Jessica Ennis-Hill’s physio, Ali Rose, explains what happens to your stomach muscles during pregnancy and how to look after them once your baby’s born…
What is abdominal separation?
Abdominal separation, or rectus diastasis, is a perfectly normal part of pregnancy. All of your stomach muscles have to stretch both in length and width as the baby grows – it’s perfectly natural. Now for the science bit… The muscle that runs down the middle of your abdomen, from the bottom of the ribs down to the front of the pelvis is called the rectus abdmominis (your six pack). The two halves of the rectus abdominis are joined by a fibrous structure called the linea alba. During pregnancy it is normal for the linea alba to separate to help create more space. The gap can widen by several inches and can happen early into the pregnancy, with subsequent pregnancies, which may mean you start to show earlier.
“Abdominal separation, or rectus diastasis, is a perfectly normal part of pregnancy”
Will I get it?
Most women will get rectus diastasis. But remember, this is perfectly normal.
Did Jess get it?
Yes, like most women, Jess did get abdominal separation. Having great abdominals before getting pregnant is no barrier to the normal processes of pregnancy. Because Jess was planning to come back to defend her world and Olympic titles, we were really strict with how she trained and strengthened up her tummy muscles AFTER she’d given birth, and that meant taking it slowly.
How can I prevent it?
You can’t prevent abdominal separation. If it’s going to happen it’s going to happen – that growing baby needs the space! The important time to focus on the separation is AFTER the baby is born.
How can I fix it after baby is born?
It’s only AFTER (have we made our point?) the baby is born that you can focus on the rehabilitation of your stomach muscles. It’s really important to do abdominal exercises in the right way to make sure that the separation of the linea alba draws together. If the wrong exercises are done or you do exercises that are too hard, the split can widen, which can mean that the tummy muscles might end up looking domed (or still slightly pregnant). The correct exercises should draw the two sides of the spilt together and it’s important to check that this is the case.
How do I know if I have rectus diastasis?
In this video (above) we share a test called the ‘rectus diastasis test’. This is simple and safe to do a week after giving birth (unless you have had a Caesarean section), and basically involves lying on the floor with the knees bent up, and feet on the floor. Your hands are by your sides. Gently lift your head and shoulders just off the floor (NOT a sit-up) and then feel with your fingers just above and below the belly button. Use your fingers to feel the edges of the split, or the sides of the rectus muscle. You should be able to measure this in terms of fingers widths. Ideally, the split should be two fingers wide or less. If the split is wider than two fingers, then abdominal separation is still present. It should start to come together quite naturally during the first eight weeks after the birth, and when you start to do abdominal rehabilitation and strengthening exercises it is important that this is used as a guide.
This test is really important as it can be used to monitor how well your tummy muscles are working when you are doing anything – whether that’s an exercise, hanging out the washing or picking up your baby. It’s what we used to monitor Jess’s recovery, and we didn't move forward with any exercises unless the abdominal split was able to draw together while she was doing them.
How often should I check my abdominals with the rectus diastasis test?
The test can be used repeatedly to monitor progress, and it’s important to flag this up with a health professional if you feel the spilt isn’t drawing together after a few months.
“You can’t prevent abdominal separation. If it’s going to happen, it’s going to happen – that growing baby needs the space!”
How will I know if the exercises are the right level for me?
The exercises are the right level if the sides of the split are able to draw together. If they don’t and get wider, you need to reset the abdominal muscles or do an easier exercise. This is REALLY important. This also applies to other exercises, such as balance work, anything on your hands and knees and anything that works your abdominal muscles, such as lunges and squats.
Did Jess stick to these rules?
Yes, she did. It was important and it gave us an objective measure that showed Jess when she wasn’t ready for a particular exercise – it enabled me to say no and for her to listen.
What impact does this have on what exercise I can and can’t do?
It shows you which exercises you can do safely in the post pregnancy stage. There will be a number of things that you may have done before pregnancy that will take a while to get back to safely. It will be worth doing it the right way. Just remember that even high level athletes have had to start at the same level as you.
What else do I need to know?
As a general rule of thumb, do not do any crunches or big sit-ups, planks, press-ups, burpees, leg raises etc, until your abs are ready. They are really hard exercises and put a lot of stress on the abdominal muscles. There will be things that you may not have thought about – like getting out of bed or getting off the floor if you have been lying on your back, which are effectively a sit-up, and these will put stress on your abdominals. Roll onto your side and get up in a safer way.
When should I seek help?
Your health visitor should sign you off at about six weeks post-birth and this is a good place to start. You may also have a physio on hand to help. If your split is not improving and is three fingers or wider, and doesn’t come together when the right muscles are activated, I would suggest that you do ask a health professional who is experienced in this area. It can take a bit longer for the abdominals to come together with each subsequent pregnancy.
Find out about Jessica Ennis-Hill's postnatal exercise app, Jennis Postnatal, for when your abdominals are ready