Diastasis Recti - Do's and Don'ts
Diastasis recti occurs when the connective tissue in the abdominal wall thins and contributes to your rectus muscles (think 6-pack) moving away from the midline
While diastasis recti is defined by the gap between the rectus muscles, it is actually more accurately reflected as the inability to create tension in the linea alba - the connective tissue that holds the 2 straps of the rectus abdominis in place at the midline.
The distance between the 2 rectus muscles is called the inter-recti distance and is what is most commonly measured in a diastasis recti assessment. There has never been a consensus on what is considered a normal inter-recti distance but it is perhaps commonly agreed that somewhere around a 1-2 finger gap would be 'normal'.
After pregnancy and birth, it is common to have a gap that is 3 or 5 or even 7 fingers wide but more and more research is pointing to the fact that the inter-recti distance is not the biggest determinant of function but rather the ability of the connective tissue to generate and maintain tension needed for control and support.
Diastasis recti is considered a normal response to pregnancy and it is important to be aware of it so you can take a proactive approach to managing the development of the condition while pregnant and then know how to optimize recovery so you can return to full form and function.
To determine if you have diastasis recti, you can perform a self test
- Lie on your back in a comfortable position. Bend your knees and put your feet flat on the floor.
- Place one hand on the midline of your core with your fingers flat on your midline.
- Place your other hand under your head and neck for support. Lift your head slowly and begin adding pressure through the pads of your fingers.
- With no diastasis recti, there is the sensation of a toned wall as you lift your direct. If you feel a space, or your fingers sink into your core, you likely have diastasis recti.
- Repeat the procedure for the areas directly above your belly button down to the pubis to determine whether the diastasis recti is isolated or in your core as a whole.
Here is a general list of do’s and don’ts.
- Pay attention to how you hold your body in pregnancy- your posture. Here is a great video explaining it.
- See a pelvic floor physiotherapist to have your abdominal wall assessed as well as your pelvic floor. The key to healing the abdominal wall is a pelvic floor that is working synergistically as part of the inner core unit.
- Move in varied ways. Restricting movement for fear of making it worse is not ideal. Move with awareness and find ways to move that does not contribute to doming or an inability to manage the pressure.
- Wrap the pelvis/belly postpartum. By providing temporary external support to the pelvis and abdomen in the early weeks postpartum it helps support the muscles that are hindered in their ability to contribute to control. Internal support is re-trained with the use of restorative exercises.
- Re-train the core. Healing the abdominal wall requires core synergy between the diaphragm, the pelvic floor, the transversus abdominis and the multifidus - the core 4. Re-training the synergy with posture and restorative exercise is key.
The Core Confidence Program is an 8-week core retraining protocol that is very effective.
- Don't Stop Exercising. Many women with diastasis often stop doing core work or stop exercising for fear of making it worse. Doing nothing does not support healing. Movement does. It is about finding what movements you can do that do not contribute to doming in the abdomen.
- Don't Panic. The internet has contributed to a lot of fear. Many people have gaps that are larger than 1-2 fingers and are completely functional and not limited in movement.
- Don't Practice Static Front-Loaded Positions in Pregnancy. When the abdominal wall is under stretch and strain as the pregnancy progresses, it is advisable women avoid static front-loaded positions like plank and bird dog. They place further load on the connective tissue and are not functional. Dynamically loading the abdominal wall such as doing a deadlift is much more effective and trains you for putting your baby into a crib and picking up a car set.
You deserve to be supported through your pregnancy, birth and postpartum recovery.