What is Diastasis Recti?
Diastasis Recti is a common condition that affects many women during the childbearing years. As a fetus grows within the uterus, the uterus expands, which places stress across the structures surrounding it, specifically the muscles. The primary abdominal muscle on the front side of the body is called the rectus abdominis. This muscle is divided into a left and right half by a thick band of connective tissue called the linea alba. You may hear people talk about "6-pack abs"; this is referring to the rectus abdominis. As the uterus expands, stretching across the rectus abdominis potentially could occur. In some cases, the weakening and stretching of the linea alba connective tissue creates a separation between the right and left sides of the muscle, or diastasis.
Diastasis Recti may affect women during and after pregnancy. Typically, DRA develops in the second or third trimester. It is during this time that the fetus is growing most rapidly, and can result in the greatest increase in distance between the 2 sides of the muscle.
There are several factors that may make a woman more susceptible to developing Diastasis Recti. These include age, being pregnant with multiple children (multiparity), and having many pregnancies. The abdominal muscles have many important functions within the body, including postural support, movement, breathing, and protection of the internal organs. Therefore, if their structure is affected by Diastasis Recti, a woman may have difficulty controlling her posture, which may put her at an increased risk for injury. Additionally, for a woman juggling the many stresses of having a new baby, the discomfort, weakness, and changes to postural control that may result from Diastasis Recti can negatively affect her quality of life.
Do I have Diastasis Recti?
Most women with Diastasis Recti report a feeling of their abdominals being ‘too loose’ or that they feel that their abdominals just aren't supporting them. Some women feel low back or pelvic pain, while others have urine leakage or a feeling of bulging, either in the abdomen or in the pelvic floor.
Sound familiar? While your OB-GYN or a women’s health physical therapist can evaluate your core for Diastasis Recti using calipers or an ultrasound – whether you are a few weeks or a few years postpartum – you can also get a sense of any separation with a simple at-home test.
Here’s how: Lie on your back with your knees bent and your abdomen easily visible. Place your pointer and middle fingers together and pointing down directly over your navel. Lift your head and shoulders off the floor as if you were performing an abdominal crunch. While carefully holding the lift, press your fingers down into your stomach, feeling the distance between the left and right sides of the muscles and the gap they may or may not form, explains physical therapist Lauren Tadros, supervisor of outpatient physical therapy at NYU Langone’s Joan H. Tisch Center for Women's Health. Work your way up and down the midline of your stomach, feeling from about 2 inches above to approximately 2 inches below your navel. If you notice a gap greater than two finger-widths along any point, then it’s likely that you have Diastasis Recti.
4 Exercises to Heal Diastasis Recti
Hold off on your usual core work. Exercises like crunches or situps can actually worsen the Diastasis Recti if the muscles aren't first taught to sync up in the best way with the pelvic floor and respiratory muscles. We used to be concerned about narrowing the Diastasis Recti, but the latest research actually focuses more on this ‘syncing up’ of the muscles and how a ‘tensioning' of the abdomen is likely more important than actually 'closing the gap’.
The quality, tension, and density of the connective tissue is what’s important in assessing the healing process. You can still have a gap with a healed diastasis. We're looking for function, this means when you're assessing yourself for Diastasis Recti, you’ll feel strong, taut tissue under your fingers when you press into your belly, exhale and lift your head. You should not have tissue doming or bulge out.
Start by performing these rehab exercises daily. (While you should always talk to your doctor before beginning a post-pregnancy exercise program, these moves are designed to be gentle enough to begin even one to three weeks postpartum.) Try reassessing your Diastasis Recti every two to three weeks to gauge your progress.
1. Abdominal Drawing In
When getting in and out of bed, lifting or carrying your baby or getting up from a chair, pull in your stomach as if you were trying to fit into a tight pair of jeans. You should be able to hold this abdominal muscle contraction and breathe normally for 10 seconds. This exercise will safely start to engage and strengthen your abdominal muscles without compromising them.
2. Belly Breathing
Lie flat on your back on a mat. Take a deep inhale, allowing your belly and then your chest to fully inflate. Then, slowly and forcefully exhale, drawing your abdominal wall in as if you had a corset on as you do so.
3. Heel Slides With Alternating Arms
Lie flat on your back on a mat, with your knees bent and feet flat on the floor. Straighten your arms and raise them directly over your shoulders. Exhale, and slowly extend one leg out in front of you, letting it hover a few inches above the floor, and simultaneously extend the opposite arm back above the head, just off of the floor. Inhale and slowly return to start. Repeat on the opposite side. Work to keep your hips and core stable through the entire movement.
4. Quadruped Abdominal
Get on all fours (hands under your shoulders and knees under hips) and pull your shoulders wide and away from your ears to form a flat back. From here, take a slow, deep inhale, allowing your abdominal wall to relax and expand toward the floor. Then exhale, drawing the muscles up and in while maintaining a flat back.
Want some help with your diastasis recti? Agape Physical Therapy is here to help. We offer Women's Health Physical Therapy and Pelvicore Classes too. Request an appointment with one of our trained physical therapists or email Natalia Farnsworth or Kristina DiMartino to learn more and schedule an evaluation.