Diastasis Recti Rehab

What is diastasis recti? Your rectus abdominis muscle is the traditional “6 pack” abdominal muscle, and it connects on either side of your body through a piece of connective tissue called the linea alba. During pregnancy as the belly expands, the linea alba stretches and thins, resulting in an increase in the separation between each side of the muscles. Studies indicate that the prevalence of diastasis in pregnancy can vary between 30-70% of pregnant people. Many people recover without any rehabilitation during the postpartum

period, although some people may benefit from pelvic floor therapy. Studies indicating prevalence vary wildly, with some studies suggesting that 82% of participants presenting with diastasis 12 months postpartum(1) and other studies suggesting that 32% of participants were presenting with diastasis at 12 months postpartum(2). Diastasis can occur in people who have not been pregnant as well, due to habits that place increased pressure on the linea alba, including poor core mechanics or straining to pass stool. A functional diastasis is two finger widths apart. If your diastasis is wider than two finger widths, or you’re still feeling disconnected from your core postpartum, it can help to see a pelvic floor physical or occupational therapist.

Why seek help?

Connecting a strong and dynamic core allows you to move through postpartum life with a decreased risk of pain and dysfunction. In early postpartum life, you’re suddenly “strength training” many times a day by picking up, holding, and putting down a 6-10+lb weight--your baby--many times a day. Postpartum rehab will help teach your body to activate more of your deepest abdominal muscle, your transversus abdominis, which will put less strain on your diastasis, and will allow you to feel not only confident in performing your new day to day tasks with your baby, but will give you the support and coordination you need to return to exercise.

What to do?

Many people associate “core exercises” with things like crunches, v-sits, or planks. Ideally, people in early diastasis recovery are not performing those exercises, as they put more pressure on the linea alba. Your pelvic floor therapist will teach you simple ways to use your breath to activate the transversus abdominis muscle, facilitating increased strength. Besides working on deep core strengthening, there are many other important aspects of a person’s lifestyle that are important to address for diastasis healing.

Posture

Posture can play a big role in diastasis rehab. Many pregnant people compensate for the new center of mass by leaning backwards, which can place an increased stretch on the linea alba. Other postural habits that can create more tension on the linea alba are flaring the ribs, excessively anteriorly or posteriorly tilting the ribs, rounded shoulders, and forward head posture. Body mechanics throughout the day, including always holding your baby in one particular way, can also place stress on your rectus muscle. Finding dynamic postures and body mechanics throughout the day can help the abdominals activate more effectively,

Breath holding/Pressure management

Many of us tend to hold our breath when we’re doing something that requires a lot of strength, including picking up something heavy, pushing a heavy stroller, or even putting away groceries. Breath holding can put excessive strain on the linea alba due to increased pressure in the abdominal cavity. It’s important to try to “blow as you go” or “exhale on exertion” and make sure you’re not breath holding when you don’t need to be.

Exercise

Returning to exercise too quickly postpartum, especially heavy weightlifting, can put a strain on your diastasis. Diastasis healing is also about taking the time you need to recover proper core functioning. For some people this is 2 months, for others it looks more like 18 months. Returning to exercise slowly and with the guidance of your pelvic floor therapist will help you know which exercises you can do with confidence and control, and which exercises you need to build back strength for.

Constipation

Managing chronic constipation can become a very important part of diastasis management. People with long term constipation may be used to straining or using breath holding to pass stool, which puts excess pressure on the linea alba. Your pelvic floor therapist can work with you to build better bowel habits to ensure that you’re not straining to pass stool.

So what next?

Diastasis healing is multifactorial, involving proper muscle recruitment and coordination, spinal and thoracic mobility, breathing mechanics, posture and functional movement training, and managing bowel habits. Our pelvic floor therapists are trained to look at your holistically in order to best support your core rehabilitation and diastasis healing. Check out the Heal Your Core Mini Course by The Healthy Pelvis Project.

References

1. Fei, H., Liu, Y., Li, M., He, J., Liu, L., Li, J., ... & Li, T. (2021). The relationship of severity in diastasis recti abdominis and pelvic floor dysfunction: a retrospective cohort study. BMC Women's Health, 21(1), 1-8.

2. Sperstad, J. B., Tennfjord, M. K., Hilde, G., Ellström-Engh, M., & Bø, K. (2016). Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British journal of sports medicine, 50(17), 1092–1096. https://doi.org/10.1136/bjsports-2016-096065