For those of you that don't know what Diastasis is you're lucky, and probably represent a majority. If you DO know what Diastasis is I am happy to report a viable, successful and research proven approach to recovery that I can now say I have experience with myself! Its called the Tupler Technique and I'll tell you a little bit about it and the acupuncture and supplements I am combining it with to aid in recovery. Before I get to that, however, let me explain what diastasis is and why I am dealing with it.
What is Diastasis?
Diastasis is separation of the abdominal muscles, the Rectus Abdominis specifically. It happens most commonly in women post partum though it can happen to anyone male or female for a variety of reasons.
The linea alba (as in the picture at left) is the connective tissue that holds the rectus abdominis together and everyone has a gap of about 1 finger width between those muscles. If you lay down and lift your head off the bed/floor with your fingers on your midline you will feel your rectus abdominis lift on either side of your finger and you can measure that gap yourself.
If you have more than two finger-widths between your muscles at any given point from the ribcage down to the pubic bone, you've got a diastisis or a larger than normal gap that may need repair. Very large diastasis' can be healed surgically, but it is always recommended to start with a rehab program before you pursue a surgical option.
I developed a small diastasis during my first pregnancy, and having a C-Section delivery after 36 hours of labor only made it worse. Luckily for me, it was small and healed on its own with little to no intervention on my part.
Fast forward two years later to another labor and deliver (successful VBAC, woohoo!) leading to another diastasis. While recovering from a vaginal birth is much easier and quite preferable to C-Section recovery, I had a 2 year old son at home who was 35 pounds and wasn't going to stand for not being carried around by mama. I did my best with posture and position, but I lifted my son daily and often and he was FAR beyond the 10 lb weight limit my midwife attempted to impose on my postpartum.
With a belly still stretched from pregnancy, this gave my abdomen no chance to heal and the result was a diastasis almost 5 finger widths across at my belly button a year later that was not going to heal on its own.
So here is a picture of my diastasis belly before I started the Tupler Technique program:
(Yes, I'm in my pajamas, wasn't really thinking about sharing the photos when I took the picture…)
As you can see, the top of my belly button kind of protrudes a little bit. I used to have a true "innie" before, and above my belly button is this strange pouch that I assure you I didn't used to have. This is me comfortably back to pre-pregnancy weight, fyi. The crazy thing is that when I would tense my stomach muscles or try to suck them in, I would still have that strange upper belly bulge. After I ate it would stick out even more like my stomach was physically protruding, and I was experiencing some regular back pain from the abdominal weakness. Not fun, folks, not fun.
I waited until the weather got a little colder here in Portland because the Tupler Technique involves exercises, movement modifications (sitting, standing correctly etc) and wearing a specialized splint (read "girdle") to physically hold the separated halves of the muscle closer together so the connective tissue in between has a chance to shorten up without being overstretched again and again. The splint is thick and heavy and warm and I knew I couldn't wear it in the summer months.
Okay, so now I am 3 weeks into the process and here is what my abdomen looks like:
I haven't weighed myself but I think I have gained some weight - the program involves NO EXERCISE aside from brisk walking until you get farther along so you don't risk stretching your tenderly healing connective tissue, and since I live on spinning and aerobics this is affecting me quickly. Still, I know the wait will be worth the reward and that I can lose what little I might gain in a few more weeks with focused effort.
You can see the splint marks there on my abdomen, but I am very impressed with the results thus far and feel very confident that my tummy will go back to its previous diastasis-free state once I am done. I've already had to order a second splint in the smaller size this week because my abdomen has come together so much that the arms of the splint wrap all the way around to my back, where they used to wrap only to my hips just a few weeks ago. To make it to 6 weeks and beyond I will therefore need a smaller one.
I know my success is also due to the added alternative medicine steps I am taking to give my body the best chance possible to heal.
The full Tupler program is actually 18 weeks if you stick with it religiously. It takes a minimum of 6 weeks for your transverse abdominis muscle (your internal muscular girdle if you will) to strengthen enough to start supporting you appropriately and for the connective tissue to heal enough to hold well, so depending on the severity of your diastasis you may be able to shorten the term of the splinting, but it is recommended to go a full 18 weeks if you want the best results from the program.
Rebecca's Diastasis Rehab Program
Three weeks in and 9-15 to go depending on my perseverance, and here is what I am doing to heal my diastasis on all fronts:
The Tupler Technique program also called "Lose Your Mummy Tummy" can be ordered on Julie Tupler's website - she is the RN who developed and did the research to prove its effectiveness.
