Transcript: Podcast/Episode 17

From Pain to Possibility


Episode 17: Diastasis Recovery

Intro: You're listening to From Pain to Possibility, with Susi Hately. You’ll hear Susi’s best ideas on how to reduce or even eradicate your pain and learn how to listen to your body when it whispers so you don't have to hear it scream. And now here's your host, Susi Hately.

Susi: With this episode, I want to dig into the diastasis recti, and I want to use my own personal experience to highlight some core teaching concepts that I utilize when I work with women who are recovering. And my hope is that sharing my own personal story and sharing these principles, that you get some insights and ahas for your own process of recovery, and if you're a healthcare professional, that you can build out your own toolkit, perhaps some languaging or some ahas and insights for how you piece together your own process with your clientele. I'm going to divide the episode into three specific time periods—early, mid, and later—and how I used my principles inside of those particular time periods. 

My kids are three and a half years old right now, at the time of this recording, so this is a process that has been really about three and a half years. I'm not exactly sure if you ever stop being postpartum after you've had kids because the process is one that really shifts and changes us on so many levels. And the good news by saying that is that shifting and change can happen at any time in that period. So if you're someone who is three, five, 10, 20 years postpartum, post the last child that you delivered or gave birth to, there's still an opportunity and room for shifting and changing. I can say that because I've seen it happen. I've spoken to other professionals who have seen it happen. So I'm very clear and certain in the way that I can say that. 

The key principles that I utilize when I help people learn to move better are, number one, to become aware and to nurture relaxation to really help bring about this idea of ease. And from that place, we can start to understand and become clear about what's working and not working and then intervene a lot more effectively for ourselves. And then when we do move, I like to keep in mind where the spine is in place, because so often with our movement, whether it's at our hips or whether it's our shoulders, when those areas are not moving well, there can be compensations in and around the spine. So I like to keep a focal area of how that spine is in all the movements that I'm offering. 

With that, then, comes moving at the largest joints first, which I somewhat referred to just a moment ago. Because there are so many degrees of freedom, because there's so much available and that so much can become congested at the shoulders and the hips, I know that when I can improve the movement there, I can make such a significant difference for people and that when people move in their optimal range of motion, which is the next principle, that we really can make some gain. And what optimum is, is different for each person, even on a given day. 

So it harkens back to principle number one of becoming aware, of really noticing what your movement is and isn't, and just what your day is. And let me tell you. Any of us who've had kids, we know what our days were like in those early days. It's very different than it was before we had kids, before we even got pregnant.

Which then leads to this idea of core stability and my way of articulating what I believe core stability has altered over the years. Right now, I really like this idea of control and coordination over a range of motion, that when we move more purely, when we move better, our core becomes a lot more responsive, and there's a lot more agility and versatility in it. So it really arises out of better movement, and we don't need to brace to make it happen, and I don't like to teach people bracing unless they're in an activity where bracing is absolutely necessary. 

When you think about it, we don't walk down the street in brace mode, anticipating that someone might jump out at us. However, maybe when I am playing with the kids and I know they're just about to pounce on me, and then maybe there is an opportunity for that. But really, it's more about being responsive and taking in the load when the kids come on top of me so I can respond to the changing dynamics. 

Which then leads into as you gain more and more functionality, to build this idea of effortless effort or relaxed resilience. So you're up-leveling your game. And all the way through, we're moving in a range that doesn't increase pain, because when we give a pain signal like a consistent pain signal back to the nervous system, and the nervous system will respond in kind. So if we say to the nervous system, “This is the normal way for us to move,” that will be the way to move. So I can help people reduce their symptoms by that principle alone, by helping them move in a range that doesn't increase pain. 

And then the last one being, if you think and focus on the simple positions first and build the dynamic of the simple movements and then build up to the complex, because the simple forms the foundation of the complex, and we go after the complex first, we don't have those underlying foundational concepts. It becomes really challenging to make gains. 

So those are the principles overarching that we can think about as we move through this. 

And when I think about when I came back from the hospital, having had a planned C-section, having my two kids, I was also really, really, really swollen, full of fluid from the surgery, and I had a diastasis. My abdomen had no control. It had no coordination. I was pooped out. I could hardly walk even half a block because my legs and my ankles were so swollen. And it took about two weeks for that swelling to really settle down, and then I think I peed it out like a racehorse. But it took a little bit of time. 

