abdominal separation

Should you use a Postpartum Belly Binder?

I'm asked a lot about the use of abdominal binders and braces after having a baby.

Maybe you're considering using a belly binder after having your baby or you heard belly binding is good for a diastasis recti.

Before you rush out to purchase a binder, here are a few things to consider first.

Belly binding has been used for hundreds of years after having a baby. Typically a binder is used within a few days of birth for 2-6 weeks.  There are special cases that a binder is used longer for more severe abdominal separation, but should always be addressed with a postpartum physical therapist first.

Here are some benefits for belly binding*:

  • Provides postural support for the torso and organs as they return to pre-pregnancy position

  • Supports and assists abdominal wall healing and diastasis recti recovery

  • Supports the body's natural spine and posture realignment post birth

  • Constant pressure on the torso and abdomen hastens healing by reducing water, fat and air in the tissue and cells

  • Stabilizes loose ligaments

  • Helps to prevent and relieve lower back aches and strains

  • Prevents slouching while feeding or holding your child

Your goal after having baby should be returning to optimal movement and function in your body. So when does belly binding no longer promote healing and return to function but cause problems instead?

1. A belly binder is only meant for short periods of time.

If worn for longer than 6 weeks (unless directed by a specialist practitioner) it starts to replace the function of our core muscles. Which means the muscles no longer need to build strength to do the job they are meant to do...support your posture and organs, and stabilize your spine for movement. Your body will rely on the binder, which not a long term solution.

2. Cinching can cause too much compression.

When pulled too tight the compression around your waist alters the natural pressure system without your trunk. Instead of even pressure, it is now pushed upward into your chest and downward into your pelvis. This can lead to hernias and pelvis organ prolapse, which nobody wants.

3. It alters your breathing pattern

When you breath your trunk expands in all directions, up, down, front, back, and to the sides. The abdomen is meant to rise and fall as your trunk and pelvis expand with every inhale. If your abdomen is compressed, as your respiratory diaphragm contracts and pulls down while you inhale there is no place for the lungs to go except just into the chest. This causes shallow breathing, leading to an increase in cortisol levels and perpetual fight or flight mode.

4. Your core may establish bad habits

There are two ways this may happen. One, the core may stay contracted. The constant compression triggers a perpetual contraction of the abdominal muscles. This is like always holding your shoulders up to your ears. Eventually those muscles  become tight and unresponsive to proper movement. The core needs to relax to function properly. Part of the core's job is to let go to allow you to go to the bathroom or to have sex. If the muscles are in a state of contraction this cannot happen! A tight muscle can no longer provide stability for movement, which may lead to [more] pain and dysfunction.

Two, the core may push out when it contracts. Having a binder wrapped around our waist gives the body something to push into. When someone pushes your shoulder, what do you want to naturally do? Push back.

For some (like myself) this is what can happen when wearing a belly binder. When you brace against the binder it creates internal pressure, again leading to hernias and prolapse, and bad form for an abdominal separation. You may not even realize you're doing it.

In the end, do I think belly binders are bad?

No.

I think they are beneficial for immediately after having a baby when you are mindful of how your body is responding to wearing one.

You need to be aware of how you body feels when you take it off. Are you paying attention to your movement patterns or just relying on the binder? Do you have a game plan for weaning off the binder?

These are all relevant and important things to consider before you use a binder.

*https://www.thewombwellnesscenter.com/postpartum-bengkung-belly-binding.html

The Low Down on Diastasis Recti

Let me start by saying.... YOU ARE BEAUTIFUL, mommy tummy or no.

That being said, there can be more to a mommy tummy than meets the eye.

Our bodies are amazing. They are able to stretch, contract, contort, rebound, over and over again.

As woman we are able to expand enough to grow a baby in our womb!  This takes a lot of STRETCH of the surrounding tissues.

There is a healthy amount of stretch and rebound that the body can handle. And there is an unhealthy amount of repetitive stretch or frequency of stretch positioning that puts our tissues at risk for injury.

