had to relearn how to get out of bed! Sit-ups put needless pressure on abdominal connective tissues while rolling to the side and getting up in a slow curling motion don’t.
Sneezing coughing bending getting up sitting down picking up a baby etc. all engage the core too; I needed to make sure I was activating the proper muscles instead of simply pushing outward and thereby straining the connective tissue.
After just four weeks on the program, I lost about 90 percent of my pooch!
“You look fantabulous!” my friends and former exercise partners told me. “Your stomach is totally gone!”
I’d kept them apprised of my situation and what I was learning about diastasis recti, but I knew there were so many people who’d never heard of it — and maybe were suffering too.
Why is this a secret? I wondered. Why aren’t obstetric offices plastered with articles about diastasis recti?
I wrote up my experiences and e-mailed whoever I thought would be interested. Feedback was constant; friends of friends of friends were soon calling to ask about the Tupler Technique, and I encouraged them to go for it.
After my stomach shrunk, I needed to shrink my splint.
“In my country, all women wear something similar,” the Mexican guy at the dry cleaners told me when I handed it over for alterations. When my Russian dressmaker said something similar, I really felt cheated. The great, technologically advanced, superpower USA is clearly lagging way behind.
Success with the Tupler Technique exhilarated me. But after six weeks on the program, I allowed the exercise to slide. Between mothering, housekeeping, and holding down a demanding job, the exercises I was supposed to do three times a day soon dwindled to twice daily, then once, and finally zero. However, I still wore the splint and practiced safe movements. I experienced no more than a slight regression, and for the time being, was satisfied with that.
Then came summer. Though the splint is comfortable, I needed to wear an extra layer beneath it — way too sweaty for hot city summers. With time, my progress started wilting away.
Since I hadn’t completed the program, my diastasis hadn’t ever healed, and soon I looked pregnant again, though not as bad as before.
After summer came Yom Tov, then getting back into schedule, and an exceptionally busy time at work… as they say, there’s never a dearth of excuses. As of now, I’m not a success story.
However, I’m hopeful that sharing my story will motivate me to make time for myself — and make the changes I need to make. I know it can be done.
What is Diastasis Recti?
Diastasis rectus abdominis is a separation or widened gap of the most superficial layers of the abdominal muscles, along with the weakening of the connective tissue that holds them together.
The rectus abdominis muscles run side by side from breastbone to pubic bone, with connective tissue called linea alba in between. This connective tissue normally holds the muscles together, though it will stretch and weaken when the rectus abdominis muscles move apart. When the muscles separate, the linea alba stretches sideways, causing it to become thinner and weaker, and leading to inadequate support for your back and organs.
Though this condition can be found in men, women, and children, it’s prevalent in women who have had multiple pregnancies and/or pregnancies above age 35. Studies show that as many as 1 in 3 women develop diastasis recti at some point. It’s one reason many women have a pooch long after giving birth. In severe cases, the organs poke out past the connective tissue, resulting in a hernia.
To check if you have diastasis recti, lie on your back with your knees bent, feet flat on the floor. Place one hand behind your head and the other three inches above the navel, fingertips pressing down. Slowly lift your head off the floor, and feel the muscles contract. See how many finger fit between your rectus abdominis muscles, and how deep the fingers can penetrate. Test at three inches below the navel as well. A gap of more than two fingers’ width is considered diastasis recti.
Experts typically recommend an exercise regimen to heal diastasis recti like the Tupler Technique or other programs including MuTu System, Befit Mom, and Dia Method. Some of these recommend additional diet and other lifestyle changes too.
What they all have in common is an exercise regimen focused on healing the connective tissue, using the abdominal transverse (inner) muscles, and protecting the linea alba from overstretching or abdominal pressure.
Q&A with Julie Tupler
When Julie Tupler, RN, a popular childbirth and fitness educator, started working at a health club 20 years ago, she was asked to teach the prenatal classes because she was a nurse. Upon discovering that most of the pregnant women at the club struggled with diastasis recti and could find no treatment, she became obsessed with finding one.