And then along that way, one of the key things that I utilized to provide the support, because I had so little control and coordination, was to use a belly band. And the belly band that I used, and I really, really love, is from Bellies Inc., and that's the company that I believe Kim Vopni is still very much a part of. And this is a band that was created with her and some physical therapists. What I love about the band is that I actually used it right about the same—later in the same day. I delivered early Thursday morning, and I think I was wearing it Thursday afternoon. And it provided a degree of support that was so profound that I actually started to cry. 

I was one of those moms who the first pee after delivery was really painful because I didn't actually know that my bladder was filling. I thought it was just pressure from the C-section, so I didn't actually know who was asking me to evacuate my bladder. So then when one of the nurses said, “Maybe you should just try,” and I hung onto the side of the walls and peed, it was really, really, really, really painful, which then just made me even more scared to have a bowel movement. 

But I put on the belly band at that point, and it just, there was the amount of support and the connection between my ribs and my pelvis. And it was almost like this vacuous space of my body was, like, gotten—I had my own back is what it sort of felt like. And tears, just out of nowhere, started streaming down my face. It was beautiful to feel that way. 

And so I remember going out and watching how to wash the kids' eyes and face and all that kind of stuff, and coming back and then being able to let go enough to have the bowel movement. And it was one of those moments of like, I can do this. And it was just very much of a very, very—it was a huge amount of freedom. 

So that band was very pivotal for me in the early days. And then as the early days moved into a week and then two weeks, so still in that early stage of postpartum, the band provided a lot of extraneous control and coordination so that I could go about my daily life without having to brace in my rib cage, in my obliques, or yank up on my pelvic floor, because I literally had very little—I mean, maybe it’s not literally no core, but it certainly felt that way, where it was challenging to move about, having both a diastasis and abdominal surgery. 

So that was really useful having that. And I didn't get back to exercise straight away. I did a lot of relaxation. I did a lot of meditation. When I was with my kids and breastfeeding them, I had a lot of support. There's a pillow that I use called the Twin Z pillow that I would utilize to help me. It was just a wider breastfeeding pillow that would help me sit upright a little bit better and helped me hold them a little bit better. And it was a very effective tool. And then I could put in some yoga bolsters beside me just to keep me in a sitting-up position. So between the belly band from Bellies, Inc. and the Twin Z pillow, that really started the process. 

One other thing that I paid close attention to early on was rolling out of bed. Rolling out of bed was actually very challenging because it felt like my belly was this amorphous blob, and it wouldn't go along with my pelvis or my rib cage. So what I would do when I was in bed is I would take a pillow, just a normal-sized pillow, and I'd drape the long side of it over my body. So one end was on my pelvis; the other end was on my rib cage. And I would hold that. Obviously, I wasn't wearing the belly band at this point, sleeping or early, when I would wake up. And I would roll my whole body, I’d brace with that pillow around, and I’d roll with my whole body over toward the edge of the bed, and then I'd somehow topple out of the bed and land my feet. But that became a really effective tool, and then when I got up into stand and I could put on that belly band and carry on with my day.

At about the six-week mark is when I would say that I moved from the early stages of postpartum to middle stage. And that was when I went for my first appointment with a pelvic-health physical therapist, Gayle Hulme, over at Lakeview Physiotherapy, which is in Calgary. She was incredible, and she still is incredible. And what was great about it is she could do an interior exam on my pelvic floor to see how that was. 

And granted, I didn't deliver the kids vaginally, but just bearing the load of two babies, or even one baby, can have an impact on the public floor. Think about a grocery bag filled with oranges and the pressure downward on the bottom of that bag. So that can have an impact on someone's pelvic floor. Turned out that my pelvic floor was intact and was functional and was structurally sound. And then when she looked at my diastasis, it was a pretty solid separation from the solar plexus down through to my pubic bone. There were some pieces that were intact, but it was generally a pretty good split and very little tone of my abdominal muscles, which made a lot of sense. 

Along with that, I started back to Pilates on the reformer. And Pilates on the reformer was a technique or an activity that I started utilizing shortly after an injury I had falling down my stairs in 2011, and I found it to be really beneficial in supporting myself getting back after that injury. And so I returned to it after having my kids, and I had been doing it through the first trimester of my pregnancy before I discovered that I had a placenta previa, and then I had to back off of that kind of activity. 