During pregnancy our abdominal tissues go through an incredible amount of stretch.  I can't tell you how many times I thought "I can't get any bigger" but I did.  I could literally feel my tissues stretching after my daughter had a growth spurt in the womb.

This stretch is very healthy and is meant to happen to provide space for the growing baby.

However if the tissues being stretched were already under unbalanced loads prior to pregnancy, they may be at risk for injury.

This injury of the abdomen or symptom of unbalanced mechanics in our body is commonly known as Diastasis Recti (DRA) or abdominal separation.

I would like to clear a few things up about Diastasis Recti, and I'm going to channel Katy Bowman, a biomechanist who wrote a phenomenal book about DRA which gets to the heart of how I have been working with my patients for years.

DRA is typically the result of years of stress on the connective tissue of the abdominals, called the Linea Alba. Our abdominals expand and contract for gut function, respiratory function, structural support, reproductive health and much more.  It is when the abdominals are used over and over again in a posture, or are placed under unbalanced forces frequently that cause the weakest point of the abdomen, being the connective tissue to give.

Then there comes a point when the weakest point just cannot take it any more and stretches or separates past the point of natural.

We all have different widths of linea alba, which can change after pregnancy, but still be normal.

In our modern day society, for many of us these unbalanced forces are sitting in a slouched posture all day at a computer, holding our breath while performing heavy lifting or extreme dynamic exercise, or driving leaned off to one side. These are just examples, there are so many other ways we repeatedly and frequently stress our body.

What we need to take into consideration is DRA is not just an abdominal problem, but a whole body problem.  The way we sit can either help or hinder our ability to properly engage our abs. Try it...sit slouched and see where your belly goes.  Then sit upright so you feel you are sitting on top of the two bones in your bum and see what your belly does. Is it easier to contract them in one of these positions versus the other?

Our trunks are pressure chambers and when we are honoring the natural curves of our spine and neutral positioning of our joints, these chambers are stacked, all the parts insides are in place and the container (bones, muscles, skin, etc) are not distorted.

When we don't honor neutral these chambers are not stacked, the parts insides are displaced and the container has to distort.  It is when we repeatedly dishonor neutral that this becomes a problem.

Imagine a woven shirt, if you repeatedly stretch it, the fibers will eventually start to break down and the seams, being the weakest point will tear.

This is what happens with the linea alba. However, for most woman the tissue doesn't actually tear, it just gets really thin and weak.

99% of expectant women have a DRA, based on the measurable definition of abdominal separation. However, it doesn't become a problem unless the abs are pulled past an unnatural state of stretch during pregnancy and then is not addressed post birth.

Again, DRA is a symptom of unbalanced forces in the body putting strain on the connective tissue of the abs that results in back pain, pelvic pain, abdominal pain, gut & digestive issues, and pelvic floor dysfunction.

66% of women tested with DRA had at least 1 support-related pelvic floor dysfunction diagnosis.

The good news is there is a way to help correct this problem. And it doesn't mean just closing the gap or having a flat tummy.

Here's a little inside into my life...I had a DRA after my pregnancy.  I was very fit before and during pregnancy. I was doing prenatal yoga & Pilates and I ran until I was 8 months pregnant.  But I have past injuries and compensations that my body found challenging to withstand the forces placed on it.

I have worked hard to create a functioning abdominal wall again, and I still have what some would consider a separation.

BUT, my abdominal muscles all work properly, there is proper fascial tensioning in my linea alba, I can close the gap, I do not have any pelvic floor dysfunction, gut issues or pain issues.

What does this mean? By addressing the issues of unbalanced forces in my body, through bad posture, tight muscles or fascia, repetitive movement patterns and the like I put less strain on my belly.

You can too! The first step is recognizing what unbalanced forces you are creating in your body then taking the time to recalibrate how your body responds by creating healthy movement patterns!