Bringing a baby into the world (from pregnancy to childbirth) is one of the most amazing experiences for any mother. It also brings a lot of body changes. As an athlete and a physical therapist, I thought I would be able to avoid these changes. I did all the breathing, core exercises and practiced safe lifting techniques and transfers. However, I still ended up with a Diastasis Recti. Although I practiced the steps to avoid it, I could not avoid having a large baby (10lb 4.5 oz). This resulted in a lot of stretching of my abdominal wall. However, it doesn’t just happen to postpartum women.
What is Diastasis Recti?
Diastasis Recti is a separation of the Rectus Abdominus (Rectus) muscle. This is the muscle commonly known as the “six pack”. The Rectus muscle is a set of two muscles linked by a band of fibrous connective tissue called the linea alba. This muscle flexes our trunk forward and tilts our pelvis. During pregnancy the abdominal muscles get stretched, which causes the linea alba to become strained and lengthened.
Postpartum, this lengthening does not automatically return back to it’s normal approximation. This makes it difficult for the two sides of the Rectus Abominus to contract, stabilize and return to normal. The majority of women (60%) will recover from Diastasis Recti around 6 months.
Anatomy Review: The 4 Abdominal Muscles
There are four main abdominal muscles that work together to protect our organs and create stability for your spine. While Diastasis is referring to the Rectus Abdominis muscle, it is important to note that Diastasis can affect the entire abdominal area. When rehabilitating a Diastasis, studies have shown that recruitment and sequencing of abdominal contractions will affect the pressure on the linea alba. This pressure affects the separation. It is important to understand the anatomy of the abdominal region as a whole, as treatment may affect all of these muscles.
1. The Transverse Abdominis (Deep Abdominal)
This is the deepest (innermost) layer of the abdominal muscles that is under the obliques. This muscle is extremely important for stability of the lumbar spine. It creates a corset-like effect on the stomach/lumbar spine as it contracts and “flattens” out the stomach.
2. Internal Abdominal Oblique (Deep Abdominal)
The internal obliques also add stability to the abdomen and spine. These muscles rotate and side bend the trunk to the same side. They also play a role in respiration.
3. External Abominal Oblique
There are two external obliques on either side of the Rectus. These muscles help have a small stability role to the abdominal region. These muscles rotate the trunk to the opposite side and side bend to the same side
4. Rectus Abdominis
As explained above, the Rectus is a set of two muscles linked by the linea alba. It originates on the pubis and inserts onto the ribs and the sternum. The Rectus is covered by a fasical tissue sheath (aponeuroses) which is an extension of the transverse abdominus, and the internal and external obliques. When the pelvis is stationary (such as standing or sitting) this muscle causes our trunk to flex forward. When the ribs are stationary the rectus causes a tilt of the pelvis (posterior pelvic tilt).
As you can see the muscles of the abdomen are all closely related. When treating Diastasis it is important to incorporate treatment of all these muscles. Studies have shown that when treating a healing Diastasis a contraction of the transverse abdominis/internal oblique prior to a contraction of the Rectus can help decrease strain on the linea alba. In these same studies, contraction of the Rectus alone (without the deep abdominals) resulted in increased separation of the Rectus muscles and increased pressure/strain on the linea alba.
Types of Diastasis Recti
The separation of a Diastasis Recti can occur at different levels along the linea alba.
- Around the naval ( belly button)
- Above the naval
- Below the naval
- Open Diastasis – this includes all 3 types listed above
Personally, I have an open Diastasis with the most significant opening being around and above my naval.
Who is at Risk?
Anyone is at risk for Diastasis Recti but it is most common in pregnant and postpartum women. Large babies, multiple baby pregnancies (twins, etc.), successive pregnancies and babies of older mothers (over 35) are those with the highest risk.
However, men and newborns can get this too. The most common cause for men is from heavy lifting due to a significant increase in abdominal pressure (ie. poor core strength) or varying body weight (ie.”beer belly”). All babies are born with some form of separation. Some babies may have a more prominent Diastasis if they are premature. Sometimes the Diastasis can become worse as the baby uses their core to become more mobile (ie. sitting up or rolling). With newborns, Diastasis is usually not a concern and as it usually fixes itself as they grow.