When I started on the reformer, it was really interesting because, again, Megan, who is the physiotherapist, Megan Jenkinson, who she knew my body, she knew my movement, and here I was coming back. We could see how my movement patterns were limited, where they were braced, where there were wobbly. And what was really cool, I remember, is how I could tell where I wanted to compensate in order to do the movement in a way that I hadn't noticed prior to getting pregnant. Or I should say—let me rephrase that—it was more that I knew some of those patterns existed, but I couldn't necessarily get to them before I got pregnant, whereas now, because of my abdomen being the way it was, I now had an opportunity to rebuild in a way that really served my abdomen and really gaining better function again. 

So I was seen Megan pretty regularly, and we were able to just slowly add in movement, add in load, pay really close attention to how I was moving. And something that we discovered very, very quickly was how my diastasis would spread and the tone underneath of my abdomen would become less toned. So it would become, I would say, for lack of a better term, it would become worse when I compensated, when I used my jaw, when I used my rib cage, if I gripped through my pelvic floor, if I overutilized any other area of my body. And it became a really fascinating experience for us to see that when I moved more purely in the movement; when I moved with more ease; when I had a very fluid, natural, easy breath; then the diastasis started to come together, and the tone of the abdomen underneath that became a lot more supple and a lot more connected. 

And this is really important because for a long time with diastasis-recti recovery, there was a long belief of let's just close the gap. But then what the research started to show is, well, you could have a gap that's closed, but the abdominal tone underneath it is really poor, so there’s still very little functional benefit to what’s going on in your abdomen. There's a lack of control and coordination, which can impact SI joint function and knee function and neck function and all sorts of other things. And what research was showing is that if you could improve the tone of your abdomen, even if there was still a gap, that you could have better function. So it's an important idea to consider. But I've also seen people take that research, though, and really—how do I want to say this?—turn it into something that also doesn't serve them. So I see some women going back at activity in a way that really pushes, and then they'll say, “I have a functional diastasis,” but there's a whole ton of domain, and it's apparent that it isn't actually functional. 

So one of the things that I wanted to be a voice for is that when someone moved more purely, when someone moved with more precision, but in an easeful way, then things changed in the abdomen. And what Megan and I started to notice is not only did we see it with my body, but we also saw it with the other women that we were working with in our own clientele. And then as I spoke to other physical therapists and physiotherapists about their experience, for those of ones who were very movement inclined, they started to see that as well. 

So it became really interesting as an idea to the point where I remember being on the reformer and we were moving from what in Pilates is called elephant—in yoga it's called downward dog—and I was moving out to a plank pose. Now, I could do plank. I could get there, but I could feel something not quite right as I was moving there. And when Megan checked, it was like, yeah, there was a period of movement where something would happen with my ribs or my shoulders. It wasn't painful. It wasn't achy. It wasn't strained. It was just this thing that sort of showed up. And she would put her fingers in the diastasis, and then, lo and behold, it was more split where the tone wasn't very tone-y. So I just stayed within the range that actually enabled better coordination to my brain and my tissue. And lo and behold, the tone was there. The diastasis was coming closer together. 

It was really exciting because it just went to show that the principles that enabled my clients to reduce pain, the principles that enabled my clients to improve function to do their athletic endeavors with more finesse was also helping me and many other women improve the overall function of their abdomen, the abdominal tone, which was helping them have less knee pain, less SI joint pain, better breathing, easier in through the neck and above. 

Now, in this phase, what I also noticed was that I had a tendency to really overutilize the obliques. And this made a lot of sense. And when I speak to other physical therapists and others who work with people with diastasis recti, it's very common. And if you think about it, the reason makes sense is when there's a split in the abdomen, something has to help maintain control between the ribs and the pelvis. So one of those ways that can be utilized are through the obliques. 

The other way that can be done is an overly engaged pelvic floor or an overly—I'll use the word tight because that's what it sometimes felt like—but a rigid, stiffened rib cage that wasn't very mobile. So someone might use one of those strategies. Someone might use all of them or even other ones like the jaw or the feet, or any other tissue in the body can come in and support, or provide some support even if it's not adequate support, some support to try to keep the duct tape together, to try to keep the body together. 

