A woman’s body takes quite a pounding during pregnancy and postnatal exercise can address many of the issues that arise as a result. The abdominal muscles are put under enormous stress and are inevitably weakened by the process. As strong abdominal muscles are necessary to support the back troublesome backache often results both during and after the pregnancy. In 66% of women diastasis recti abdominis will occur during the third trimester. This condition refers to the splitting of the fascia (the linea alba) between the rectus abdominis (or RA) muscles. This separation can persist for up to 12 weeks following the birth and sometimes even longer. Most women will not be aware that diastasis recti has occurred because the actual separation isn’t painful. To visualise this imagine the RA as a zip running down the length of the abdomen from the sternum to the pelvis, then picture the zip being opened revealing the swollen abdomen.

The issue for postnatal mums is firstly to establish the extent of this separation and then reduce the separation through appropriate core conditioning exercises. “Appropriate” being the key word here as any curling up movement, sit up variation or abdominal crunch is likely to result in further weakening of these muscles leading to permanent damage and long term back pain.

The “rec check” as it’s often referred to – the test to establish the extent of diastasis recti – should be performed as follows
• Lie on the floor in a supine position (face up)
• Bend the knees keeping feet flat on the floor
• Place two fingers of one hand sideways across the abdomen around the area of the tummy button and apply gentle pressure
• Inhale and as you slowly exhale raise your head and shoulders off the floor and hold (you should continue to breath)
• Lower head and shoulders to the floor with control
As the abdominals contract during the lifting of the head and shoulders you should be able to feel two hard ridges of the RA muscle closing in around your fingers. You may need to perform the test several times to be sure of the result and if you can’t feel the two hard ridges with two fingers try three. By six weeks after delivery this separation may be two fingers or less.

Strengthening the abdominal muscles should always commence with exercises to encourage transversus abdominis (or TVA) recruitment followed by those designed to shorten the RA. The TVA is a deep postural muscle responsible for core stabilisation. Weakness here will result in lower back pain. Learning to activate the TVA can be tricky at first and will be weak in all postnatal women, even those with a small separation. Full recovery of the abdominal muscles will be hampered if these basic exercises are omitted in preference for more challenging abdominal work. In my experience this is frequently as issue in postnatal women who attempt to perform high level RA work (in the mistaken belief that this will flatten the abdomen) too soon following childbirth. The two examples given here can be safely performed by all women in the early weeks following delivery, even those who have been found to have a separation greater than two finger widths.

Navel to spine contraction:
To shorten and strengthen the transversus abdominis; flattening the abdomen and re-establishing correct posture.
Perform either standing or sitting. Inhale then as you exhale draw the navel into the spine, hold for a few seconds then release. Repeat 8 – 10 times, rest, and then repeat.

Supine Pelvic Tilt:
A low level exercise to shorten the rectus abdominis.
Lie on your back with knees bent and feet flat on the floor in a neutral spine alignment. Inhale and as you exhale draw the navel to the spine tilting the pelvis so the pubic bone lifts. You should feel your back pressing lightly on the floor. Hold and continue to breathe. Then release. Repeat 8 – 10 times, rest, and then repeat.

Full rehabilitation of the abdominal muscles is possible with appropriate core training. It is advisable to seek the assistance of a qualified trainer to ensure abdominal exercises are being performed with correct technique; ensuring they are effective and reducing the risk of injury.