If you have a severe diastasis it is highly recommended to work with a certified professional to get sized right for your splint and have help with the exercises. You can find a list of licensed therapists on Julie's website. Here in the Portland area, the "Tummy Team" is the best known group who specialize in diastasis though I don't know that they are actually Tupler certified.
I freely admit that I ordered the kit and have been pursuing it on my own. My body awareness is fair and I have a physical therapist husband at home to assist me, so I feel confident in my ability to follow the directions of the program without going to the Tummy Team myself.
Next, on my program above is Acupuncture focused on the Dai Mai along with Chinese Herbs appropriate to my pattern, and I'll tell you a little more about that.
According to TCM theory, connective tissue weakness is related to blood deficiency and weak Liver function. Indeed, Blood and Yin are deeply depleted in pregnancy and birth due to the needs of the fetus and the challenge and vigor of labor. I always recommend women eat chinese herbal soup or congee post partum to help rebuild their Qi and Blood post partum in addition to getting regular Acupuncture.
For Diastasis specifically, it is important to focus Acupuncture treatment not only on the Liver and Spleen to help tonify and build blood to strengthen the connective tissue, but also on the Dai Mai a.k.a. the Belt or Girdle channel (as seen at left).
This is an extraordinary meridian that encircles the waist exactly where the worst of a diastasis is found, and the presence of a diastasis means a weakening or disruption of proper Qi flow in this meridian. Like the Transverse Abdominus muscle - the only muscle that encircles the waist, the Dai Mai is the only channel that travels horizontally across the body instead of vertically. This means it has a very difficult job to do and it must do this job alone - just like the transverse abdomens!
Chinese Medicine is also hallmarked by what is called "syndrome differentiation" which translates as individual treatment for individual needs. I have an energetic baseline of Spleen and Heart Qi deficiency with Dampness so I am taking herbal tonics specific to this pattern and I believe treating my constitution this way is further helping me to recover and rebuild well.
The western nutritional supplements I am taking are a basic protocol I recommend for everyone - multi vitamin and fish oil/EFA in particular, B vitamins, green food - with the Ligaplex which is a whole food supplement specifically for ligament and connective tissue rebuilding and repair. Standard Process supplements are very tried a true - a company from the 1920's with a strong track record of success. I have taken the Ligaplex before for heart palpitations related to leaky (weak connective tissue) heart valves and found it helpful. Indeed, my regular heart palpitations related to a congenital murmur have actually decreased over the past 3 weeks as well.
The result so far is what you see in the pictures above - at only 3 weeks in my abdomen is drastically changed, and my back pain is also gone. How much the back pain is gone because I am effectively wearing a brace 24/7 and how much it is gone due to strengthening is yet to be seen, but I can tell that my transverse abdominus is noticeably stronger, so I am hopeful that the weak-ab related back pain is going to go away as well as my "mummy tummy" as part of this process.
I hope I will make the full 18 weeks of splint-wearing but I am not sure. It already feels tedious to wear it and dress around it, and my abdomen is healing rapidly, so my goal at this point is to make it to 12 weeks and then reassess. Even if I don't wear the splint 24/7 anymore I will definitely continue with the increasing transverse abdominus exercises for the full 18 weeks.
Julie Tupler has a saying that "every belly should be checked" and as I move ahead with this process, I think she is right. Even if you don't have a diastasis, learning to do these kinds of transverse abdominus exercises and learning to engage that muscle consciously during all strenuous activity is very valuable - I can already tell that my back is much safer for learning to use my abdomen this way. I feel very confident recommending her program and I will definitely be educating more of my pregnant and postpartum patients about it as time goes on, because even a mild diastasis deserves care and attention. After all, all mom's want to be able to lift and carry their children safely without compromising their backs and essentially, that is what this program will allow you to do - for as long as your children let you pick up and cuddle them!
As I continue with this journey I will post about it more, and if you have any questions or know someone who might have a diastasis or is struggling to heal a diastasis, please send them my way. I would be overjoyed to help other people heal from this uncomfortable weakness and learn how to "lose their mummy tummies!"
Until next time,
Rebecca M H Kitzerow is a Licensed Acupuncturist practicing in La Center, Washington. With over a decade of experience she has won 10 Nattie consumer choice awards from Natural Awakenings Magazine since 2014.