Diastasis recti- abdominal separation- is a hot topic right now. Obstetricians, midwives, primary care physicians, and physical therapists are getting more and more questions about it. Healthcare providers offer screenings at postpartum health and wellness fairs. There’s also a lot of misinformation out there (especially on Youtube) about how to “fix” it.
There is no concrete evidence that abdominal exercises truly treat diastasis recti post-delivery.
This is a hard thing for a PT like myself, who believes so strongly in the power of exercise. But, honesty is the best policy. And, in the scientific community, it’s where things currently stand.
It’s 2 big words that mean there is some abdominal separation. This happens along a band of connective tissue on our stomach called the linea alba.
Let me just say this:
100% of women at 35 weeks into pregnancy have diastasis recti. It’s part of beautiful divine design. If this area didn't allow for expansion during pregnancy, we’d have much more abdominal muscle tears and discomfort. This separation usually re-connects on its own 8-12 weeks postpartum.
It is defined as a separation larger than 2.5 finger’s widths (pointer and index finger) or 2 cm. The depth is usually assessed as well. Unless it is symptomatic, or significantly wide, there’s no cause to worry.
There is not a strong correlation between how big the gap is and abdominal strength. So, you can have Diastasis Recti and still have strong abs.
Here's when you should be concerned:
When the connective tissue is so stretched out that it leaves an opportunity for herniation of internal organs. Herniations can always be assessed with ultrasound.
Pregnant women are not the only ones who get Diastasis Recti. Anyone can have it. Those who most commonly do are:
Between 30% and 68% of postpartum women have diastasis recti.
And, as I said, 100% of women who are 35 weeks pregnant have some degree of abdominal separation. This allows space for the baby!
So, it’s really common.
The curl-up test.
It's recommended that you do this test
Here's how it's done
Have your doctor and/or PT check you.
Unless your separation puts you at risk for a herniation, it’s more productive to look at whether you can activate your transverse abdominus muscle in multiple positions.
That's the muscle just behind the rectus abdominus.
Channel your concern about preventing/treating diastasis. Use it as a gateway to improving your overall deep core health.
This is a cautionary tale. Out of respect for your future sleep-deprived, I always encourage women to not feel like they have to “bounce back”.
You had a baby.
Some correlate the impact of this event on the body to competing in a season of the NFL.
The NFL has an "off" season.
We need our own “off” season during postpartum.
We need time to move with more intention...rather than speed or strength.
So, yes, you will get back to being active again.
It may look or feel different, or... honestly, it may not.
I always advise gently activating your deep core first. After being cleared by your doctor, start with light, modified planking. Crunching typically puts too much pressure on the abdomen (at any stage of life).
Please feel free to reach out if you have any specific questions or concerns. We can make your postpartum healing timeline work best for you.
Depending on your symptoms, wearing a belly band at night can help.
Taping while sleeping support your body when it’s in its loosest state. It can be a supportive option for your abs and a potential preventative technique. There are also taping techniques that help support the tummy as it expands. But there’s no guarantee that it’ll prevent diastasis.
Treatment for any diagnosis focuses on function. Your PT will look at how you move. They'll listen to your goals. And help align the two factors for overall injury/incontinence prevention.
There are some manual techniques for“encouraging” your fascia to approximate back toward the midline.
The main key to healing your stomach after having a baby is to avoid overloading it. Don't lift too much before everything has a chance to come back together naturally.
Initial research shows that NMES (neuromuscular electrical stimulation) administered three times a week for 8 weeks along can improve ab strength and reduce diastasis width.
NMES involves little electrodes placed on the abdomen. They deliver an electrical current (similar to a TENS unit).
NMES engages the type II muscle fibers at a lower intensity than exercise would do. This helps your brain connect to the electrical impulse of a muscle contraction.
I also like to recommend postpartum pants. These are the opposite of pregnancy pants. Instead of being stretchy around the top, there is gentle, midsection compression. This can help keep things approximated. I don’t recommend wearing them all day every day. But if you know you’re going to be out. Or lugging the heavy car seat around, then it can be nice to have a little extra support.
Diastasis Recti has become another thing that women are told to “fix” about their bodies. Instead, we should be thankful for it. I highly encourage you not to think about yourself as "broken" postpartum. You are someone who has grown, given, and continues to actively grow, give, and heal. From the very cores of your soul,
Bø K, et al. Br J Sports Med 2017;0:1–10. doi:10.1136/bjsports-2017-097964
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