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June 15, 2022 2 Comments
Falling into the swing of things post-baby is challenging to say the least. Late-night feedings, a healing body, and a new baby (while amazing!) are a lot to take on all at once. It also doesn’t leave a lot of time for re-kindling your fitness routine, a feat that can seem even more challenging when also dealing with diastasis recti.
Many factors can cause abdominal separation, including old age, intra-abdominal pressure, weight lifting, and weight gain. However, pregnant and postpartum women are the most susceptible to diastasis recti, a common health issue that results in the separation of the two rectus abdominis bellies: the muscles that are visible when someone has a six-pack. It is so common that research estimates that up to 90% of women in early postpartum have it1. Now, your little bundle of joy is more than worth all of the changes your body goes through, but diastasis recti can take a toll on your body and self-esteem.
For some, diastasis recti heals on its own, but around 60% are still dealing with it around six weeks postpartum, and 39% are still affected six months postpartum. This abdominal separation can wreak havoc on the pelvic muscles and lead to some other serious health issues - the last thing a new mom (or anyone, for that matter) wants to deal with! Fortunately, there are ways to close your diastasis recti. And while we can’t watch your little one while you take a quick power nap, we can help you with this.
In this article, we’ll cover:
Remember, it took nine months of stretching to get to this point, so it won't disappear overnight. But with proper exercises, breathing techniques and contractions, and some safety precautions, you can close the separation of your rectus abdominis muscles and start to feel like your old self again.
As the uterus expands during pregnancy to continue making room for your growing baby, the ab muscles and surrounding connective tissues also have to stretch. As these muscles and tissue stretch and there is additional stress and strain placed on them, it can lead to the rectus abdominis muscle flaps separating, causing diastasis recti2. This separation can occur during pregnancy or postpartum.
Typically, with diastasis recti, it is easy to see visible separation or a bulge between the two bellies of the rectus abdominis muscle. If the rectus abdominis separation is greater than 2 fingers, around 2 to 3 centimeters in width and 2 to 5 centimeters in length, it's typically considered an issue2. Factors contributing to diastasis recti include hormones such as relaxin, progesterone, and estrogen, the fetus placing stress on the abs during growth, and re-shifting of the organs in the abdominal area to make room for an expanding uterus (and baby!).
The expanding uterus causes the abdominal wall’s strength and mechanical control to become jeopardized. The abdominal separation can have detrimental impacts on pelvis stability, posture, and trunk mechanics, potentially leading to issues with the lower back, trunk movement and flexibility, and abdominal function. If you consider how important the abdominal muscles are to posture and stabilization, and the role the pelvic muscles play in protecting internal organs, including the bladder, uterus, and rectum, the seriousness of diastasis recti becomes very obvious. Weakness and separation of these stabilizing muscles affect everything from how you sit, stand, walk, and run, to how you're able to rotate, and your ability to bend over.
The pelvic floor muscles, consisting of muscle and tissue running from the front of the pubic bone to the back of the coccyx and side-to-side on the sitting bone, are also impacted by diastasis recti. The abdominal and pelvic muscles work together, so when abdominal strength suffers you can assume your pelvic muscles are struggling as well. Spanning the bottom of the pelvis, they protect and support several organs and work with the abdominal, back, and diaphragm muscles to provide spine support and abdomen pressure. When they’re weak, it’s a recipe for injury. And while diastasis recti isn’t usually a cause of pain, all of the issues it causes can lead to pain, both during and after pregnancy.
For most, yes! It’s important to remember that everybody is different, so what works for some may not help someone else as effectively. However, research shows that many women who perform exercises to strengthen their core can effectively close their diastasis recti1.
First and foremost, please be gentle with yourself as you heal from diastasis recti and your pregnancy. We don’t have to tell you how hard it is to carry and then have a baby, but we don’t want you to lose sight of it in your desire to fix your abdominal separation.
If you are unsure whether you have diastasis recti, this is an easy way to check.
As with all health concerns, make sure to talk to your doctor about it, get their advice, and most importantly get the okay to proceed with physical activity. One of the best ways to help your diastasis recti in the early postpartum phase is to avoid activities that may worsen your abdominal separation.
Avoid activities like lifting heavy things and straining your abdominal muscles when sitting up. At first, it’s safer to roll to your side and push yourself up with your arms rather than straining your core.
