Diastasis Recti

Word Origin:
Diastasis, from Greek, meaning separation
Recti: refers to the rectus abdominis muscle (see illustration below)

Definition: Diastasis recti is a fairly common condition of pregnancy and postpartum in which the right and left halves of Rectus Abdominis muscle spread apart at the body's mid line fascia, the linea alba.

Widening and thinning of the mid line tissue occurs in response the force of the uterus pushing against the abdominal wall, in conjunction with pregnancy hormones that soften connective tissue. A mid line of more than 2 to 2.5 finger-widths, or 2 centimeters, is considered problematic. Diastasis recti can occur anytime in the last half of pregnancy but is most commonly seen after pregnancy when the abdominal wall is lax and the thinner mid line tissue no longer provides adequate support for the torso and internal organs.

A small amount of widening of the mid line happens in all pregnancies and is normal. Diastasis recti occurs in about 30% of all pregnancies. Some postpartum women's mid lines close to less than 2 finger-widths spontaneously, but for many, the tissue remains too wide, causing problems.

Diastasis recti can also be seen in infants and adults with excessive abdominal visceral fat.


Illustration of normal abdomen, without diastasis recti/abdominal separation. Illustration of diastasis recti/abdominal separation after pregnancy.

Diastatsis recti reduces the integrity and functional strength of the abdominal wall and can aggravate lower back pain and pelvic instability. Separation in a previous pregnancy significantly increases the probability, and severity, of the condition in subsequent pregnancies. Women expecting more than one baby, petite women, those with a pronounced sway back, or with poor abdominal muscle tone are at greatest risk. Genetics also plays a big role. For some women, it simply how their bodies respond to pregnancy.

Unfortunately, flurries of misconception swirl around diastasis recti and abdominal exercise during and after pregnancy in general. You're likely to encounter a broad range of contradictory opinions and advice about how to recondition your abdominal wall and how to restore the midline after childbirth. Some of these assertions can cause unnecessary alarm, while another common piece of advice-do a lot of "crunches"-can actually worsen diastasis recti/abdominal separation.

COMMON MYTHS about Diastasis Recti/Abdominal Separation and Postpartum Abdominal Reconditioning:

  • Diastasis recti/abdominal separation causes permanent damage to your abdomen.
  • Diastasis recti/abdominal separation requires surgical repair.
  • Diastasis recti/abdominal separation causes permanent bulging of the abdomen, i.e., "mummy-tummy."
  • Diastasis recti causes pain.
  • The abdominal muscles will always be weaker after childbirth.
  • All women should wait for at least six weeks after delivery before beginning any abdominal exercises or postnatal reconditioning program.

None of these statements are true!

Diastasis Recti/Abdominal Separation Test

This simple self-test will help you determine if you have diastasis recti.

  1. Lie on your back with your knees bent, and the soles of your feet on the floor.
  2. Place one hand behind your head, and the other hand on your abdomen, with your fingertips across your midline-parallel with your waistline- at the level of your belly button.
  3. With your abdominal wall relaxed, gently press your fingertips into your abdomen.
  4. Roll your upper body off the floor into a "crunch," making sure that your ribcage moves closer to your pelvis.
  5. Move your fingertips back and forth across your midline, feeling for the right and left sides of your rectus abdominis muscle. Test for separation at, above, and below your belly button.
Woman demonstrating test for diastasis recti/abdominal separation.

Use Correct Form for an Accurate Assessment

Make sure that you don't simply pull your head off the mat-a common mistake. To effectively contract your abs, you need to move your ribcage closer to you pelvis. If you don't adequately activate your abdominal wall, you might assume that you have abdominal separation. But for most, as the rib cage moves closer to the pelvis and the contraction deepens, the width of the gap at your midline will decrease.

Don't panic if you feel a "hole" in your belly in the first few postpartum weeks. Everyone's connective tissue at the midline is lax after childbirth. As you recover, your midline will slowly regain its former density and elasticity, and the "hole" will become shallower, and if you do the right exercises, more narrow too.

