What is Diastasis Recti?
As a new mom the words Diastasis recti were daunting. A separation through my abdominal wall? What?! The thought scared the sh*t out of me and I immediately turned to social media and google for all things Diastasis recti. There is a ton of information out there on Diastasis recti, some good and some bad. I found promises of exercises that cure “mommy tummy” and “heal” Diastasis quickly. A quick fix seems great, but if there were five exercises that could “heal” Diastasis, wouldn’t everyone do them?
What is Diastasis Recti?
Diastasis Recti (DRA) is the stretching of the linea alba, the connective tissue that holds the right and left sides of our abdominal (six-pack abs) wall together. It’s naturally occuring. Your abdominal muscles have to expand to make room for a growing baby. Although there is no way to prevent Diastasis recti, adjusted training strategies can help with the severity for most people throughout pregnancy and postpartum. As you continue in your pregnancy, nearly 100% of mamas have it by the time they give birth.
Jessie Mundell gives a great example for this “stretching.” Think of your favorite yoga pants. Over time the fabric becomes more stretched, not as dense and not as “thick.” Eventually you may find your favorite yoga pants are a bit thinned out. This is what happens to the connective tissue, which leads to the abdominal muscles having a separation.
Will Diastasis Recti heal on its own?
Sometimes it does and sometimes it doesn’t. If alignment, breathing, movement patterns, and exercise have not been ideal during pregnancy or early postpartum, it’s likely a diastasis may need to be addressed. Working with a Pelvic Floor Physical Therapist and creating an adjusted training strategy can help with recovery postpartum, as well as the severity for most people during pregnancy.
Continue on in this post to read about Healing Considerations.
Measuring Diastasis Recti
A diastasis is assessed by looking both at depth and width, as well as location, checking above and below the belly button. Especially early postpartum fingers may “sink” along your linea alba (too little tension), or you may experience a doming or coning out appearance along the linea alba (too much tension/pressure). Either scenario would indicate diastasis.
Set up: Start by rolling to your side and over to your back. Bend your knees at a 45 degree angle, like you’re setting up for a glute bridge. Lift your shirt so you can see your midline.
What are you measuring? The goal is to tune in to the distance between the two sides of your abdominal wall, as well as what the fascia feels like. Do your hands sink in or do you feel a bounce back/firmness when you push down?
Three spots to measure:
Halfway between belly button and rib cage
Right above your belly button
Halfway between your belly button and public bone
Questions to think about as you measure:
When you pick your head up, so you feel a gap? How wide is it? Do your fingers squish in?
When you pick your head up, do you feel a firmness? Or is it soft and squishy?
Once you’ve done the test in all three locations, I recommend adding in and coordinating with the breath and pelvic floor lift. Inhale down in the body, exhale lift pelvic floor, ribs come in and down. Does that change anything in the appearance? We’re looking for changes that happen when you exhale and draw the pelvic floor up.
When is Diastasis Recti healed?
Less than 2 fingers width distance and less than a knuckle deep is often considered “healed.” But, the size of the gap is less important than the density of the tissue. A “functional diastasis” may have a distance greater than 2 fingers, but if the density of the tissue increases and can manage pressure well during exercises / exertion, then that diastasis may be considered healed or functional.
Having a gap doesn’t mean something is wrong with your core or you are not functional. “Normal” is variable and there are a ton of factors to consider. Instead of obsessing over the gap, focus on your tendencies and overall exercise strategy, and tension and control through the midline.
Exercises to avoid with Diastasis Recti
I often see lists of “what to do / what not to do” when it comes to Diastasis recti. But, rather than focusing on WHAT movements we should avoid, we can focus more on HOW the exercise is performed.
During pregnancy our bodies change and adapt.
Diaphragm movement / breathing is restricted
The abdominals are stretched
The pelvic floor takes on additional load
With these changes in mind, when we approach exercise postpartum we want to swap out movements that bring our body into a less than ideal position OR movements in which we cannot manage breathing and pressure. A lot of these movements can be adjusted both during pregnancy and the in postpartum healing. These small tweaks can make a big difference.
Example: Standing tall while holding a kettlebell or dumbbell out in front. You may find you lean forward into the weight, thus shifting pressure outwards into your Diastasis. A simple tweak can impact body positioning and how that pressure is managed.
With all this being said, there are certain categories I recommend limiting until your body is ready for the demand and can progress appropriately.
Direct front loading: front planks, push ups, V-ups, roll downs, burpees, crunches or sit-ups, ab wheel roll outs, etc.
Indirect front loading: deadlifts, pull-ups, squats, standing arm work, transitions in yoga, running, overhead medicine ball throws, etc. All of these exercises require a ton of effort from our core too.
Diastasis recti is a full body issue impacted by how you move, breathe, and load your body. These exercises aren’t totally off limits, but we need to approach them with a strategy in place.
Additional Diastasis Recti Considerations
Add Challenge
If you have mastered core rehab movements in supine (on your back) and are able to manage pressure through the system, it may be time to progress and add challenge. After all, life happens in lots of positions, not just on your back.
Two ways to add challenge:
Switch up your position: try all fours, side-lying, half-kneeling, tall kneeling, seated, or standing.
Add resistance /external load: By adding load, we add challenge in a new way. By increasing load we become stronger, thus improves density and coordination of our muscles, tissues, and bones. We are better able to manage pressure and adapt to changes in our environment. We can hold weight or use bands and adjust stance here and position too.
2. Breathing and Postural Shifts
Posture: As the belly grows throughout pregnancy there is an increase in weight out on the front. This increased weight out front leads to postural shifts and compensation patterns for our body to feel more “upright.” These compensations play a role in our healing and overall pressure management strategy throughout pregnancy and into postpartum.
There is no "perfect" posture. Ideally we move and switch it up throughout the day :) The problem becomes when we get stuck in one position all the time.
Swayback position
Rib thrust and anterior tilt
Forward head and rounding through the upper back
Decreased mobility of of the thoracic spine / tightness
Moving away from our "go to" position takes time!
Pregnancy Posture
Breathing
As pregnancy continues the diaphragm's movement becomes more restricted and lead to poor breathing patterns. We often hear of belly breathing or chest breathing. utilizing secondary breathing muscles in the neck and shoulders.
Breathing is a key for stabilization in our core and managing pressure through the system, another reason we start here in postpartum healing. If the abdominal wall and pelvic floor cannot manage pressure, we may get a pressure leak somewhere in the system: diastasis, hernia, prolapse, leaking, etc.
Final Diastasis Recti Thoughts
Pregnancy and recovering from birth is a big deal, even for “fit” women who exercised their entire pregnancy. Recovery is a process. It doesn’t happen in a few weeks, or maybe even a few months. For some it may take years. Our bodies are vulnerable. Start small, and build up.
Rehab
Adjust the strategy
Give yourself time to build demand (volume, intensity, load)
Monitor your systems
Make adjustments
My abs are a bit different than they were pre-baby. Yours are too! They grew a baby, and now they are challenged to respond to new tasks.
“Control what you can, and surrender to the rest.” - Brianna Battles
Interested in learning more about Diastasis recti and returning to exercise after pregnancy? I’d love to chat!
xoxo,
Erica