To heal diastasis recti, strengthening your deep transverse abdominis muscles is crucial. The stronger the transverse abdominis, the more support they can provide to your stretched rectus abdominis and pelvis muscles.
A study of exercises for diastasis recti found that the most successful ones focused on core muscle hypertrophy2. Overloading the transverse abdominis muscles increases motor unit recruitment, resulting in stronger core muscles, and improves endurance and power. As your core is responsible for helping stabilize your body in almost all movements, strength, endurance, and power are what your abdominal area needs. A strategy for fatiguing your transverse abdominis muscles - while doing so gently as your body is still healing - is through safe movement, prolonged contractions, and focused breathing. As your transverse abdominis strengthens, it starts to shorten your rectus abdomens muscles, closing the separation of the recti muscles.
Step one in your healing process involves deep breathing exercises. This move's purpose is to help you focus on the transverse abdominal and pelvic floor muscles as you take long, deep breaths. By tightening your core, you are also encouraging a posterior tilt at the end of the exercise, which is essential for promoting core contraction and trunk strength.
How to do transverse abdominal breathing:
Abdominal bracing is another exercise that focuses solely on breathing and practicing abdominal contractions. None of the other movements on this list will be effective if you can't fully contract your deep core muscles. Focus on deep breaths and core contractions during this exercise.
How to do abdominal bracing:
A great alternative to a standard plank, this strengthens the transverse abdominis without placing unnecessary stress on the weakened abdominal muscles.
How to do a bent-knee side plank:
No diastasis recti exercise list is complete without the dead bug exercise, an ideal move for safely working the core and pelvic floor. It will activate your transverse abdominis, pelvic floor muscles, and erector spinae muscle group and provide that much-needed stabilization to your core and pelvis.
How to do the bent-leg dead bug:
The reverse sit-up, also called a bent knee leg lift, activates your core without placing too much stress on the abdominal and pelvic area. Lying down on your back provides extra core stability, so you work the muscles without pushing them off and worsening separation. You can also make this move easier if you need to by lifting your legs, bending your knees, and holding this position. Or, try alternating toe taps, only lowering one foot at a time.
How to do a lying bent leg raise:
In addition to strengthening your core, activating all of the surrounding muscles that help support the core is a good idea. At the top of the must-strengthen list are the glutes and hip flexors. Enter: the glute bridge, a great butt muscle and hip strengthening activity that also requires core activation. And as you’ll be in a lying-down position, you can do it all safely.
How to do the glute bridge:
Activation of the transverse abdominis and obliques? Check. A safe exercise that won’t worsen separation of the abdominals? Double-check! The bear plank is a challenging exercise that strengthens your deep core muscles, great for protecting the spine, stabilizing the lower back, and correcting diastasis recti.
How to do the bare plank:
A seated trunk twist may seem simple at first glance, but don't be fooled! We promise it’s working your transverse abdominis and pelvic muscles while encouraging deep breaths for the diaphragm. As an eventual progression, you can hold a light dumbbell or medicine ball as you twist.
How to do a seated trunk twist:
A progression from the bent knee side bridge, you can continue making this more difficult by eventually straightening both legs. But for now, as you continue strengthening your core, we suggest mastering this one before attempting an even more challenging version. Your body (and core!) will need to work harder to hold yourself up in this exercise, as one straightened leg adds some instability to the movement.
How to do the side bridge with a bent leg:
The straight leg dead bug is a progression from the bent-leg dead bug as your core will have to work extra hard to keep your legs straight throughout the exercise. This variation requires lower core strength to complete, so master the other moves on this list before progressing to this exercise.
How to do the straight leg dead bug:
While your abdominal separation is healing, avoid lifting heavy objects, bending backward in an abdominal stretch, harshly twisting the abdominal area, activities that cause the stomach to bulge out, crossover exercises, or exercises that place too much pressure on the abdominal wall.
This list certainly doesn't include every exercise you should avoid, but this will give you an idea of the major exercise no-nos and the types of movements you shouldn't attempt.
Avoid:
We know you want your abs back, but these movements can be harmful. In the beginning, you should avoid doing them, and we recommend staying away until your doctor clears these abdominal exercises. It’s also best to get clearance from your practitioner before starting a weight-lifting, running, or HIIT program. These exercises all involve using weights or performing activities that place a lot of stress on the body, so it’s best to make sure they won’t have negative health implications for you before starting.