Her work with thousands of pregnant women and new moms clued her in to possible solutions to close the diastasis — and the Tupler Technique was born.
Upon Julie’s request, Columbia University’s program in physical therapy researched the method, finding that pregnant women who used the Tupler Technique had a smaller diastasis than the control group, who did no abdominal exercises. According to her website, the Tupler Technique can make diastasis recti 55 percent smaller after just six weeks on the program.
How does the Tupler Technique heal diastasis recti?
It works in three ways:
Correct positioning of the muscles and connective tissue with the Diastasis Rehab Splint. I liken it to a cast; when someone breaks a bone, they need to continuously wear the cast to keep the bone in place while it heals. It’s the same with connective tissue; it needs to be continuously supported during the healing process.
Protecting connective tissue from stretching forward or sideways. For the first six weeks of the program, participants avoid most exercise workouts to allow the connective tissue to heal; cardio exercise like walking, riding a stationary bike, or using an elliptical machine is permitted. Pass on abdominal face-down exercises such as planks, swimming, and push-ups until the diastasis is closed. Crunches and rollbacks should never be done as they create or enlarge diastasis recti.
Strengthening the transverse muscle and connective tissue with seated Tupler Technique exercises. It is important to have transverse strength as well as awareness of the muscles being used in activities of daily living, and when working out. This prevents force or stretching of the connective tissue.
What about women who don’t have diastasis recti? Can they be harmed by traditional ab exercises such as crunches?
Absolutely! When you bring your shoulders off the floor, there’s no way you can engage the transverse muscles. This means you’re working the muscles in the wrong direction and putting force on the connective tissue between the recti muscles. Instead of allowing your muscles to move backward — the way they are supposed to — you’re forcing them forward. That can either create or worsen diastasis. Once you close diastasis recti, you can do modified abdominal-muscle exercise, but never crunches.
What about the fact that traditional fitness instructors promote ab exercises — with plenty of flat tummies to show for it?
I’ve noticed that many fitness instructors have moon-shaped abdominals, and have a separated six-pack or already have diastasis. It’s just that their connective tissue is still strong. Over the years, this connective tissue will get weaker. When the muscles separate, they don’t support the back or inner organs, which often leads to medical problems. There’s no way you can continue working the abdominal muscles in the wrong direction (outward instead of inward) for a prolonged period of time without developing or worsening diastasis recti.
Since pregnancies — especially those close together — are frequently a precursor to diastasis recti, what can pregnant women do to protect themselves?
A large diastasis puts a pregnant woman at risk for a cesarean. When the muscles separate and the connective tissue stretches sideways, the heavy uterus will tilt forward, putting the cervix out of alignment with the birth canal. Conversely, a small diastasis supports the uterus the right way, and keeps the baby in the proper position for delivery.
To keep the diastasis smaller during pregnancy, I teach pregnant women the four-step Tupler Technique. The program needs to be modified during pregnancy; for example, no motionless standing exercises and limited time in a back-lying position. I also teach women how to labor effectively to prevent the creation of a larger diastasis, as well as pelvic floor. This needs to be practiced during pregnancy so it’s second nature in labor.
What are some everyday activities women with diastasis recti should avoid?
Women with — and without — a diastasis should get up from a back-lying position correctly. They shouldn’t “jackknife,” that is, come straight up; this is the worst forward-forceful movement. It can undo all your progress on closing your diastasis because the force of your entire body is on the weak connective tissue. Rather, roll to the side first before getting up. It’s also important to engage the transverse muscles when going to the bathroom, sneezing, coughing, or picking up a baby.
The medical community hasn’t offered much in terms of solutions for diastasis recti. Why is that? Do you see things changing?
For a long time, the medical community ignored this condition for lack of a solution. It’s been an uphill battle, but of late, medical professionals have become more open to the reality that diastasis can be treated with the Tupler Technique.
(Originally featured in Family First, Issues 535)
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