Understanding Diastasis Recti

WHAT IS IT?

Recently there has been a lot of noise around Diastasis Recti and for good reason.

Diastasis Recti is the separation of the rectus muscles resulting in a gap down the midline of the stomach of 2.5cm or wider. This can happen in both men and women but is more prevalent in women due to the physical changes during pregnancy. However, as a diastasis is caused by excess pressure on the abdominal muscles and Linea Alba (connective tissue) that runs down the centre of the stomach, it can occur in men too.   

PREGNACY

During pregnancy the uterus naturally stretches causing the rectus abdominis muscles that meet in the middle of the abdomen, to separate. This horizontal stretching of the abdominals is a natural process which occurs to allow the uterus to grow and house a growing baby. 

This separation of the abdominals in addition to the thinning and weakening of the connective tissue (linea alba), can heal itself naturally within about 8-12 weeks of giving birth. In fact, post birth as hormones change, collagen fibres will usually regain their normal connectivity. But for many new mums, the gap can remain and a delay in the healing process means the area stays vulnerable.  A diastasis can be seen anywhere along the midline of the stomach and often by a bulge, where the intestines can push through the gap. Often the connective tissues no longer provide tension and stability and the stomach muscles can be compromised. This lack of protection and stability affects the whole body both aesthetically and functionally.

YOU ARE NOT ALONE

Although a relatively common disorder, diastasis recti can often be overlooked. In fact, there is a strong chance that many of us have struggled with this condition, without knowing the real cause. According to research, approximately 60% -70% of women have the condition six weeks post-delivery, with 30% still suffering up to a year after birth. If left undiagnosed, it can leave women with significant pain and discomfort in the pelvis and lower back. It can also result in a frustrating post-baby tummy protrusion that won’t shift even when any baby weight is long gone. The main thing is not to despair as there are ways to help your diastasis.

DIASTASIS ELSEWHERE

As mentioned, a diastasis can occur in both men & women.  This is often seen through improper exercise technique where too much pressure is placed on the abdominal wall. Incorrect abdominal breathing, core connection and pelvic floor recruitment means that the abdominals are not activated correctly and pressure builds up within the abdominal cavity and places increased pressure on the abdominals. This can often be seen with weight training, boxing, cycling or even through everyday activities.

THE ABDOMINALS & CORE

Understanding what has or is happening to your abdominals is key to correcting a diastasis or avoiding one caused through improper technique. The abdominal muscles in addition to the rectus muscles (which are discussed when reviewing a diastasis) are made up of a collection of muscles, including the transversus (deepest muscles), internal & external obliques.  These along with the back muscles, diaphragm (for breathing) and pelvic floor make up the CORE.  All of these are essential for protecting your internal organs, supporting your spine and stabilising the pelvis, giving more control over the body’s movements.

Your core should be active during daily activities and physical exercise, however often when underutilised, the back muscles and incorrect posture is used to compensate. Post-delivery this is heightened by a diastasis, which has disturbed the rectus muscles and effects the recruitment of your core muscles, that have also been weakened during pregnancy.  This is totally normal and why it is imperative that anyone with a diastasis re-educates muscle memory & strengthens the core correctly.

HOW TO CHECK FOR A DIASTASIS RECTI:

A Diastasis is a gap of more than 2.5cm-3cm between the rectus abdominal muscles (this can be measured by fingers) at home. Here is a simple step to help you check:

1. Lie on your back, knees bent and feet flat on the floor.
2. Place your fingers onto your belly button.
3. Lift your head and neck slightly off the floor as if to do a curl up whilst connecting your abdominals. Press down gently between your abdominals – if there is a gap larger than a couple of finger widths, that could be diastasis.
4. Perform these tests around your belly button (above, below) so you can measure if there is a gap in different places
5. As important as the width of the gap, is the tension (or lack of tension) of the linea alba (connective tissue). Contracting the muscles should create tension and resistance when you apply gentle pressure with your fingers to the midline. If it doesn’t, don’t panic you just know you have some focused reconnection to do.

If you believe you have a diastasis, firstly do not worry – you do not need to suffer in silence. The information below is designed to help you understand what diastasis is and how you can overcome it safely to regain your strength and fitness. There are also many professionals – physios, Pilates teachers etc. – who specialise in managing this during pregnancy and postpartum rehabilitation, so do contact your GP for further advice should you be concerned. My niix.fit app also has post-partum exercises and tutorials to help you get back into shape and above all, safely.

