Let's talk about Diastasis Recti:
Diastasis Recti is a pretty common condition that can occur during pregnancy, after birth, or can even be caused by rapid weight gain or a large amount of visceral fat. The right and left sides of the Rectus Abdominis (what you know as your abs) muscle spread apart at the body’s midline causing a gap of 2 or more finger widths apart. This interrupts the integrity of the abdominal muscles.
During pregnancy, the uterus starts pushing against the abdominal wall as baby grows. In conjunction with pregnancy hormones that soften connective tissue, this can cause the fascia to separate and all connective tissues between the two sides of the abdominal muscles to separate.
So...how do you know if your abs have separated?
Well, if you've been pregnant, they've separated. Naturally, there is a slight widening of the midline in all pregnancies. Diastasis recti occurs in about 30% of all pregnancies and in many cases, the gap will close on its own to less than 2 finger-widths apart. Anything larger than 2 finger widths separation is deemed Diastasis Recti and can cause problems.
Diastatsis recti reduces the functional strength of the abdominal musculature and is often diagnosed by complaints of lower back pain and feelings of instability. Obviously, if you've experienced a separation in a previous pregnancy, there is a significantly higher probability you'll experience it in subsequent pregnancies. Often with greater severity.
Anyone is prone to DR but often it's women with petite frames or low abdominal strength going into pregnancy. However, women with significantly strong abdominal muscles like dancers and acrobats are also found to be more susceptible to an ab separation.
Not sure if you have DR? Check for yourself!
Lie on your back with your knees bent, and your feet flat on the floor.
Place one hand on your belly with your fingertips touching your midline right at your belly button.
Gently press your fingertips into your belly.
PLace your free hand behind your head to support the weight of your head and roll your head neck and shoulders off the floor into a “crunch.”*
You should feel your abdominal muscles harden a bit as you hold the crunch position. Use the fingers to push down at the belly button and find those muscles. You may be immediately met with a solid (ish) wall of muscle. OR your fingers will go straight down with nothing stopping them but some skin and tissue. Move your fingertips back and forth around your midline to feel for the right and left sides of your rectus abdominis muscle. Check around and feel how many finger tips you can fit side by side between the two walls and test for separation at, above, and below your belly button.
*To make sure you are effectively contracting your abs, feel like you are sliding your ribcage down toward your pelvis. If you're not activating your abs properly, you might feel an ab separation when you don't actually have one!
Signs of DR
A gap of more than 2 1/2 finger-widths when your abs are fully engaged.
The gap does not shrink as you engage the abs.
When you engage your abs, you can see a mound protruding along the length of the midline of the belly.*
*If you see or feel a round, hard, or painful bulge protruding from your belly button area or anywhere along the midline of your belly, consult with your OBGYN.
Feel a separation?
Don’t panic! Especially if you are in the first few postpartum weeks. Remember how I said everyone has an ab separation after birth? Generally, the separation will regain its integrity and the “hole” will become shallower and narrower. So let's make sure you're doing the right things now!
Don't feel a separation but still feel like something is "wrong?" Schedule a free video consult with me and let's figure it out! There are plenty of common reasons you may be feeling pain, instability or lack of core muscle engagement!
Some things you may have heard about Diastasis Recti/Abdominal Separation and Postpartum Abdominal Reconditioning:
Pregnancy and ab separations cause permanent damage to your abdominal muscles.
True Diastasis recti requires surgical repair.
The abs will always be weaker and "floppier" after childbirth.
Women should wait for at least six weeks after delivery before beginning any abdominal exercises.
None of these statements are actually true!
Ok, you have DR. Now what?
Take a deep breath and tell yourself it's no biggie! I want to walk you through how to stay safe, how to be able to stay active and not aggravate the separation, how to avoid back and hip pain and, hopefully, how to recover without needing surgery! Surgery is always an option but you should always do whatever you can to try to "heal" without it.
Some Types of Movement to Avoid
Think of your abs like those old coin purses. Not the kind with a latch, but the ones that have a thin metal strip along each side on the top that, when squeezed at the ends, the strips open up and you can drop the coins in, but with no tension, the strips snap back together, keeping your change safe and sound in a glittery little bag.
So any "crunching" movements where you are "squeezing the coin purse" end to end will exacerbate the DR. Does that make sense? As you slide that ribcage toward your pelvis (as I Just instructed you to do!), those abs will open up even more! So that's a no-no.
And any movements where you have your coin purse upside down and gravity is pulling the weight of those coins down, the integrity of coin purse is compromised, too. Imagine a plank where you may not be totally crunching, but there is tension on the abs and gravity pulling down. Yeah. So don't do that either.
Tired of the coin purse metaphor? Me too. Here are some more No-Nos:
Movements where the torso twists around the spine and the hips stay in place.
Exercises that require lying backward over a large exercise ball - Both because this probably means you'll be crunching up and because you should avoid opening up and stretching out that area. So that also means yoga moves like “cow pose,” “up-dog,” all backbends, and “belly breathing.”
I'll go over this one again - No crunching the abs - so, again, no crunches (have I said no crunches yet?), oblique crunches, “bicycles,” roll-ups or roll downs, etc., etc., etc.**
No double leg extension. Even if your head is down and especially in the beginning of your rehab, no two leg extension/leg lift exercises.
The following exercises should be avoided if you don't have proper abdominal support in place: lifting and even carrying heavy objects (you'll know!), being on all fours, and, yes, even coughing and sneezing!*
And if I've missed any, if any exercise causes your ab wall to bulge out, don't do it!
*place your hands on each side of your belly and use your arms as a splint for your abdomen by pushing the sides together as you cough or sneeze. This will provide the support you need to help to prevent exacerbating the separation.
**During pregnancy, early postpartum, and if you have diagnosed as having DR, use the “log roll” maneuver when sitting up from a prone or supine position. (With your torso and head aligned and in one piece, roll over onto your side, then use your arms to help push yourself up to a sitting position.)
Is there anything I can do to prevent an ab separation or help it heal if I have DR?
YES! There is a lot you can do to help prevent or lessen the severity of DR. This is where we focus on the Transverse Abdominis, or TvA. We call this the girdle muscle - when contracted, it compresses the abdominal wall.
Keeping these active during pregnancy is key and making sure to maintain the neurological connection between your brain and the activation of these muscles will significantly help any DR from forming/staying/getting worse.
Even if you don't have DR (or never had a baby!), strengthening the TvA is pretty key to alleviating or avoiding back pain and instability in the pelvis. Coincidentally (or maybe not so coincidentally!), the TvA is what does a lot of the expulsion work in the pushing phase of labor.