Updated: Sep 22, 2020
Diastasis recti can be a scary and confusing diagnosis. You may not know exactly what it is or what to do about it, and you may be living in fear about what it means and what to do about it! So let's figure it out...
What is Diastasis Recti?
In simple terms, diastasis recti (DR) is a separation of the abdominal wall at the midline connective tissue insertion, the linea alba.
The abs have to stretch during pregnancy, and sometimes they stretch apart so much that they actually start to pull away from the center line.
Pregnancy related diastasis recti is common. In fact some studies show that 100% of women experience this in their 3rd trimester.
And it may take a while to close up.
While some separations do spontaneously disappear, many women will still have a gapped belly well after delivery.
You may recognize a DR by looking at the picture below. It looks kind of like a wrinkly little pooch around the belly button, and sometimes you can even see separated abdominal muscles:
How do you test for diastasis recti?
Testing for DR is a simple process, but I want you think think more about assessing for quality of tissue tension vs the number of fingers you can fit into "the gap."
Check out this quick video clip to do your own self assessment:
Perhaps more important than evaluating a DR is assessing the response of your abdominal wall to some basic movements.
I'm more interested in knowing if you can keep tension across your abdomen as you lift, cough, or walk.
How do you heal Diastasis Recti?
Today, thanks to some brilliant researchers, we have a better understanding of what this DR separation is really about, and therefore "the best" way to go about closing it.
DR is an outward signal of an inward problem, mainly a dysfunctional core.
Let me just say first, as of now there is no evidence that points to one specific exercise protocol, and this is mainly because every individual will present with their own unique pattern.
But here's what we can say are necessary requirements for healing across the board:
Alignment
We need to reverse pregnancy posture and shift things back into neutral alignment. A tilted rib cage or pelvis can put unnecessary, chronic stretch and stress on the abdominal wall.
As a PT I get involved here by providing myofascial release to specific muscles that maybe got shortened and over-tight during pregnancy, or that are compensating for deeper weakness.
From here it's a lot of brain re-training using mirrors and other cueing tactics to re-align the body.
Breathing
Yep, you more than likely need to re-learn how to breathe.
The diaphragm = your core
Pregnancy changes the available path for the diaphragm, and it's easy to develop altered breathing patterns.
The diaphragm initiates breath by contracting downward, and this sets up a series of responses from your pelvic floor and abs, and only when that interplay is in sync can you have a balanced pressure system that allows the tissues in the front of your core to come back together.
Strengthening
Once you have the coordination down, you can start working on strengthening your pelvic floor and transverse abdominals, along with the rectus abdominals, obliques, back and shoulder blade muscles.
There are a few components to a kegel that I want to share, because it's more than just squeeze and hold.
The pelvic floor muscles connect front-to-back and side-to-side inside of your pelvis. When we contract them they should both squeeze and lift to support the pelvic organs and to help provide tension to the abdominal wall.
A kegel is a contraction and relaxation of this squeeze-and-lift motion. Close the holes, lift up and into the body (both front and back side!), and don't clench your jaw or butt muscles.
Relax everything on your inhale.
Work on holding a contraction for up to 10 seconds while you breathe naturally, and then work into quick contract/relax blips to help prepare you for things like sneezing our jumping.
Integration
Fitness is an important way to prepare our bodies for life. Re-integrating fitness moves that involve other muscles of your hips and torso help to strengthen both your core synchrony, but also your functional movements.
You can absolutely run again, lift your kids up to the monkey bars without back pain, and even jump on a trampoline without leaking!!
Would you like more help closing your Diastasis Recti?
I will tell you when it comes to DR it's never too late to make change, but the foundation HAS to be in place.
If the coordination and strategic timing of all your core muscles are not working right this little unsightly separation just simply won't close up for you.
What I want you to know is that treatment is not some top secret set of exercises, it's simpler than that!!
The best treatment is restoring the strategy. It's not what you are doing, it's how you are doing it.
Everyone responds differently to different cues and movements, so please don't hesitate to find a Physical Therapist who can save you lots of time, frustration, and confusion!
This post is intended to serve as general information and discussion about diastasis recti and postpartum healing. The content is not intended and should not be construed as medical advice. If you have a medical concern, Patricia Fasciotti and Patricia Fasciotti Wellness, LLC recommends that you consult with an appropriately licensed health care provider.