WHAT TO WATCH OUT FOR?

• During pregnancy, a diastasis is more likely to occur in the second & third trimester (or with multiples or large babies) once the uterus enlarges and the muscles separate to allow space. However, if a previous diastasis from a former pregnancy has not been addressed, you may notice this earlier and feel the effects through a lack of connection, strength; along with back & pelvic pain.
• Generally, a Diastasis can be seen with a doming down the length of the stomach, particularly around the navel. You may notice this during every day movement, such as sitting up in bed or even relaxing back on the sofa.

WHAT CAN BE DONE?

Being aware of this from conception through to postpartum will help protect your body and lessen a diastasis. Although there can understandably be some confusion about which stomach exercises are safe to do during pregnancy, in fact, many are safe. The key is to practise regularly, focusing on working your deep core stabilising muscles and above all, correctly, to lessen the risk of a diastasis and at the same time as helping prepare for the postpartum healing process.

PRENATAL EXERCISE AND WHAT TO AVOID!

If you have been exercising before falling pregnant, with no obvious muscle separation, it is completely safe to continue with the same exercise (if you have no pregnancy or long term health related complications), however as the pregnancy develops, adaptations need to be made.

During your first trimester continuing with flexion (forward bend), extension (backward bend), rotation and side flexion exercises are safe to do in moderation and with good practice. HOWEVER if you have an early onset diastasis (more likely if it is your third or fourth baby) then these movements should be avoided.  Usually diastasis becomes more pronounced as you progress into the second & third trimester, so being shrewd with the way you work out and during everyday movement is key. Although a diastasis cannot be healed during pregnancy there are many ways in which you can help minimise the damage.

During the second & third trimester, spinal flexion not advised whether there is a diastasis present or not.  Instead this is a time to keep strength through the lower body, with exercises such as gentle squats, kneeling leg lifts and pelvic tilts and elevators to keep the glutes, pelvic floor & deep core strong. The upper body will also begin to tighten as the upper back is compromised as it helps support the bump and the increase in breast size – so working the arms, back and opening of the chest during these months is essential.

CORE BREATH

A fundamental part of exercising is the use of your core breath.  This is where the outbreath is used to connect the pelvic floor and abdominals prior to movement. This will create a connected place from which to move from, working the deep abdominal muscles (TVAs) rather than the superficial surface muscles affected by diastasis recti.  Working the abdominals incorrectly or too much during pregnancy can contribute to enlarging or worsening a diastasis recti.

My general advice is that if there is doming down the midline of your stomach or something does not feel right, it is probably not right, so look to avoid that exercise or movement. It is essential to listen to your body….it’s normally correct!

EXERCISE TO AVOID WITH A DIASTASIS OR IN THE SECOND OR THIRD TRIMESTER:

Flexion of spine (curl up/stomach crunches etc)

Lateral/side Flexion

Rotation

PRENATAL EXERCISES

Below are three prenatal exercises that are safe to practice at home and will help with working your deep core stabilising muscles:

Core Breath: As you exhale, connect your pelvic floor from front to back.  Then think about your abdominal muscles wrapping around you as you lift your belly button up and inwards towards your spine. Your bump/stomach will lift and visually reduce in size as you hold this connection.  On the inhale release and allow the tummy to rest.

Pelvic tilts: Lie on your back, with your knees bent.  Breath in to prepare and on the exhale, connect your pelvic floor (zipping up back to front) followed by your abdominals (as above). Gently tilt your pelvis drawing your navel to spine and imprint the pelvis & lower back onto the mat. Hold for the breath and on the inhale return to the start position.

Rib Cage Closure: Lie on your back, with your knees bent, legs in alignment with your hip joints. Raise both arms above the chest, palms facing each other.  Inhale to prepare and on the exhale (connect your pelvic floor and your abdominals) and lower your arms towards the floor over your head. As the arms lower ensure the pelvis is stable & the ribcage connected by recruiting the core.  This will avoid the ribs flaring and the upper back extending. Movement will come from rotation of the shoulder joint. On the inhale return to the start position with the arms above the chest.

