If you’re pregnant or a new mum, you probably would have heard about diastasis recti. You may have also noticed your midsection looks a little different than it did before pregnancy. Maybe you have new stretch marks or lax skin. Many women also report having a feeling of weakness in their abdominal wall or ab muscles, or see bulging along the midline of their abdomen, or doming of the rectus abdominals with certain movements.
But don’t be alarmed as these are all completely normal. Your body went through some remarkable changes to grow and birth a baby after all. First of all, let’s start with a quick anatomy review of diastasis recti.
Diastasis recti is the natural separation of the abdominal muscles that occurs during pregnancy. A diastasis is a stretching and thinning of the linea alba (the connective tissue joining the two sides of the rectus abdominal muscles). It is commonly diagnosed based on the width of the gap between the two sides of muscles. A width of 2.5 fingerbreadths or more on a sit up is technically a diastasis.
Research has shown that up to 100% of pregnant women have a DR in their final trimester.[1] In other words, prenatal DR can’t be avoided – the linea alba needs to stretch to accommodate the growing fetus safely. But what happens during postpartum? Well, the results vary considerably. One study found that at six weeks postpartum, 60 percent of women still had a diastasis recti of at least two fingerbreadths. By one year postpartum, that number dropped to 32 percent.[2] This means that for some, changes resolve on their own over time. For others, the physical changes may be long lasting.
Often new mums will ask pelvic health physios if they can heal their DR postpartum. Clinicians used to define healing as ‘closing the gap’. But width isn’t as important as depth or bulging. Depth and bulging tell us that the abdominal system is not firing together. So clinically speaking, when we’re talking about healing DR, we’re referring to regaining optimal abdominal wall function. And whether a diastasis can be healed depends on how much fascial damage has been done.
Firstly, you may be wondering whether there are exercises that should be avoided all together. The answer is ‘yes’! In the first few weeks postpartum, it’s best to avoid direct front loading exercises as they cause excessive distortion of the linea alba. Exercises including front planks, push ups, v sits, roll downs, burpees, pikes, crunches or sit ups should be worked up towards. The load of these exercises could potentially be too much on the healing fascia.
There are a number indirect front loading exercises that may also be unsafe. Pull ups, especially kipping pull ups can be very intense, while heavy and even regular squats if you flare your ribs out can cause doming. It’s all about being aware and not doing more harm to help support and promote healing of the fascia.
The good news is that there are a number of things you can do that may improve your DR. Here are some ways to help you begin to take control.
1. Fix breathing - You need a great 360 breath that expands the ribs in the back and out to the sides, feeling the breath all the way down into the pelvis. It takes practice to establish this breathing after everything got moved around to make way for growing a baby. Try to avoid shallow and all-belly breathing that often causes too much expansion of the front tissue and bulging in the lower abs.
2. Improve posture - Think about stacking your ribs over your pelvis and your diaphragm over your pelvic floor. Many new mums adopt the swayback posture where they hang forward into their hips or stay in an anterior pelvic tilt when their pelvis tips forward and downward and clench glutes. These postures lengthen and weaken the abdominal muscles and create stress on diastasis. A useful way I find that helps to correct this is to lift from the pelvic floor so you’re not scrunching over and think of how it would feel if someone was pulling on your ponytail.
3. Get functional - if your tummy gap feels 'squishy' i.e. with depth, you'll want to strengthen the connective tissue, the deep core (transverse abdominis) underneath to get it feeling firm (like a trampoline). The TAs are the muscles that wrap round like a corset so helps to flatten that tummy when strengthened
4. Progressively load the abdominal muscles - As you return to exercise, focus on gradually increasing the difficulty, intensity and loading of your ab exercises over time. Many women tend to keep things too easy for too long. Try different positions ie. through all three different planes of motion – sagittal, frontal and transverse. Start with single arm/leg versions of deadbugs and work up to plank exercises. Use balloons to overload but avoid at any signs of bulging.
Note: A little bit of doming, especially if it's soft, is not necessarily a big deal because you need to load the body to move forwards in the recovery process. That said, bulging or sinking in the linea alba could be an indication of ineffective management of intra-abdominal pressure and an inability to coordinate abdominal muscles with PF. Be aware of your body and regress exercises as needed until you work up the ability to manage pressure.
Diastasis is a total body issue. It’s how you move, breath and load the body. The focus should be on re-establishing breathing and better movement patterns. It’s important to understand how to load the body to do exercises. Pay attention to signs of overdoing, like heaviness or worsening diastasis during and after exercise.
Overall be patient. Fascia can take up to 18 months alone to strengthen. And here is the thing, particularly on corrective exercise, the way to get your abdominals functional and strong will vary from mum to mum. It varied for me significantly from postpartum 1 to 2. That’s why I consider all aspects in my Strong and Empowered Coaching, tailored to your body and the level you are at.
If you’d like to learn more, as I’d love to learn more about you and your journey, please do get in touch.
[1] Fernandes da Mota PG, Pascoal AGBA, Carita AIAD, Bø K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual Therapy. 2015 Feb; 20(1): 200–5.
[2] Sperstad JB, Tennfjord MK, Hilde G, Ellström-Engh M, Bø K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. BJSM 2016 Sep; 50(17): 1092–6.
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