Updated: Sep 22
Diastasis recti (DR) – the abdominal separation that typically comes with pregnancy — is a hot topic today, and I’m really glad it is.
We’re finally talking about women’s health and postpartum issues, like incontinence and abdominal separation…and in general not pretending that we’re all as perfect as Kate Middleton after childbirth!!
Let’s start with what DR is:
Diastasis recti is a connective tissue disorder.
When the abdominals get stretched during pregnancy beyond a certain point, they will actually separate from the midline connective tissue (the linea alba). DR has a signature look:
Professional treatment for this condition is relatively new.
This is because in medicine we are what we term “evidenced-based providers.” Meaning insurance won’t pay until it’s backed by enough research.
Thankfully some amazing Physical Therapists (credit to Dr. Sinead Dufour, PT and Diane Lee, PT as two of my favs!!) are trailblazing this specialty with new research coming out every year.
Consensus statements have been presented and are in the process of being published. What we’ve learned from this panel of experts is that:
no hard evidence exists on specific DR risk factors during pregnancy; in fact some studies indicate 100% of women in their 3rd trimester have DR.
identifying the width between the muscles is the old way of defining DR; today we actually want to assess the behavior of the connective tissue and the function of the entire core system. looking at the distance is clinically meaningless, assessing the functional behavior of the tissue correlates more meaningfully to clinical presentation and therefore drives our treatment plan.
this tissue quality is directly related to the function of the deep core system, which is more of a pressure management system inside of a core “canister” that depends on the coordinated action of the diaphragm, pelvic floor muscles, transverse abdominals and multifidus. When these drivers sync back up we see an improvement in the desired tissue tension.
it is agreed that a better assessment of DR is to assess the ability of the system to generate tension across the linea alba with a voluntary pelvic floor or transverse abdominal contraction
therefore it is not about the exercises that are prescribed, it is about each individual’s strategic response to that exercise that deems it successful or not. no hard evidence points to one exercise or set of exercises to do or NOT do during the DR recovery period.
it IS valuable for each individual to know how to assess their own tissue quality response to exercises in order to safely self-manage and progress healing of DR. check out a video on how to do that in this post.
In light of this new information I have changed my approach to treating postpartum women. Function is everything!!
I spend a lot more time on neuromuscular re-training exercises BEFORE we even get into isolation exercises like the traditional transverse abdominal series many of us traditionally prescribe.
Abdominal exercises are definitely part of the program, and I often prescribe yoga exercises as the perfect way to seal in the new strategies and build on strength and awareness of optimal strategies.
For today I’d love to share the beginning stages for setting yourself up for optimal healing and success.
Exercises for healing diastasis recti
Re-discovering alignment. Alignment and posture play a vital role in your healing. With a careful balance of strengthening with stretching and possibly some manual therapy, you can safely rebuild your structure and set yourself up for optimal function, strength, and success.
Tension-free breathing. Coordination of your diaphragm, pelvic floor, and transverse abdominal recruitment patterns is vital to restore the appropriate amount of tension in your core. Pregnancy changes your posture and breathing patterns. Beyond stretching out your abdominal muscles, this has a detrimental effect on how your core is able to stabilize during functional movement. Breath pattern is hugely important and needs to be even, not stressed or forced, and coordinated.
Motor re-learning of your pelvic floor and abdominals. Your body and brain need to re-learn how to activate these muscle groups in an anticipatory fashion so that they kick in to stabilize with the functional movements that are most meaningful to you – lifting and carrying baby, running, hiking, weight lifting, yoga, or whatever else you enjoy. We need to go way beyond kegels. The pelvic floor needs to respond to the diaphragm and the pressure/release cycle of the breath. And it needs to know how to dial up or down in preparation for the activity at hand. Picking up a sock requires a bit less activation than picking up your baby in a car seat carrier. When the pelvic floor timing is on the transverse abdominals can come back with greater meaning. It’s all connected, it’s all sequential, it’s all about coordination vs. isolation.
Doing exercises to rebuild abdominal strength and endurance is one thing, applying that strength to your movement passions is another. We need to take the strategies we re-build on the mat and integrate them with our bigger muscles into real movements like squatting and pushing/pulling. This is where yoga and fitness become great adjuncts to healing. But only after the foundation is solid!
Ladies, you do not need to live in fear of your Diastasis Recti.
It’s not about doing crunches or not, planks or not.
It’s not as simple as closing the gap with a specific set of exercises.
There is no one set protocol.
We need to re-frame our objective and focus on HOW you move vs. WHAT exercise you choose.
If you are overwhelmed and would like more guidance during your recovery, please remember that Physical Therapy is available to you!
In many states you do not even need a prescription from your doctor to go to PT. We have what is called direct access, which means you can simply call and make an appointment.
And honestly, you will likely only need 3-4 appointments to get this under control!
So don’t waste time with fear and worry. Get some help, it will be well worth it in the end!