You may have heard of abdominal separation during pregnancy. Sharp stomach pain during pregnancy is quite common. The term can be frightening and confusing for mothers to be. However, this is a commonly assessed and treated condition by Physiotherapists.
What Causes Abdominal Muscle Pain in Pregnancy?
Diastis of the rectus abdominal muscle (DRAM – Diastis Recti) refers to a separation of the connective tissue between the two halves of the rectus abdominus muscle down the middle of your abdomen. This occurs in pregnancy due to hormonal changes, rapid weight gain and the increasing size of the baby and uterus. This results in stretching of this muscle and connective tissue, as seen in the video below. Following birth, the muscle often remains separated and does not autonomously return to its pre-pregnancy function and strength.
Abdomen Pain During Pregnancy
How Common is Sharp Pain in the Abdomen During Pregnancy?
Separation occurs in 2 out of 3 women during pregnancy, being a very common and normal part of pregnancy.
Does pain in the abdomen matter?
Despite this being normal, it can have various effects on the body. The abdominals work in synergy with the pelvic floor for important functions for posture, trunk and pelvic stability, respiration, load transfer, trunk movement and support of the abdominal viscera.
They create stability between these parts of the body by creating something known as force closure. Force closure refers to the effect the contraction of a muscle has on it surrounding joints and ligaments. When the muscle contracts, it pulls firmly and stiffens the area, creating a natural bracing. This is important for spinal stability and also pelvic floor activation.
Diastis Recti can weaken these functions which is a contributing factor for lumbo-pelvic pain, pelvic girdle pain, incontinence and increased prevalence for lumbo-pelvic injuries. This can lead to lower back or pubic pain and pelvic pain in pregnancy.
Specifically, because the abdominals have widened, their ability to carry the load is somewhat compromised. This can also lead to a feeling of bulging as more pressure is put on the connective tissue.
Most DRAMS realign close to a natural position within the first six weeks of delivery. However, factors such as pregnancy number, pre-pregnancy fitness and weight, race can affect this. Some DRAMs fail to heal and can require further rehabilitation and intervention.
Physiotherapy for Abdominal Pain in Pregnancy
What can a Physiotherapist do for pregnancy abdominal pain or separation?
A Physiotherapist can complete a comprehensive prenatal or postnatal assessment which will include assessing for a DRAM. This assessment involves the Physiotherapist gently measuring with their fingertips for a gap along the abdominal wall. This is a simple and pain-free assessment which allows the physiotherapist to gauge size, significance and location of the DRAM. A significant DRAM has been shown to be a separation of greater than 2.5cm. A larger DRAM is considered more significant and requires a longer time period to heal.
Treatment during pregnancy
If the Physiotherapist deems that the DRAM is significant the following treatment can be delivered:
Exercises during pregnancy to reduce pain and widening of the DRAM:
Severity, width and incidence of Diastis Recti has been shown to be reduced by completing physiotherapy led abdominal exercises in the ante-natal period.
Depending on individual assessment a Physiotherapist will prescribe some tailored exercises including light walking, activation of the pelvic floor and deeper abdominal muscles. A Physiotherapist will assess individual strength and activation of these muscles and then prescribe appropriate dosages and progressions.
Following correct activation of these muscles clinical pilates can be commenced in our studio. We offer Pre-natal and Mums and Bubs classes which focus on building strong physical foundations so you can avoid injuries, pain or discomfort and importantly do all required activities in a busy day. Importantly you can bring your baby along postnatally and exercise in a safe and supported environment.
We also offer prenatal and clinical pilates and have a nannying service who can happily care for your baby while you participate.
In the video below, we set out 3 fantastic core strengthening and stabilising exercises. These are 3 examples of exercises we run in our pregnancy pilates classes, under physiotherapist guidance.
- Scooter – scooter is a great pelvic stabiliser. During pregnancy, due to hormonal changes, the pelvis can become unstable. To assist with this, we need to improve the muscular strength around this point. Scooter is a great way to do that. It activates the gluteus medius on the standing leg, and the gluteus maximus on the pushing leg. You also need great core abdominal activation to hold your trunk, without flexing the spine and putting further pressure on the rectus
- Chariots – these are one of our favourites. Simply because the work the core as it should be worked, not as a flexer of the spine (think sit ups) but as a stabiliser and force transmitter. You see, our cores main goal is to transfer force from our extremities whilst creating a stiff, stable base. This allows us to do normal things like run, jump and throw. This is why we love chariots. The activation occurs, without the bulging.
- Modified plank – again this is a great exercise. The rectus here is activating longitudinally, ensuring your spine stay nice and straight. By drawing your tummy in and up, you get good co-contraction of the deep transversus muscle and pelvic floor.
Some women may find comfort in wearing an abdominal support, such as tubi-grip or high/firm compressive underwear or shorts. This is for temporary comfort and does not assist in faster recovery or realignment of the muscle. If the birth was via caesarian care should be taken wearing these garments to ensure they do not place extra pressure to the healing wound.
Activities and Exercises To avoid
Don’t make the same mistake a lot of women make in pregnancy and immediately post-natally. In order to avoid bulging of the stomach muscles and increasing stress on the healing separation, skip the following exercises.
- Sit ups – exercises which involve flexing the spine such as sit ups and crunches should be avoided due to the pressure placed on the healing abdominals. This includes activities such as sitting straight up to get out of bed where a Physiotherapist can teach a log roll to avoid this strain.
- Heavy lifting – try to avoid lifting anything heavier than the baby until the muscles have recovered.
- Jumping – this puts an undue load through the pelvic floor and rectus abdominus. It multiplies the force and can lead to disruption and pain, until the muscles have recovered.
Marney graduated with a Bachelor of Physiotherapy from Charles Sturt University, Albury, in 2008. Following a period working as a physiotherapist in the public health system in Melbourne, she ventured overseas to work and travel throughout Europe before returning and becoming a senior member of the Domain Health team. Marney has a special interest in sports physiotherapy, fitness, Pilates-based rehab, and holistic wellness. Marney has had experience in Women’s Health physiotherapy and involvement in football, netball and rhythmic gymnastics clubs.
As a director at the Sum Of Us, Marney advocates that a foundation of sound postural control and dynamic stabilisation through movement, can not only help reduce pain and assist in rehabilitation, but prevent pain, injury and improve quality of life. She also believes that a multitude of factors can affect the wellbeing of people. She likes to have an open minded approach with her clients to optimise outcomes and assist them in generally improving their body, health, wellbeing and life.