Signs of Diastasis Recti/Abdominal Separation

  • A gap of more than 2 1/2 finger-widths when the rectus abdominis is fully contracted.
  • The gap does not shrink as you contract your abdominal wall.
  • You can see a small mound protruding along the length of you midline.

NOTE:
If at any time you see a round, hard, or painful bulge protruding from your belly button area, or along your mid line, consult with your OBGYN.

Special Precautions for Women with Diastasis Recti/Abdominal Separation

Avoid all activities that place stress on the midline, that stretch or overly expand the abdominal wall through everyday activities, exercise, or breathing techniques.

Some Types of Movement to Avoid

  • Movements where the upper body twists and the arm on that side extends away from the body, such as "triangle pose."
  • Exercises that require lying backward over a large exercise ball.
  • Yoga postures that stretch the abs, such as "cow pose," "up-dog," all backbends, and "belly breathing."
  • Abdominal exercises that flex the upper spine off the floor or against the force of gravity such as: as crunches, oblique curls, "bicycles," roll ups/roll downs, etc.
  • Pilates mat and reformer exercises that utilize the "head float" position, upper body flexion, or double leg extension.
  • Any exercise that causes your abdominal wall to bulge out upon exertion.
  • Lifting and carrying very heavy objects.
  • Quadruped exercises without adequate abdominal support.
  • Intense coughing without abdominal support.

During pregnancy or after childbirth, if you develop a cough from allergies or a respiratory illness, such as a cold or flu, place your hands across your belly and manually splint your abdomen together during coughing episodes. This will provide needed additional support, and help to prevent separation of your midline.

To protect your mid line during pregnancy, always use the "log roll" maneuver when rising from the floor or out of bed. Log roll: with your torso and head aligned and in one piece, roll over onto your side, then use your arms to help push yourself up to a sitting position.

Exercises to Prevent or Lessen the Severity of Diastasis Recti/Abdominal Separation

You can do a lot to help prevent or lessen the severity of diastasis recti by strengthening your deepest abdominal muscle, your Transverse Abdominis, or TvA. The TvA is the body's internal "girdle" and when contracted, compresses the abdominal wall.

All pregnant women should perform basic TvA exercises throughout their pregnancies to help prevent diastasis recti as well as back pain and pelvic instability. As an added bonus, because the TvA is our body's major expulsion muscle, building and maintaining strength here greatly aids in the pushing phase of labor.

Safe TvA Exercises to Prevent or Lessen the Severity of Diastasis Recti/Abdominal Separation:

Two safe TvA exercises to prevent diastasis recti, watch and learn here:



Pregnant and postpartum women with diastasis recti, should perform TvA exercises with manual splinting of the rectus abdominis. Watch and learn here:



While the model in these videos is pregnant, these exercises are safe and beneficial to perform throughout the postpartum period as well.

Diastasis Recti/Abdominal Separation Recovery and Rehabilitation

Most postnatal fitness programs feature standard abdominal exercises like crunches and curls, and advise women with diastasis recti to manually splint their midlines together with either the hands or a towel wrapped around the belly while performing these exercises. However, reliance on external forces only will not adequately close the gap in your midline.

Additionally, prenatal and postpartum exercises that use lower spine flexion rather than upper spine flexion provide many more benefits and should be used whenever possible. Exercises that flex the upper spine should be done sparingly, if at all during and after pregnancy.

External splinting (either with the hands, a towel, or belly binder) of the rectus abdominis without first having established adequate strength and functional control in your TvA will not repair diastasis recti. External splinting performs the function that your TvA should be doing, therefore the muscle does not engage and stays weak with poor functioning. When the TvA lacks adequate strength and functional control, then the abdominal wall bulges out upon exertion, which stretches the midline and can make abdominal separation worse. (Please see Abdominal Reconditioning After Pregnancy for more information on this topic.)

After pregnancy, abdominal splinting with the hands or other devices is an acceptable technique only after the TvA has been thoroughly reconditioned.