So when I was able to progressively bring in more and more rectus abdominis without the obliques being the big kicker or the rib cage being the big kicker, then the tone got even better. And then I was able to do a lot more movement because now I was redeveloping the wall, so to speak, in the front of my abdomen, which, then, as I went into more complex, greater load-bearing movement, I didn't have this path of least resistance through that linea alba. I could bear the load elsewhere through my body much more effectively. And so then that helped continue the progress of my diastasis and continue the progress of my abdominal control and strength.

So this might lead to a question that you have about, well, how did your C-section play a part in all of this? And this is what's really interesting is what I found is the same thing around my C-section scar recovery applied to my diastasis recovery, that when I compensated, I could feel some tugging and some pulling through my scar that didn't really feel all that great. But when I moved in ranges that were much more appropriate, there wasn't that tugging and that pulling, so that as I improved overall the way that I bear—I bared, bore, as I moved load is probably a better way of saying this—as I moved loads through my body, as I developed greater ability to have more complex movement in my practice, I was able to utilize both the feeling around my C-section scar as well as my diastasis closer and abdominal-tone improvement. I could use those as measures. 

Now, specifically, how was I doing that? Well, the C-section, the sectional scar was really more of a feeling. It was more of like, there was, like, this tug that didn't quite feel good. And interesting, where I felt the tug was where the scar remained more purplish for longer, whereas the rest of the scar was going white much more quickly. And then as I was able to settle out some of those compensation patterns, that scar then went white as well. And there was just this greater feeling of mobility of that scar, and my abdomen started to feel quite normal.

As it relates to the diastasis recti, in the middle phase of my recovery process, I would often do a self-massage through my abdomen and notice the relationship between my outer abdominal muscles, meaning my obliques and more laterally, and more along the midline, and where was there a difference in tonality and where there was something that was tighter or felt tighter or more tense versus something that I felt more gushy, and I was able to see the relationship all through my abdomen. Then, I could start to add a little bit more load in whatever exercise that it was that I chose, and I could feel that that started to change. And if I could feel that split was happening, then that would tell me what my bandwidth with was for that day. 

Now, interestingly, what I noticed is when I was more tired, I had less bandwidth, and the diastasis would split more. Also, if I’d eaten something that created bloating, I would find that there would be more of a split. So I often return to The First Forty Days—which is a book written by somebody who I can't remember her name at this point, but I'll put it into the show notes—that was very, very simple eating. There’s a philosophy of traditional Chinese medicine that infuses the book, and the recipes were just really, really easy and easily digestible. And so I utilized that when I noticed that my bloating level was going up or my digestion was a little bit off. I returned back to that. And literally within a day or two, that diastasis had shifted up. So there was an interesting relationship for me between that diastasis and my digestion. 

It was at about nine months where I believe I started to shift into the later stage of my recovery. And that was when my diastasis, for the most part, was closed, and the abdominal tone was pretty consistent. It was a time where I was easily able to go from the elephant to plank or from downward dog to plank. And it also was a time that I felt ready to challenge myself to coming up into some kind of flexion. 

Now, some people ask me, you know, why do you want to do a sit up? And my response was, because it's a movement. It's a movement in my day-to-day life, and I want to be able to get as much of my movement back that I had before I was pregnant. And I also knew that I was likely to be spending a lot of time on the floor with my kids, and I didn't want to always have to roll over to one side and come up. I wanted to be able to get into that sit up. 

So it was interesting to watch how my abdomen responded in the various planes of movement and in orientation to gravity. So when I started to add more complex movement, something like movement against gravity into forward flexion, I could feel the tonality of my abdomen gush out a little bit. So that told me that while I had the integrity for all the other movement, all the other gains that I had made, I had to go at this one slowly. 

So one of the things that I did is I put a bolster in behind my body, and it’s kind of like being in a bit of a La-Z-Boy. So I was in a bit of an angle. I wasn't all the way on my back. And I would start doing a little sit up or a little bit of forward flexion from that angled position. Then, as my abdomen showed me that it could still respond with tone and not split through that linea alba, then I would lower myself down a bit more. Do the same thing. Then I would lower myself down a little bit more. And that took another few months to really, really get, so that by the time a year had passed, I had a pretty solid feel in through my abdomen and the way that I was standing and overall how I felt. 

