Lower Back Pain and Abdominal Separation

Editor’s Note: The First Lady of Restore/Thrive, Dr. Jessica Cummings, is back this week with some help for mom’s and mom’s to be who are struggling with low back pain or the pain associated with an abdominal separation.

One of the biggest issues I see with women postpartum is an onset of lower back pain. This can either start during pregnancy or be present after baby has arrived. Unfortunately, so much of this back pain is preventable, but I find that women are not getting the education they need on how to care for themselves prior to conception, during pregnancy, or postpartum and this sets us up for a host of physical issues.

Consider the massive amount of change our bodies go through during pregnancy and birth: weight changes, hormonal fluctuations, changes in posture and alignment, joint changes and changes in muscle flexibility to allow for the birth of your child, more hormone changes after baby, the physical demands of caring for a newborn, and the list goes on. If you are someone who has had prolonged physical pain after baby, you know it is very stressful.  You’re already dealing with a lot (did someone say, “sleep deprivation”?), and then as baby grows you’re carting them around in heavy car seats, lugging strollers in and out of the car, picking baby up off of changing tables, in and out of cribs, and up and down from the floor. If you are nursing you spend a decent majority of the time sitting on your behind in a chair feeding your kid, and pretty soon you’ve got lower back, upper back, shoulder and neck pain.

Having a baby is like running a marathon. If you do not train for the demands of the task you will end up with an injury. If you go into pregnancy with a weak link you are more susceptible to having an injury. This leads to our conversation today on diastasis recti and why I think it’s important to give yourself a screen prior to conception or early in your pregnancy so you can catch any underlying issues that might be present and set you up for having this issue.

Don’t freak out too much if you aren’t on the preventive side of things. This is a fixable issue after it’s already happened, but it does involve changes in lifestyle, your movement patterns and posture, and some intentional effort with the right exercises and stretches to get you back to normal.

So, what is diastasis recti?

It’s just a fancy term for abdominal separation.

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The six pack muscles that run down the front of your abdomen are separated in the middle by something called the linea alba (a fancy term for the connective tissue in this particular part of your body). A normal amount of separation between the abdominal muscles is OK, but when this separation becomes excessive, or large enough to cause a malfunction of the abdominal wall musculature we have a problem.

Why is this an issue? It’s a basic physics concept. There is a length/tension relationship in all muscles within our body. Muscles produce force (ie. tension), and maximum force, when they are at a specific length. The longer your muscles get, the weaker they can become. Long muscles have a harder time producing the requisite force required to move our bodies the correct way.

Think about it:

Your abdominal muscles connect at the mid-section of your trunk. If the mid-section of your trunk is separated then your abdominal muscles cannot fire as they should.  This can lead to instability which subsequently causes lower back pain. If you are already a mom, think about how much you lift your little ones (and all their stuff) throughout the day. If you have crappy stability because of a weakness in your abdominal wall  you will end up putting stress on the structures in the spine and eventually something will wear down.

A less serious issue (or maybe a more serious issue to some) is that it also leaves your abdomen pooching out, and no mama wants to look like they are pregnant months and months after they have had their baby. If you are unfortunate enough to have some crazy person at the grocery store ask you when you are due (but you’re not) that might be a sign that you need to get checked out for diastasis recti.

What are common problems that lead to a diastasis?

Let’s start with the big one, inert forces (a.k.a. pressure). Pressure will take the path of least resistance, so the weakest parts of your body will be the things that give first. In the case of a diastasis, our posture and how we move is a huge factor. If you constantly stand with your belly protruding forward and lower back arched, this places a tremendous strain on the linea alba, not to mention your lower back joints and discs. When you transfer positions if you engage your abdominal muscles incorrectly (or don’t engage them at all) you place increased strain on the diastasis.

The other BIG problem I see related to inert forces is the tendency for women to suck in their bellies. Where do you think all the contents of your abdomen go when you suck in?  They don’t just disappear, right? The forces just distribute differently and this places pressure on your weakest point, and if you have an abdominal separation, this is a weak point. Not only is this an issue for your abdominal separation but this is an issue for your diaphragm. Your diaphragm is the muscle that, as it drops down, expands your chest cavity so that your lungs can take in air to breathe. If you are constantly holding your diaphragm in and up you cannot breathe effectively.  This causes tension in your neck and shoulders and decreases your body’s ability to handle stress. Diaphragmatic breathing has been shown to decrease our fight or flight (stress) response.

Let’s talk about tension.

Perhaps you do a ton of crunches and abdominal work that creates a lot of tightness in your abdominal muscles. This abnormal amount of tension can pull on an already weakened linea alba continuing to create that abdominal separation. It’s not just a tight abdominal wall that can be a problem. There are many other muscles that attach to and pull on the pelvis, which in turn will pull your pelvis and lower back into specific positions that cause too much pressure on the linea alba or tugging on an already separated linea alba. A BIG one I see often is a tight rectus femoris (a muscle in the front of the thigh).

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The rectus femoris attaches to the front of the pelvis, and when short and tight it will pull the pelvis forward which will also pull your belly forward placing strain on your anterior abdominal wall.  Why do so many people have short and tight hip flexors and quads?  SITTING!!!  STOP IT!  If you have a desk job, get a standing desk.  So much of what our society does is done in a seated position and people are sitting on their behinds all day. This places your hip flexors and quadriceps in a very shortened position. Muscles are stretchy and they adapt to the position they are in the most often. If much of the day is spent sitting, these muscles will adapt to this shortened position. If you are a new, nursing mom, a lot of your day will be spent SITTING to feed your baby. The good news is, there are multiple things you can do to offset some of this sitting time which I go over with all of my clients being seen for back pain or a diastasis.

In summary, if you have a diastasis, it takes a multi-faceted approach to healing. You need coaching on movements to avoid, corrective exercises to do to facilitate healing, education on correct movement strategies to allow the separation to heal, as well as flexibility techniques to decrease the tension in things that can pull on the diastasis and stall healing. I would love to see you for a consult if this is new information to you and you are struggling with an abdominal separation or have lower back pain. If you have already been treated for an abdominal separation and you haven’t gotten the results that you want, it might just be that you are missing one of the pieces listed above and that could very well be hindering your healing.

Thanks for reading, and I’m wishing all of my mamas a happy and safe journey through motherhood and their quest to achieve their best health.


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