Another Common but Ineffective Postpartum Exercise: "Mini-Crunches"

Other postpartum exercise programs suggest that women with diastasis recti start abdominal reconditioning with "mini-crunches," or lifting only the head, while applying manual compression with the hands across the abdomen. Isolation of the head exerts a small amount of work on the external abdominal muscles, but only in some individuals. Women with good neuromuscular coordination will, for the most part, engage the muscles that flex the neck in this movement, not their abs.

In addition, lifting the head off the floor as a preamble to exercises like crunches teaches poor technique. Ideally, in all abdominal exercises that flex the upper spine, movement should be initiated in the thorax, which will pull the rib cage closer to the pelvis. The head and shoulders should stay fairly relaxed, and basically "go along for the ride." In Pilate's exercises, this is aptly called the "head-float position." (For more information see Abdominal Reconditioning After Pregnancy)

Signs of Midline Recovery

Abdominal separation resolves when either your muscles have pulled back together to less than two finger widths, or when you can feel that your midline has become strong and elastic, at about six to nine months postpartum. At this point, you will no longer feel a hole in your abdomen. Once your connective tissue has regained its former density and elasticity, you are no longer at risk for hernia or other associated problems.


Diastasis Recti/Abdominal Separation: Success Stories from Real Moms


I found Be Fit Mom a few months after having after baby #6 in 2008. I began exercising and was amazed: my abdominal separation closed to within 2 fingers and my balance was better than it had been in years. We were surprised with baby #7 in 2010 and this time I did the first gentle exercises in the hospital after delivering and in less than 2 weeks I had no abdominal separation at all!!! I never imagined that was possible after 7 kids!

I recommend this to women even if it has been years since they had children because the basic first moves are so effective at helping you focus on the innermost abdominal muscles. I am convinced that had my mom done these exercises when she was in her 30s and 40s she would not have suffered from bladder prolapse in her 70s. I think this program is fantastic and can help anyone at any age or fitness level be a stronger, more balanced, healthier individual.

Thank you so much for your inspired resource. It's my top baby shower gift choice or recommendation.

Sabra Gosselin,
Ohio

Dear Helene,

Thank you so much for making your DVD. I started your dvd 6 weeks post-partum with a 2.5 - 3 finger abdominal separation. I'm now 4 months post-partum and have closed the gap! I can't tell you how happy I am to have fixed that!

Thanks again,
Alison Barton
San Diego

Hi Helene-

Thank you so much for your help. My presentation went very well and I spoke very highly of you. I corrected my diastasis over the past few months..from a 3 to a 1...and I have had it for 10 yrs!

Regards, Jen

I used your DVD... and closed my separation from over 5 fingers apart (I'm not joking!) to 2 fingers. I spread the word about your DVD/exercises wherever I go. You've helped me so much.

Lisa G

I would also like to mention that I keep advising patients to buy your DVD. Thanks for a great product!

Best Henrik Solmenius


Diastasis Recti/Abdominal Separation Recovery and Rehabilitation

Reconditioning after pregnancy with diastasis recti can be more challenging. To safely and effectively restore your abdominal wall you need a postnatal exercise program that is specifically designed for women with abdominal separation.

If you have abdominal separation and would like to get started on reconditioning, see my DVD, "Bounce Back Fast! Post Natal Core Conditioning." This DVD contains three easy-to-follow progressive postpartum workouts:

  • "Gentle First Moves" featuring safe, restorative exercises that you can start just days after giving birth.
  • "Bounce Back Fast!" a complete post natal core-conditioning program and an alternate program:
  • "Bounce Back Fast!" alternate program featuring special exercise variations for those with abdominal separation.

Or consult my book, "Exercise After Pregnancy: How to Look and Feel Your Best", which provides an in-depth look at post natal fitness and exercise and offers three progressive postpartum core-conditioning workouts that require no specialized equipment, and includes exercises variations for those with abdominal separation.

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