I wrote Under Pressure Part One and Part Two in 2011 and in 2016, they were expanded into a full section of Diastasis Recti: The Whole-Body Solution to Abdominal Weakness and Separation. If you're wondering how breath, whole-body alignment, and pressure relates to issues of the core and pelvis, this might clarify things a bit. I combined both articles, made edits so they read a bit better, added photos and updating resources in 2020. For exercises and more information on these matters, read through Our Best "Healthy Pelvis" Resources.
I originally wrote this article, trying to explain how a diastasis recti (DR), a separation of the front and center abdominal muscles, can be affected by how we move. Like all musculoskeletal issues, there can be various components at play, but this article is about how organs that are supposed to stay on the inside of the body make their way to the outside of the body, or also, as in the case of a hiatal hernia, move from one cavity to another.
If all your parts are in place, DON’T HANG UP! This article is about pressure and posture. Pelvic organ prolapse, constipation, hemorrhoids, hernias, high blood pressure, and even how you breathe can be affected by pressure so hear me out.
So, class! Let's start with a simple model. There are three main cavities in the body and probably more than that if you loved Now&Laters as a kid.
The cavities include the thoracic cavity, which houses your heart and lungs; your abdominal cavity, housing your guts and possibly a baby-to-be; and your pelvic cavity. P.S. Don't make fun of my pictures. Even if the feet are tiny and the femurs excessively long.
Alignment is different than posture. Posture is about how something looks. Alignment is about how something works. So, to work on your alignment is to pick a position that improves performance, not necessarily aesthetics. The above-pictured alignment of the cavities is very important because the pressures within the cavities, and the movement of things inside a cavity to outside a cavity, are affected by various positions.
So let’s talk about pressure.
The best way I can explain pressure is like this. If you have 20 small children and put them in a small room, the pressure will be very high. If you wanted to increase the pressure you could either add more kids or make the room smaller. You could also give all the kids candy.
The only way to decrease the pressure would be to 1) remove some of the children or *stuff* from the space or 2) get a bigger room. Preferably at someone else's house.
Now back to body alignment, or more importantly, how alignment affects inter-cavity pressure.
After decades and decades of sitting, shoe-wearing, sucking in the stomach, and various postures that we have selected for aesthetics or cultural reasons, this has become a common stance:
The most important thing about this picture, when it comes to a diastasis recti, is what is happening to the abdominal cavity. When the ribs lift in front, they drop in the back. What happens if you pinch the back of a balloon? The front of it expands. Similarly, decreasing the space on the back of the "abdominal balloon" moves it's contents forward. Things under great pressure try to escape. Because the spine bone makes a strong boundary in the back, when your guts are under pressure, they have to go...somewhere. The choices are up, down, or forward—or any combination of the three.
In a diastasis recti, the forward push on the organs moves them forward into the muscle (and if there's a baby in there then the forward "push" moves that forward, too) where they can overload the connective tissue between muscles, thinning or separating it until the organs poke through.
Hernias and pelvic organ prolapses share similar mechanisms. Here is a crappy picture showing how abdominal contents under pressure force parts to escape the abdominal cavity:
The way your guts move under pressure depends on what else is offering resistance. If the supposed-to-be-flexible walls created by your pelvic floor, abdomen, diaphragm and ribcage muscles aren't, which is to say when these soft-tissue parts have become stiff, then we lose our ability to accommodate the natural variance in pressure.
If your abdomen is the path of least resistance, then things will move through the walls there, as in a DR or umbilical hernia. If your abdomen is stiff then abdominal contents can shift downward onto pelvic contents and as they displace pelvic organs, those can push down (onto prostates, or tear the connective tissue at the groin for an inguinal hernia) or out the vagina as in a pelvic organ prolapse.
Or the path of least resistance can be upward, as in a hiatal hernia, when the organs move up through the diaphragm and party with the heart and lungs in the thoracic cavity. Hint: It's no party. And, FYI, neither are the other two types of hernias.
The pic might be a little silly, but these hernias (especially the hiatal) can be dangerous. Even minor hernias can be taken as a red flag: Pressures are not as they should be in your abdominal cavity (and neither is the alignment).
If you are ready to say buh-bye to your DR, or your "fill in the pressure ailment," start by checking your whole-body posture. Before you do any stomach exercises, a pilates roll-up, or try any other type of "strengthening" solution, observe the pressures (and thus movements) you create all day long by how you carry yourself.
Take a look at these postures and see what you see.
And once you've checked out my super-duper postures and bed-head (yes, I took these about 10 minutes after rolling out of bed after sleeping for about two hours less than I needed...please don't zoom in), let me know if you saw this:
Study these pictures and learn to recognize the differences between them. Focus particularly on the rib shearing and pelvis thrusting, and not so much on the bed head, which technically isn't an alignment issue.
The second part is to start to look for and recognize these postures as you are out and about. Once you learn how to see these positions, you'll start noticing them everywhere. Eventually you'll be able to see them in yourself, and adjust.
In addition to how you stand, there are other habits that can increase your intra-abdominal pressure.
1. Breathing in a non-optimal way. I tried to write this out a million times and eventually I just ate a PB & J sandwich and made this video instead. I hope it makes sense. You can read more about breathing and find lots of exercises in How To Move Your Breathing Parts Better. Breathing matters a lot to pressure-related ailments because you do many breathing reps a day. If the way you breathe is pushing on your internal parts in a way that pushes them out, then this might be the most important movement to address. But, of course, working on better breathing begins with making all your breathing parts more mobile, so it's also just getting your parts moving more, and then moving more.
2. Holding in your stomach. Seriously. If you stand in front of a mirror and "let it all hang out" (just make sure it's after midnight...) you are going to see some stuff. Now I know that many of you out there aren't engineers, but I'm going to ask you something. Where do you think all of that *stuff* is going? I'll give you a hint. Or better than that, I'll give you the answer.
You are displacing your organs upward (or downward) to make room for the stuff, while also increasing the pressure in the abdomen. What gives? Eventually what gives is the tissue (fascia) that connects one discrete muscle to the next. When the pressure gets very high, the guts push into the muscular wall, which gives out, thinning and eventually tearing the fascia between the muscles. And note, learning to relax your abdomen and diaphragm is part of breathing better. Learn and practice the Abdominal/Diaphragm release in this article.
3. Holding in gas. Has the following ever happened to you?
You dress up for a party in your oh-my-gosh-I-can’t-believe-these-fit jeans. You swear you won't eat anything. You look great. You feel great. But then, a couple hours into the party you do eat something because looking this good works up an appetite. And on an empty stomach, that something you ate caused some gas. You can’t fart though, not in this smokin’ hot outfit. So you hold your stomach and gas in, for the rest of the party. When it's time to leave, you can’t leave fast enough because now you have a stabbing pain in your lower abdomen and the desire to fart 1000 farts. But when you try, they don’t come out with the vigor you were hoping. Once at home you put on your super-stretchy, comfy pajamas only to find that the stomach that was flat earlier at the party, now resembles something more from the days of a six-month pregnancy. Let your gas go and maybe don't cinch things so tightly around your waist.
So, how do non-moving, "inside the body parts" like organs move their way outside the body? Ironically it's because the moving parts of the body, aren't. When you don't move your moving parts enough, then the non-moving parts move. Which is tripping me out right now. You too?
For exercises and more information on these matters, read through Our Best Healthy Pelvis Resources.