postpartum advice
Is diastases recti really that bad?
It’s misinformation time again…
I might be a little passionate about this one.
Why?
I was a victim too back when we didn’t know any better.
Now we do.
A story on Good Morning America about Ashley Tisdale began as a story about how hard it is to navigate postpartum & ended with some unfortunately common misinformation about diastasis recti. The advice this doctor was providing was literally out of the year 2000.
Let’s make a few things abundantly clear about diastasis recti:
♦️It’s not painful
♦️It’s not preventable
♦️Sit ups are not damaging
♦️You aren’t broken with DRA
Instead, can we update what we DO know:
🟢All women have DRA in pregnancy
🟢Cat/cows aren’t enough
🟢DRA isn’t a sentence for lifelong inactivity
🟢Pain may mean hernia NOT DRA
🟢Surgery is a LAST resort
🟢Physical Therapy 1st
The second you conceive is the second you lose control. We should be focusing on education instead of prevention because some things are impossible to prevent.
Diastasis recti DOES NOT mean you’re broken! Abdominal separation HAS to happen! You don’t want to prevent that!
Literally, at least once a week, someone comes in saying they need treatment for their diastasis recti. (I’m serious, it’s the gateway drug to postpartum physical therapy). They have leakage, but they won’t come in for that. They will come in because they don’t like the way their abdomen pooches out.
DRA just isn’t that big of a deal. If you have pain, we need to make sure you don’t have an umbilical hernia because that IS a big deal.
Stop telling moms that cat-cow is enough, because it isn’t.
We are not delicate and I will tell you from experience. When my youngest was 3 and I was doing these tiny “strengthening” exercises (because that’s all I thought I could do), I felt so weak.
What do I do now? Whatever the hell I want! I bend, lift, overhead press, snatch. And I’m fine. And I’m strong.
We shouldn’t be afraid and we need to stop scaring moms. What have you been told about DRA?
Getting stuck in the minutiae | Postpartum Pitfalls
Does this spark joy? ( I know you know what this means.)
Think back to the beginning of the pandemic when Marie Condo was super popular, many of us got caught up in this question.
The idea was if you pulled out every last thing and placed it in a big pile in the middle of your room, then you’d be forced to deal with it. And I almost feel like this is where we are going with postpartum return to running.
Let’s be honest, until 2019, we weren’t even having these conversations! But this is how the pendulum swings, isn’t it?
The pendulum swing is inevitable, because without it, how do we find out what we don’t know? But through this process, unfortunately, some people will get pulled down.
We’ve gone from no screens at all to full gait screens, screen for pelvic health, screen for impact readiness, and comprehensive musculoskeletal screen.
Yikes.
I’m going to predict that some physical therapist will see these recommendations and revert back to their initial training and get lost in the minutiae of a less-than-optimal foot swing (or whatever).
THEN they will spend precious time trying to rehab something that 1) isn’t that big of a deal and 2) they aren’t really qualified to treat in the first place.
We’re going to have some therapists straight up Marie Condo-ing postpartum return to running.
What things really matter and what things don’t?
Mom just wants to run. But now we’ve given her a huge pile of crap to deal with, most of which may not even matter.
We need to figure out better systems to gather information, figure out what’s relevant, and put the other stuff off to the side.
We don’t have the time or patience to pick up every little thing and ask if it sparks joy.
This isn’t a criticism of the research. The research is important for guidance! But we CANNOT let it pull us into the minutiae.
Are you really that delicate?
We took our border terrier, Addie, for her first formal grooming last week. We volunteered her to be a part of a training where the groomers were learning how to hand strip (what you do with wire hair dogs). I stayed with her and was petting her to help her stay calm. But when I started to pet her against the grain, the groomer straight up reprimanded me and said I would damage one of her muscles (I don’t remember which one. Not relevant.)
Here’s the thing, Addie’s breed was bred to pull vermin out of holes. And, now I’m stating the obvious, if a dog goes in the hole, it has to come out of the hole. Which will pull hair against the grain SIGNIFICANTLY harder than I was petting her!
I was telling my friend this story and she said, “Yeah, this is exactly how it is in pelvic PT.”
“DON’T LIFE WITH PROLAPSE!”
“DON’T RUN WITH LEAKAGE!”
“DON’T BREATHE WRONG!”
Give me a break. We are NOT that freaking delicate!
I feel far more confident saying this 23 years into practice, going through this myself, and seeing how the research has changed. We really need to reexamine what we tell our clients.
Or if you’re a client, what someone is telling you!
But it can be so hard because usually when you’re seeking help it;s because you feel like something is wrong and you’re afraid. The fear drives the feeling of fragility.
My dog isn’t delicate and neither are we.
We also have to remember, it’s only recently most of this research is coming out and it’s getting better. That we have pro women athletes that continue to compete postpartum and showing us that we can do these things at a high level.
Women have been doing this stuff for a long time, but we’re finally getting visibility and awareness behind it.
With the lack of evidence, it’s hard to find your way. And I’m saying this as a practitioner AND a mom who’s had every symptom under the sun and experienced that fear that I was too fragile to do the things I loved. But then I realized it was all crap!
That’s why it’s so important for me to dispel this thinking. Because I’ve lived it.
This all goes to say:
- We need more research
- We have to have conversations
- We need to question the advice we are given and what the “evidence” actually means
Question the advice you’re getting. “Tell me more about that.”