A waist band trainer, belly wrap, or postpartum girdle that provides compression around your core won't directly heal diastasis recti. However, it can help to promote better stability, mindfulness of diastasis recti, and posture, which can reduce back pain and help with things like carrying your newborn!
That said, there are some risks with waist band trainers. Squeezing them too tight for too long can exacerbate diastasis recti. What you want is a light yet tight pressure, which will feel supportive and not uncomfortable.
After 2-6 weeks of wearing one, it's best to stop wearing it, as to allow yourself to naturally continue healing and building strength in your abdominal region.
If you want to get a compression waist band for postpartum support, we recommend the Belly Bandit or Bellefit Postpartum Girdle Corset.
Those two are generally safe options that many mothers recommend and OBs clear for use:
"I used the belly bandit - I only wore it during the day but I felt like it helped. I had to use two different sizes in my recovery, I probably wore each for 6 weeks each. I had a twin pregnancy with a major diastasis recti. I could fit my fist between my left and right abs. Between the binder and some pt exercises, my abs were closed by two months post partum. I still have loose skin but at 4.5 months pp I am on my way back to "normal". So my experience was good and I cleared it with my OB first." (source)
"I have to put in a word for belly binding since everyone seems against it so far. Mine really helped my back pain. A lot. It seemed like it helped correct my center of gravity and helped my super sore ab muscles after delivery. I only wore it if I was up and walking around for more than a few minutes. I had some diastes recti during pregnancy and I definitely wanted to make sure my muscles healed and did most of the work, but I thought they deserved a break. I still have a looser squishier belly but it helped a lot of the swelling go down. I also felt kind of sick and off with all my organs rearranging again and the binding seemed to relieve some of that. I will be using a belly binder after any more kids I have. I also used a belly support band during pregnancy. It was a lifesaver.
Edit: I used a belly bandit" (source)
Photo courtesy of Belly Bandit on Amazon
Here are some answers to the most common questions about diastasis recti.
Unfortunately, untreated diastasis recti can take a toll on your body. Due to the protection and stabilization your abdominals and pelvic muscles provide to your trunk, back, and organs, a weakened core can cause many problems. Some of the consequences of diastasis recti include3:
It depends on the severity of your diastasis recti, but multiple studies have shown that it can take anywhere from 6 weeks to 4 months to fix diastasis recti2.
You should perform diastasis recti exercises at least once per week, but several studies yielded good results for participants by requiring three times per week2. One is certainly better than none, but we suggest three times per week for best results and quicker abdominal separation closure.
Physical therapy requirements are a very individualized thing. Unless your primary care physician or ob-gyn suggests seeing a physical therapist, we suggest first using diastasis recti exercises and breathing techniques to see if these will fix your diastasis recti. If you aren't seeing results around the three to four-month mark, visiting a physical therapist, or at the very least following up with your doctor, is a good idea. They can examine your diastasis recti and prescribe personalized workouts to help yield better results. A physical therapist may also suggest safe stretching techniques and possibly a brace, depending on what they find.
While diastasis recti is most common in postpartum women, it can affect anyone, including men. If you are a man with diastasis recti, the same advice and exercises in this article apply to you too.
There are two workouts here: a beginner one and an advanced version. The beginner workout is for anyone just starting to fix their diastasis recti, whether you are eight weeks or four months postpartum. These exercises focus primarily on deep breathing, practicing muscle contractions, and exercises that provide plenty of support and stability. You should do the beginner workout for at least three weeks, but stay here longer than this if you’re not seeing much progress with your diastasis recti. Then you can move on to the advanced workout, which still incorporates breathing exercises but includes some of the more challenging progressions that may challenge your core even further (and still safely!).
As you move through these routines, focus on contracting your abdominal muscles for five seconds for each rep. Powerful contractions will strengthen your deep abdominal muscles and begin to help close your diastasis recti2. When you’re first starting, stick with lower repetitions of 10-12, increasing up to 20 as your abdominal area gets stronger. In addition, we recommend adding some walking as light cardio after each of these routines. Walking requires your core to engage, is low impact, and as a bonus, is something you can easily do with your baby (consider your stroller your new best friend). It’s a great addition to your postpartum workout.