MANAGING A DIASTASIS POSTPARTUM

A lot of women believe performing endless crunches and sit ups post pregnancy will bring their flat tummy back, but this can actually have a harmful effect. These exercises should be avoided until you are 100% sure that your abdominis are back together. In fact, performing such exercises when a diastasis is present can cause longer term damage by stopping a diastasis healing or causing further damage, such as a hernia.

During the first 6-8 weeks, I recommend that new mothers take time to focus on the natural healing process of the body and to not rush back into exercise. The natural separation of the abdominal muscles can improve naturally within the first 6-12 weeks particularly with rest and being mindful of the weakened muscles. Focus on rest, a nutrient rich diet and time with your gorgeous new-born. 

New mums will naturally feel weak and lack the core strength and foundation they once had but taking time for the body to readjust is the best medicine. Even if cleared for exercise by the GP (let’s face it, these check-ups are aren’t always very thorough or full of bespoke advice for your body!), I would still look to wait until the 8-12 weeks before returning to traditional exercise if no diastasis is present.  It’s really important that for the first few months you avoid running or high impact classes, as well as loaded flexion or rotation. 

Remember the choices you make now will play a key role in how you heal long term.

During these early weeks, re-educating muscle memory and focusing on key areas such as the pelvic floor, glutes & deep core muscles will ensure a safe return to fitness by building strong foundations.  Avoiding oblique strengthening exercises is also key at this stage as over working these muscles can actually pull your diastasis/rectus muscles apart. Again, working on core breath will help to bring the stomach muscles back together and help strengthen the deep core stabilising muscles.

You can then begin to add some more gentle but effective deep abdominal exercises such as:

Core Breath: As you exhale, connect your pelvic floor from front to back.  Then think about your abdominal muscles wrapping around you as you lift your belly button up and inwards towards your spine. Your bump/stomach will lift and visually reduce in size as you hold this connection.  On the inhale release and allow the tummy to rest.

Knee drops: Lie on your back, with the knees bent and feet hip width apart. Zip up your pelvic floor and connect your core.  Maintaining a still and stable pelvis open one leg, releasing the knee to the floor. The other leg should be opposing the movement an aid in anchoring your pelvis to resist rocking. Allow the foot to roll onto the outer side of the foot. Inhale to hold the position and on the exhale draw the knee back to the starting position using your pelvic floor and inner thigh. Repeat on the other leg.

Spine curls: Lie on your back, with your knees bent, with legs in alignment with your hip joints. Inhale to prepare and on the exhale (connect your pelvic floor and your abdominals) initiate the exercise with a tilt of your pelvis & then lift your spine off the floor in a sequential movement until you feel weight at the bottom of the shoulder blades and across the upper back (avoiding the neck). Maintain the position ensuring the pelvis is in neutral with a slight tuck of the pelvis. Connect the inner thighs to stop the knees flaring outward. Avoid a high bridge. Roll back down initiating the move by softening the breastbone and then wheeling the spine one vertebrae down at a time followed by the pelvis.

Leg slides: Lie on your back with the knees bent. Breath in to prepare and on the exhale, connect your pelvic floor (zipping up back to front) and your abdominals – maintaining a still and stable pelvis lift your toes up so the weight of your leg is on the heels.  Exhale and slide one leg along the floor away from the torso. Inhale and on the next exhale remember to connect your pelvic floor and abdominals (wrapping/corset sensation) draw the leg back in. 

Once past 12-14 weeks generally a diastasis will improve, and you should be able to feel the muscles coming together and the separation lessen. Continuing with pelvic floor, core & posterior chain exercises (back of the body including glutes, hamstrings, back) are the building blocks that once mastered, will put you in a stronger place to get back to your optimum fitness & strength.

However, if there is still a large separation present (over 4cm) this can be slightly more complicated and is best checked by a professional women’s health practitioner to assess the level of muscle separation, pelvic weakness, pain and postural alignment. This can often be overlooked or not properly understood, leaving it undiagnosed for years and new mums living with unnecessary discomfort or without strength and stability.

If you are in discomfort or feel you may have a diastasis, do not suffer in silence.  Get a proper diagnosis and rehabilitation plan.  Also, remember, it is never too late! 

Nicki Philips

@niix.fit

www.niix.fit