Diastasis recti occurs in the last trimester of pregnancy and commonly presents in post partum moms. During pregnancy, the connective tissue (linea alba) between the two rectus abdominis muscle bellies (aka “six pack”) stretches to accommodate the growing fetus. Following pregnancy, the linea alba gradually resumes normal position and the rectus abdominis muscles return to pre-pregnancy tension. Unfortunately, 33% of post partum women maintain a significant gap between the rectus muscles even a year after delivery that can lead to disappointing results with tummy toning exercises. More importantly, in some women, diastasis recti may contribute to symptoms such as back pain, poor balance, abdominal discomfort, and incontinence. Performing traditional abdominal exercises such as plank, crunches, and bicycle can be ineffective and can even make symptoms worseL
So, if not traditional abdominal strengthening exercises, what CAN help diastasis? Anytime we are dealing with symptoms in the body that relate to length/tension relationship between muscle and connective tissue, it is important to assess MOVEMENT. Diastasis recti is not a condition neatly contained to one little structure or even one little region of our body. Rather, it is a symptom of poor movement patterns throughout the body that further result in poor intra-abdominal pressure management throughout the midsection. The goals of treatment are to improve upon poor movement patterns which can be a result of muscle weakness, ROM restriction, joint or muscle pain, connective tissue issues, impaired muscle coordination, poor posture, preferred and/or restricted breath patterns….and more. It is not uncommon to see several of these issues presenting at once in women following pregnancy. Each women’s post partum healing experience is different, which is why a thorough assessment performed by a movement specialist (aka physical therapist!) is essential in getting started.
There are thousands of Google hits out there on “the DO’s and DON’T’S of exercise“ for diastasis recti. I tell my new mom’s to “proceed cautiously” with these recommendations. Certainly, it is good to have guidelines, but each women’s post partum recovery experience is unique. The “do’s” can create frustration of movement (FROMO), while the “dont’s” can trigger fear of movement (FOMO). For example, it is common for women to be cleared by her doctor to return to all pre-pregnancy activities about 6-8 weeks after delivery. However, due to a detected or undetected diastasis, she may have difficulty lifting her 8# infant out of the car seat or off the floor. This seems like such a simple task, yet is commonly challenging for women with abdominal dysfunction. This can lead to self-doubt in performing day to day tasks and without treatment, can greatly affect her self-confidence in performing higher level activities in the future. Meanwhile, restricting movement without proper assessment may create unnecessary fear of movement. Some women with a gap, especially if evaluated and taught proper strategies for managing intra-abdominal pressure, may be able to perform a crunch or plank with good tension and technique. For these women, this may create fear in a movement they can perform successfully which can last a lifetime.
Diastasis recti is a condition that is often treatable and can greatly improve a women’s level of success in performing day to day activities and achieving recreational or high level fitness goals. Connecting with a physical therapist specially trained in working with women with this condition is the first step in establishing an effective program. Setting and discussing reasonable goals, receiving a baseline movement performance assessment, creating and implementing individualized treatment programs, and patient education are key in getting mom’s back on the right track on their road to healing diastasis recti.