Jill Miller: Prevention and Healing of Diastasis Recti During Pregnancy and Postpartum and the Crucial Role of Proper Breathing

December 27, 2019
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Our guest on this episode is Jill Miller, a pain-relief and wellness expert with 29 years of corrective movement expertise that forges links between the worlds of yoga, massage, athletics, and pain management. Her signature self-care fitness programs, Yoga Tune Up® and The Roll Model® are found at gyms, yoga studios, hospitals, athletic training facilities and corporations worldwide. Jill is also a mama and expert at pregnancy and postpartum health and healing for women, she has a special program just for moms called Roll Model Mama. On this episode, Jill explains the crucial steps to preventing and/or healing diastasic recti during pregnancy and in the postpartum phase. Find out more about Jill and her products at www.tuneupfitness.com.

More from Jill:

 

On this show:

  • Diastasis recti (DR) – what is it? Doesn’t every woman get it during pregnancy?
  • Need understanding of connective tissue, fascia, facial interface
  • Split tear thinning of abdominal muscles (right and left hemisphere), from zyphoid process to pubis
  • Linea alba has different natural tension on different people
  • Even babies have DR! So, DR is perfectly natural and it’s natural to have weakness in this area.
  • But there can be an unnatural drift on right vs. left sides, i.e. a tensional pull away from the midline.
  • Drift occurs in various layers of the abdominal muscles, it can go through all the layers, so diagnosis is about figuring out what layer is pulling away the most?
  • The rectus abdominus is the outer most layer that we notice the most.
  • The goal is to re-establish tone that crosses R/L and also flex the spine (flexion).
  • Body has to re-train core control after DR happens.
  • Breath is key!
  • Correct intraabdominal pressure – get things to act as a unit to avoid rift in DR.
  • Sara Tar – Crossfit athlete who’s been very open about her major DR who joined Jill on the Today show to discuss DR.
  • Jill helps Tawnee through a little self-diagnosis on Tawnee’s DR, which is mostly in the upper rectus abdominus.
  • DR – not just the width but the depth of DR down in the layers. If it’s down through the TVA, surgery might be an option.
  • Jill’s daughter was born with an umbilical hernia and how Jill helped her to naturally strengthen her core to avoid surgery. (Seams in utero didn’t seal correctly.)
  • Book recommendation – Diastasis Recti: The Whole Body Solution to Abdominal Weakness and Separation by Katie Bowman
  • Whole body weakness could be birth defect or improper exercise, e.g. not engaging TVA or improper breath during core work.
  • Have you connected your breathing to your ab work?

Prepare to Repair!

    • If you get DR, you have to learn how to BREATHE well. So why not start now?!
    • You need the breathing practice for pushing anyway J
    • Breathing helps transfer proper tension into TVA.
  • Later in pregnancy, breath transfers to ribcage (because there’s no room below)!
  • Three zones of respiration.
    • Zone 1 below diaphragm.
    • Zone 2 rib cage.
    • Zone 3
    • Inner baby carriage – this capsule needs to be tensioned.
  • Jill mentions the use of her Corgeous ball in the Roll Model Mama program.

How to properly use your breathing muscles:

    • Are you ever completely letting go of muscles in the body? Are you holding unconscious tension?
    • Female core is notorious for unconscious tension. Are you always pulling in your belly?
    • Chronic shortening of these tissues is not good, we need to let them go in order to get descent of respiratory system.
  • Diaphragm is distended on inhalation. Correspondingly, TVA should receive that pressure and swell (everything expands).
  • During exhale we need to allow a reflexive rebound, i.e. drawn in and up. Diaphragm goes back to dome position.
  • Chronic tension? Diaphragm can’t descend as low as it could because it’s prevented from doing so. No cooperative play.
  • Bottom line: Don’t always hold it in.
  • Every hear someone say “pull belly button to the spine”? That’s not enough! Instead, Jill says to synch core into spine to work on TVA (which is mostly on the sides).
    • When TVA contracts is creates a global synching, it’s not a spinal flexor it’s a stabilizer.
  • Get your pelvic floor checked in the postpartum phase!
  • Breathing cues:
    • Breathe in—feel that pelvic floor (perimeter of gut) distends
    • On exhale “gather” tissues and compress in toward center. Blow out 99+ candles and rid self of all available air.
    • As you get more advance you can target activation of certain muscles more specifically, e.g. Internal abdominal obliques.
  • After many births or “life things” that affect core we lose proprioception so we want to stimulate tissues and regain control. Muscle contraction at the right time is key!

DR Stats:

  • We still don’t know why some people get DR and others not.
  • Science doesn’t show any definitive risk factors for those who get DR. (but we have our beliefs from years of observation.)
  • No consensus about risk factors for DR during pregnancy or postpartum phase. But there are some proposals that we list off.
  • DR stats
    • 65% of women have DR during third tri
    • 53% have it immediately postpartum
    • 36% remain abnormally wide 5-7 weeks postpartum
  • Of women with gynecological complaints, 52% have DR
  • Need more research of women during pre-pregnancy life to assess risk factors for DR to help prevent.
  • It would be great if DR recommendations and core awareness were a normal part of prenatal care.
  • Jill’s opinion on belly bands: Better to generate force from inside the body; could inhibit respiration.

Postpartum DR Exercises – do’s and don’ts:

    • Start with breathing, always start with the breath, and this can happen immediately!
    • To tone inside out: a minimum of 10 full breathes with full exhalation and full inhalation a day. Can be done anywhere, any time.
    • The basic rule for exercises to do and don’t do:
      • Spinal flexion is the test—if there’s doming, avoid those exercises for now! Goal is no doming.
      • Usually need to avoid sagittal movements for a while.
    • “Functional DR”—what this is: when you’re relaxed there is a little gap but you’re your core is engaged you’re strong and able to functional as needed without pain and problems.
    • Associated symptoms with chronic unhealed DR: low back pain, ITB pain, knee pain, SI joint issues.
    • If you’re long removed from immediate postpartum phase but still having a DR issue, where do you start to heal?
      • Tissue mobility is key! Need tissue play! Do soft-tissue mobilization.
      • Never too late to address this!
      • You can adapt.
      • Mobility = recovery, so you can do more!
        • More body awareness to perform better, etc.
      • When surgery might be the last and final option after exhausting all resources—for some women this can be the case and that’s ok!