Yoga and The Core: Effective Tips to Prevent Overload and Injury

Diastasis rectus abdominis (DRA) is a separation of the rectus abdominis muscles along the linea alba, the vertical ligament dividing the rectus muscles. It is typically measured in finger widths and more recently, inter recti distance (IRD). DRA is one of the signs of overload on the abdominal wall during exercise. It is more common in women as a result of abdominal wall distension during pregnancy, although men can have it, too. According to Diane Lee, a Canadian physiotherapist, 100% of women have some level of DRA in the third trimester (Diane Lee, 2013). It is estimated that 66% of women have some level of pelvic floor dysfunction associated with diastasis recti (Spitznagle et al, 2007). In addition, for many postpartum women whose abdominal wall remains unclosed at 8 weeks, the gap remains unchanged at one year, if left treated (Coldron et al, 2008, & Liam et al, 2011). In other words, DRA will not go away on its own.

The problem with diastasis recti is not the gap itself, but the improper recruitment and timing of the deep core muscles, increasing the risk for other conditions such as low back pain, pelvic organ prolapse and urinary incontinence. If the deep core muscles are not restored to function, increases in intra-abdominal pressure, such as during coughing, lifting or abdominal exercise, contributes to worsening the gap and delays in healing. In addition, co-activation of all four deep core muscles is required to transfer loads effectively through the lumbopelvic region during daily tasks (Hodges et al, 2007). To read more about DRA click here.

Yoga and Diastasis Rectus Abdominus

Yoga is a fantastic way to access the deep core musculature through breathing. As with any form of exercise, there are special considerations for performing yoga with a DRA. An evaluation by a pelvic floor physical therapist is often essential to determine where an individual needs to start with core exercise. Integrity of the core musculature and linea alba is assessed as well as neuromuscular activation, fascial support and potential adhesions. It is important to know how to properly load and monitor the deep core musculature to strengthen the linea alba, and more importantly - how to avoid overload that may maintain or worsen the diastasis.

Asana yoga practice includes the breathwork that often taps into the deep core system. However, it is important to monitor your DRA during exercise. While a posture like plank may be fine for one person with DRA, it may be inappropriate for someone else. Signs of overload include urinary incontinence, breath holding, doming (protrusion of abdominal contents against or though the DRA) and lower abdominal bulging (prominence of rectus abdominis over the deep transverse abdominis resulting in pushing out instead of pulling in). Performing yoga with DRA will require increased focus on the activation of the deep core system and self patience when a modification is needed.

Some yoga poses may increase abdominal wall pressure more than others. Examples of the positions to consider careful monitoring include...

Deep poses like crescent and deep twists: Avoid sinking into the pose or straining to twist, but instead engage the deep core and gluteals. This will protect your abdominal muscles from continued stretch and also protect your pelvic ligaments from overload.
Crunches: Activating the rectus abdominis muscle in isolation will tend to pull them apart and cause strain at the linea alba. Crunches can be okay if the deep core system is engaged and work in unison with the rectus.
Inversions: The transition into and out of inversions like wheel and headstand often creates increased intra-abdominal pressure. Once someone is inverted, proper alignment and breathing is important to regulate the intra-abdominal pressure.
Heart openers/backbends: If the anterior chest is tight, the ribs must thrust forward to allow the opening to take place, causing strain at the linea alba. The flaring ribs pull on the connective tissue of a healing core.
Unsupported prone poses (even downward dog): The abdominal organs rest against the anterior fascia of the abdomen during these poses. The weight of the internal organs can promote stretch of the DRA.
Slanted sitting poses such as boat or V-sit: Without proper attention to breath and alignment, the tendency will be to over-recruit the rectus abdominis and hip flexors to maintain upright positions, resulting in abdominal bulging and more pressure outward against the DRA.

Your core muscles are dynamic and should include both contraction as well as relaxation during exercise. Some instructors teach a “bracing” style of breathing that does not allow the core to be dynamic. Bracing may give you the feeling of strength due to the intra abdominal pressure, but it will be a detriment to healing your DRA and pelvic floor. A simple change in breathing mechanics and timing of your breath can make a huge difference. When you cannot maintain your breath, a modification may be warranted. Think of modifying a pose as a way to respect and cherish your body where it is during your practice. You will find more gains towards a healthy core that improve your sense of strength and will lead to improved performance.

Diastasis recti will not go away on its own and increases the risk for other problems. The good news is that help is available! Contact Healthy Core or a qualified women's health therapist in your area for an evaluation so you can learn how to activate your deep core and exercise safely!

References:

Coldron Y, Stokes MJ, Newham DJ, Cook K (2007). Postpartum characteristics of rectus abdominis on ultrasound imaging. Manual Therapy, epub.

Hodges P, Cholewicki J (2007). Functional control of the spine. Movement, Stability & Lumbopelvic Pain. Chapter 33

Lee, DG 2004. The Pelvic Girdle, 3rd edition.

Spitznagle TM, Leong FC, van Dillen LR (2007). Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecology J 18:3.

Wu WH, Meijer OG, Uegaki K, Mens JM, Van Dieen JH, Wuisman PI et al (2004). Pregnancy-related pelvic girdle pain (PPP), I Terminology, clinical presentation and prevalence, Eur Spine J 13 (7); 575-589.