033: A New Perspective on Diastasis Recti with Dr. Sinead Dufour

Shannon met Dr. Sinead Dufour at a pelvic health workshop for yoga teachers as part of the MamaNurture prenatal yoga teacher training. It was through Sinead that Shannon discovered she had Diastasis. Shannon talks about how some of the yoga poses done after she gave birth were contributing to her condition.

Diastasis is not widely understood in prenatal and postnatal health. It has been falsely understood as the separation of the abdominal muscles (it is even implied in the name) when it is actually the overstraining or damaging of the linea alba tissue.

It was after giving birth to her twins that Sinead discovered significant gaps and misconceptions in the health care system and fitness community that left women without the tools needed to take care of the pelvic health. She felt strongly that she needed to be part of the solution.

Sinead has been a practising physiotherapist for about 15 years, with a PhD in Primary Health Care. Her extensive studies also include training in obstetrics and urogynecology. She is a professor in the Health and Science department at McMaster University and is the Director of Pelvic Health at The Womb.  

Among this episode’s points of discussion are: the role the linea alba plays in Diastasis, Dr. Sinead Dufour’s  leadership in up-and-coming research on DRA to establish common practice principles, and what can be done to prevent this condition.

 

8:55 Sinead's journey to becoming a leading Pelvic Health expert

10:50 What is Diastasis? A common misconception about Diastasis.

Diastasis or Diastasis Recti Abdominus (DRA)

12:25 Linea alba’s role in pregnancy and Diastasis

15:30 New study by top 22 Diastasis experts in Canada in order to establish practice principles experts can agree on

18:10 Delphi Process with 3 phases setting the practice principles

20:45 Diastasis related to manometric pressure system

manometric pressure system- the pressure system modulated by the core four, inclusive of the linea alba and the glottis (think the concept of intra-abdominal pressure)

 

19:10 Dr. Sinead’s research study

20:10 What experts are saying: what is Diastasis and how should we manage it?

23:00 Prenatal - how can we prevent Diastasis?

1. Avoid exercises that concentrically engage the superficial abdominal muscles such as crunches and sit-ups
2. Emphasis on facilitating optimal co-activation of the deep inner unit
3. Ensuring the core 4 are working together: pelvic floor, diaphragm, transversus abdominis and multifidus
4. Working synergistically
5. Promoting effective, tension free diaphragmatic breathing
6. More focus on diaphragmatic breath with ease -- less extended belly breathing and more rib cage breath
7. Emphasizing postures that reduce excessive strained intra-abdominal pressure
8. Avoid plank pose while pregnant or straining on the toilet,(especially with breath holding).

25:15 Importance of continuous breath

28:45 Encouraging students, not to breath hold (and why they may be doing so)

31:00 Empowering language - What can students do instead of what can't it do

32:15 Listen to the body - pain or struggling in a pose

33:05 Intrapartum (during childbirth) considerations

1. Continuous breath - no Valsalva breath
2. Avoiding a back lying position when possible

37:35 Prenatal yoga teachers are the ones who can advocate, inform and empower those who are susceptible to diastasis or other pelvic health issues

38:25 When to refer a yoga student to a pelvic floor physiotherapist

40:00 Postpartum (4th trimester) - "critical healing period"

1. Abstain from exercises that concentrically engage the superficial abdominal       muscles
2. Promote exercises that are not the same action as a crunch
3. Every body is unique and so each person needs something different
4. Watch for doming or invagination at linea alba during exercise

5.Optimal load transfer at linea alba

45:25 Later diastasis- watch out for doming or invagination (reverse doming)

46:10 Front loading poses: bird dog, plank - when can we do these?

47:30 Any incontinence issues - because Diastasis is a pelvic floor dysfunction

 

48:50 How yoga can help with the internal pressure system and nervous system

 

49:55 Autonomic nervous system tension affects the connective and visceral tissue

 

50:45 Benefits of a yin yoga style

 

51:40 Fertility yoga series at The Womb

 

52:50 Increased inter-recti distance is normal in pregnancy

 

53:45 Diastasis has nothing to do with the inter-recti distance (the width between the rectus abdominis muscles)

 

57:20 How to test for Diastasis at home

 

58:40 How a yoga teacher can help assess linea alba during a pelvic floor contraction

 

1:00:25 Another Diastasis assessment- digital pelvic floor contraction (highlights how integrated the linea alba is with the pelvic floor)

 

1:01:25 Yoga teachers are in a great position to get ahead of the curve to spread new information discovered through research (before it will be widely taught)

 

1:05:50 Inter-recti distance as an assessment needs to be thrown out- as people get better and more functional the distance can actually increase proving that inter-recti is meaningless

 

1:06:55 The general preface statement that will be published in their research document

 

1:08:50 Preface statement for assessment of DRA

 

1:10:10 How to work with Dr. Sinead Dufour

 

 

Links

 

The Womb

 

Find a Canadian Pelvic Health Specialist

 

Mama Nurture

 

Relevant TCYT Episodes:

007: Breath and Pelvic Health with Trisha Zinn

008: Core Breath and Pelvic Health with Kim Vopni

009: Kegals, Mula Banda and Pelvic Health with Shelly Prosko

 

The Connected Yoga Teacher Facebook Group

 

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