Pain Management During Pregnancy

What happens to the abdominal muscles during pregnancy?

First the anatomy. The rectus abdominus consists of two bands of muscle fibers that are glued together by the linea alba. (See Picture). It runs from the 4th / 5th rib down to the pubic bone. 

During pregnancy the growing baby and hormones (primarily relaxin) cause the linea alba to “unzip” in such a way that the rectus abdominus separates. (See picture). This separation, referred to as diastasis, allows the baby to come forward rather than push backwards on the spine – normal condition of pregnancy. The problem comes when the recti over separate leading to lower back discomfort, sciatica, weak abdominals, separation of the symphsis pubis and more.

“Weak abdominal muscles, like diastasis recti, contribute to poor posture which in turn cause joint misalignments, nervous system interference, and ultimately, pain and inflammation.”- Dr. Laura Brayton.

“I see this frequently in my pre and postnatal massage practice; women who have a diastitis recti have more lower back pain than women who don’t have one.” – Mollie Bollers, CMT, CIMI, Doula

Do I have the separation?

Here’s a way to find out. Lay on your back with your knees bent. Place your finger tips directly on your navel pointing toward your feet. Relax your abdominals. Slowly lift your head until you feel a ridge pulling in the midline of your body. This is diastasis. For the majority of women this separation is detectable by the 5th month.

How to prevent the separation from worsening?

First, be informed that abdominal exercises such as crunches, criss cross, jackknife, roll-up, roll over, and other exercises that involves flexion and extension of the spine ARE NOT for the pregnant mother. As a rule, during pregnancy, do not perform exercises that in the prone position require exertion of the abdominal muscles through lifting of the head and shoulders off the floor or mat and/or double leg lifts.

Exercises calling for you to lay on your back decrease your circulation and your baby’s. Also, exercises that involve rounding and “curving” of the spine (for instance when your shoulders roll forward) shift your weight back onto the spine. The shift can over stretch ligaments of the spine, tilt the uterus back increasing your chance for back labor cause, supine hypertension (decreased circulation) and more.

What to do?

There are proper exercises that avoid these complications and allow you to modify abdominal or core strengthening exercises. The key is to do it correctly by working the transverse abdominus that wraps around the abdomen like a belt.

Here is an exercise that works the tranverse abdominus.

Step 1: Sit comfortably with the legs crossed. Head, shoulders and sacrum (area between the lower back and buttocks) should be supported by a wall behind you. If you feel tight in the lower back and hips and feel as if this may inhibit your posture, place a pillow(s) underneath your buttocks that allow your legs to rest at a sloping angle to the floor.

Step 2: Place one hand at the top of your recti (where your ribs come together) and the other hand over the center of button). Elbows should be relaxed and by your side. Chest and shoulders should also be relaxed much the same way they are in a sigh of relief. The same muscles are affected.

Step 3: Breathe in through the nose â” nose in hands. Keep your chest relaxed and still. Stretch the lungs by expanding the belly. Exhale with hands drawn back to the spine.

Step 4: Tighten the abdominals. Make a slight cough to engage the tummy muscles. Repeat 3 times breathing slowly.

Step 5: On the last exhale hold the backward movement. Count out loud to regulate your breathing. Start with 30 seconds and work up to 2.5 minutes a day.

Practice this exercise 3 times a day. Try it before breakfast, lunch and dinner.

And remember that most trainers are not aware of diastisis and other prenatal and post-pregnancy healing issues. If you need help with your mummy tummy, it is in your best interests to find a fitness specialist with knowledge and experience in the special needs of prenatal and post-partum women.
Editorial provided by Anne Martens. Anne is the owner and founder of Bella Bellies Studio which is a fitness studio designed for prenatal and post pregnancy exercise.