And that is when I began to bring in more weight training and started to lift. I could lift loads in a variety of different orientations. I still paid close attention to where my abdominal tone was so that I wasn't overloading it preemptively, that I could still make sure that I was within my bandwidth. And utilizing that as my measure, I stayed within my optimal range of motion. I stayed within a range that didn't increase my pain. I stayed within a range I could pay attention to my spine movement and really focus on my hip and my shoulder motion all while being more and more at ease. And this enabled me to just be progressively adding more and more effortless effort, and I could move from simple movements to complex movements, and I continued on and on.

Now, one thing I want to mention is the belly band. I think, and I can't be totally sure, but I think Bellies Inc. suggests to wear the band for eight weeks, because in eight weeks, I believe the research suggests that in eight weeks, whatever connection you're going to make in your diastasis is what it's going to make. Or I think that's what I heard three years ago. That might not be the same, but I believe, if I remember correctly, and when you have twins and you have a baby, that may not be the totally clearest memory. But I seem to remember that. 

What I found, though, for myself is I used it very consistently during my waking hours in those first eight weeks, and I kept using it, particularly when I was very tired. And so I used it just to provide extra support so I wouldn't fall into the bracing patterns, whether through my rib cage or through my breath or through other parts of my body. And I continued to use it for those nine months. Not all the time. Like, I weaned myself off of it. It wasn’t really weaning. It was more that when I noticed that I was gaining more ability to just be and move and be versatile in my movement, I didn't need it as much. But on those days where I was super pooped out or just needed extra support, I didn't have any trouble putting that back on. So I wouldn't be surprised—I can't remember rightly, but I think I used it right through to nine months periodically, in the middle stages of my recovery. So just food for thought that when you have a tool like that to really pay attention to what you do need and what support it is that you require. 

So as I continued to go along, particularly in that following year, that winter, I started to cross-country ski quite a bit. I pulled my kids in a chariot, which is like a little buggy that was put onto skis. So I was able to start to build up my cardiovascular ability. I was able to play around with my control and coordination because I was pulling them, and that wasn't super heavy. I could pull it quite easily, but it just was a nice way of adding more load to my body and getting all of us outside and enjoying the winter, because, remember, they were born in March. 

And it wasn't until the following year, likely more so because of when they were born, but it was that two-year mark that I felt ready to run. And I started to get back to my walking and my running. And I was more guided by, you know what, this feeling of, yeah, I'm ready. It was like a you know what, you're ready. It's time to get out there and put some load in through your running. So it was about two years that I started to go back into walking and running. And I picked up my running pretty quickly, starting with running until I was out of breath, and then would walk until I got my breath back, and then I would run again. And then pretty quickly, over about a month, I was back to running a 5K run pretty substantially. Like, I had the integrity, I had the structural components, and I just needed to build out the cardiovascular to match. So that's kind of the way that it's gone. 

And then since then, we're now at three and a half years, and I have my yoga practice, I have a Pilates practice, I have my running, I have my weightlifting, and I just have the day-to-day playing around with the kids. And it's working really, really nicely. Every so often, I just kind of go back in and check my abdomen, see how the tonality is, because I do think that there's a change that has happened. And it's not that it's kind of one and done. I think there's just this consistency of checking in and seeing how my body is responding to the various things that are going on in my life and the various environmental factors. And it's just a lovely way to connect and to feel into what it is that I may need as a woman, as a mom, and the various other roles that I have in my life. 

If you want to dig into this more and explore more about your own diastasis and move along your recovery process, Megan and I recorded a Diastasis Recovery Project, and it provides you not only some philosophy, more philosophy about the way that I work and that can help you, but also a series of exercises, progressive exercises, that you can utilize to help improve your movement and then add load in a safe and effective way. And in a mindful and compassionate way, I think is also important. And you can find that link in the show notes. 

One thing I want to mention again about diastasis recovery, I've had people who have taken the program or people who I have worked with, whether in a one-to-one level or at the Therapeutic Yoga Intensive, and they are many years postpartum. And they, too, have been able to increase their tone. They, too, have been able to reconnect more of their abdomen. So I want you to know that tissue can change. Habits can change. It is possible. 

So if you're interested in exploring more, do look into the show notes for the Diastasis Recovery Project. You'll also find contact for Megan and Gayle. And I'll put in the book The First Forty Daysso you can explore that concept. 

And if you want to work with me more specifically, email us at [email protected], and we can discuss the possibility of either private sessions or the Therapeutic Yoga Intensive. Thanks for listening.