Symptoms of Diastasis Recti
Symptoms may not present for months but can include:
- Low back pain
- Poor posture
- An abdomen that may “look pregnant”
- Hip and pelvic pain
- Pain with sex (women more than men)
- Urinary incontinence
For women, it is now more common for your health care provider (OB or midwife) to check for a Diastasis Recti at your 6 week postpartum visit. This is when I found out I had one. I had suspected I was getting one while I was pregnant, but did not actually check for it until later. By then I had an Open Diastasis.
Self-Check a Diastasis Recti
If you are suspecting a diastasis (even if it is years after your have given birth), you can do this self-check at home. If you do a self exam and have some of the symptoms above, I highly suggest having a health care professional evaluate you for a diagnosis and treatment of a diastasis. To self check you do as following:
- Laying on your back and bend knees up so feet are flat on the floor.
- With a hand behind your head, raise your shoulders up like you are looking down at your belly.
- Move your free hand above your naval at midline
- With your fingers in a horizontal position, see if you can fit your fingers between the gap of your Rectus Abdominus.
- Note how many fingers you can put in the gap
The Type of Diastasis you have is determined by how many finger widths fit into your gap.
- 1-2 fingers = normal
- 2-3 fingers = mild
- 3-4 fingers =moderate
- 4+ fingers =severe
Is There Hope for Recovery?
Of course there is! Even years post-baby, Diastasis can get better through proper treatment and exercise. The tissue will never be the same as before pregnancy, but the connection of the linea alba can improve. The more severe the Diastasis, the longer it may take to heal.
Important to note. Diastasis Recti recovery should not just focus on the abdominals. The core consists of the Diaphragm, Latissimus Dorsi, Scapular Retractors, Multifidus, Pelvic Floor, Abdominals, and Glutes. Treatment should be geared to all of these areas. If this full core approach is not used, too much pressure could be applied on the abdominals. This could make things worse.
Four Starter Exercises for Diastasis Recti
There has been conflicting information out there regarding what is “good” and what is “bad” exercise for those with Diastasis. This is very dependent on the person, severity, and what happens to the specific person’s diastasis when pressure is applied (aka exercise).
#1 Deep abdominal contraction with breathing and pelvic floor activation
- Laying on your back with knees bend and feet flat
- Inhale and relax pelvic floor and allow stomach to rise
- As you exhale lead with a pelvic floor contraction as you “wrap” your transverse abdominis. There should be a flattening like you are “cinching” your corset
- Then release by starting another inhale
#2 Deep abdominals with breathing and heel slide (to be done once you have control with breathing)
- Start with the above exercise
- Keeping heel down, slide heel out while maintaining abdominal contraction
- Pull heel back to starting position using lower abdominal.
- Laying on your back
- Knees bent and feet flat
- Arms straight and down by your sides with palms facing down
- Start with breathing and transverse abdominus breath
- Going into a bridge (lifting hips up) control each segment in a slow and controlled manner as you push arms straight down into floor
- Pause at the top
- Return to starting position in a slow controlled segmented manner
- Laying on your side with legs bend and hips stacked
- Breath in and let stomach rise
- Breath out and contract the deep abdominals
- Keeping heels together, open the top leg while maintaining the core contraction. (This can be done with heels down or heels off).
- Slowly return leg to starting position.
Once these exercises have been mastered safely and effectively, then progression can occur into more dynamic exercises.
For all of you out there recovering from Diastasis Recti, stick with it. Personally, it has been very difficult for me to see my body having a hard time “bouncing back” from birth. But, I try to remember that my body did something amazing. It grew and birthed a baby, and that’s pretty incredible. Every women’s timeframe and healing journey is different. Remember to love you and love your body.
© 2018 and Beyond. ALL BLOG CONTENT at duncansportspt.com by Abbey Campbell, DPT
Our clinic offers exceptional, 1:1 care physical therapy in Boulder County.
ABOUT THE AUTHOR
Abbey Campbell, DPT is a physical therapist practicing in Lafayette, CO at Duncan Sports Therapy + Wellness. Abbey is a former collegiate athlete swimmer and a new mother. She uses a whole-body, movement-based approach to heal injury and pain. Abbey is passionate about preventative care and patient education to get her patients back to happy, healthy movement.