One other note: While we're targeting the primary diastasis recti audience - postpartum women - these workouts are effective for anyone with diastasis recti. So no matter what your situation is, if you have abdominal separation and have been cleared by your doctor to partake in physical activity, these exercises are for you!
Exercise |
Sets |
Reps |
Rest |
Transverse Abdominal Breathing |
3 |
10-20; holding each rep’s contraction for 5 seconds |
20-30 seconds |
Abdominal Bracing |
3 |
10-20; holding each rep’s contraction for 5 seconds |
20-30 seconds |
Bent-Knee Side Plank |
3 |
10-20; holding each rep’s contraction for 5 seconds |
20-30 seconds |
Bent Leg Dead Bug |
3 |
10-20; holding each rep’s contraction for 5 seconds |
20-30 seconds |
Lying Bent Leg Raise |
3 |
10-20; holding each rep’s contraction for 5 seconds |
20-30 seconds |
Glute Bridge |
3 |
10-20; holding each rep’s contraction for 5 seconds |
20-30 seconds |
Bear Plank |
2 |
10-20; holding each rep’s contraction for 5 seconds |
20-30 seconds |
Walking |
Aim for 30 minutes, averaging 3- 3.5 miles per hour. |
|
|
Exercise |
Sets |
Reps |
Rest |
Transverse Abdominal Breathing |
3 |
10-20; holding each rep’s contraction for 5 seconds |
20-30 seconds |
Abdominal Bracing |
3 |
10-20; holding each rep’s contraction for 5 seconds |
20-30 seconds |
Bear Plank |
3 |
10-20; holding each rep's contraction for 5 seconds |
20-30 seconds |
Reverse Sit Ups |
3 |
10-20; holding each rep's contraction for 5 seconds |
20-30 seconds |
Seated Trunk Twist |
3 |
10-20; holding each rep's contraction for 5 seconds |
20-30 seconds |
Side Bridge with One Bent Leg |
3 |
10-20; holding each rep's contraction for 5 seconds |
20-30 seconds |
Straight Leg Dead Bug |
3 |
10-20; holding each rep's contraction for 5 seconds |
20-30 seconds |
Walking |
Aim for 30 - 40 minutes, averaging 3.5 - 4 miles per hour |
|
|
As you progress, you can check whether your abdominal separation is beginning to close using the same test we walked you through earlier in this article. You can re-test weekly, making notes of any changes. Is there more tension when you push down? Instead of a three-finger gap, is it closer to two this week?
Let these changes guide how you progress and when to make things more challenging. Don’t get discouraged if you haven't noticed any changes after the first week. Consider it your body's way of telling yourself you need more time. Instead, plan to follow the same routine you did in week 1 with no additional challenges. If you notice a little more push-back when you press your fingers down the following week, it may be a sign that you can add a few additional reps to next week’s lineup.
As with many things postpartum, it’s important to remember that your body just got done going through nine months of changes, and now as it adjusts to postpartum life, it's going through even more. And whether you are six weeks postpartum or six months postpartum, it is never too late for you to start strengthening your core. Move slow, be gentle, and give your body plenty of time to heal. You can fix your diastasis recti; it just might take some time to get there!
Related: Can You Workout While Pregnant?
References:
August 25, 2023
Absolutely! This separation can cause a number of issues, including decreased core strength, poor posture, and significant discomfort. But I found out that there are principles that govern fitness and body sculpting. One of them is “Form follows function.” You train how you want to look. If you want a flatter belly, you need to train in ways that shape those muscles into that form. Exercises that cause you to bulge your belly out won’t help, especially if you have unresolved diastasis. That outward pressure will just strain that sensitive fascia even more!
By engaging in diastasis recti exercises, mothers can reclaim their strength, functionality, and well-being, empowering them to navigate the joys and demands of motherhood with greater ease and resilience.
Blessing,
July 07, 2023
My daughter is 44 and I noticed my abdominal separation was extreme, since I was a petite woman. She was born in a third world country so there were no treatment in the 70’s. Now I have extreme pelvic pain which hampers my ability to enjoy many activities and simply living my best life. I can barely pick up something off the floor without pain. Simply turning and getting out of bed is painful. Coughing and sneezing is painful. Is this too late for me? I have done the crunches, planks and this only made my symptoms worse. I believe diastases recti is my problem, so thank you for the information. I have tried many doctors and no once seems to diagnose me, sometimes I feel they think I am crazy.
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