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Pregnancy And Postpartum Life - Complications | September 22, 2021, 4:29 CDT

Exercises to Help Address Diastasis Recti

If your stomach muscles separated significantly during pregnancy, recovery is possible.
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Illustration by Tré Carden

When it comes to pregnancy, the female body is pretty amazing—it grows, changes and stretches to accommodate a 7- to 9-pound baby (give or take), and then (not immediately, but with time), reverses the process and returns to "normal"...mostly.

As the belly grows through the third trimester, all women experience a separation down the center of the abdomen as the rectus abdominis muscles (commonly referred to as the "six-pack muscles") stretch apart to accommodate the growing baby. This separation is called diastasis recti, and it's a completely normal and expected part of pregnancy.

Even though diastasis recti is normal during pregnancy, there are circumstances postpartum where you may determine you need additional help with "closing the gap," so to speak, down the center of your abdominals.

"During pregnancy, the strong connective tissue connecting the two sides of our rectus abdominis muscles stretches to accommodate our burgeoning belly," explained Angela Fishman, a licensed physical therapist specializing in pelvic floor physical therapy.

It's very common for diastasis recti to persist for months post-pregnancy as the body heals.

"Studies have found it in up to 100 percent of women at the end of pregnancy," Fishman continued. "That said, if more than a couple of finger-widths separation persists [after birth] and you're having difficulty caring for yourself or your baby due to the separation, then it may be time to speak with your healthcare practitioner or physical therapist."

Fishman also noted because diastasis recti is completely normal at the end of pregnancy, you shouldn't feel like you did something "wrong" that needs to be "fixed" later. It's very common for diastasis recti to persist for months post-pregnancy as the body heals. In fact, doctors and physical therapists are well-versed on the concerns women have regarding the issue, as up to 40 percent of women still have diastasis recti six months postpartum.

"The focus really should be on how mom is functioning after giving birth," Fishman said. "Does she have pain while holding her baby? Or leak urine while coughing? Is it difficult for her to sit up in bed? Does she notice a 'doming' of her abdomen when she sits up? These are signs that her abdomen might need more attention."

Understanding what the goal should be

Think for a second about all the anatomical photos you've ever seen of abdominal musculature. You can picture the six-pack, right—the rectus abdominis muscles? And you probably remember the left and right sides are separated by a line down the center. This line is the linea alba, and it isn't a muscle. Rather, it's connective tissue separating the two sides of your abdomen. This separation exists for everyone.

"It's generally accepted that a gap size of about two fingers is pretty close to normal, and anything over that would be defined as diastasis recti," explained Kim Vopni, a pre- and postnatal personal trainer who specializes in the core and pelvic floor, and is the coauthor of the book "Pregnancy Fitness."

"More people are also recognizing that a three-finger gap is much different than an eight-finger gap, so there's a move to group gap sizes into mild, moderate and severe," Vopni said. "But what needs to be considered is the integrity of the connective tissue that holds the rectus abdominis in place at the midline of the abdomen. Some people may have a large gap and good connective tissue integrity, while others may have a smaller gap but poor connective tissue integrity."

So, the goal postpartum isn't to eliminate the existing gap completely—a separation has always existed. Rather, it's to gradually experience a closing of this gap and a strengthening of the connective tissue in the abdomen, until it returns to roughly a one- to two-finger width separation.

Closing the gap steadily and safely

As your body heals postpartum, it can be tough to remember, "Rome wasn't built in a day." Just as it took nine months to build the beautiful baby you now have in your arms, it takes time to heal and recover after pregnancy.

In the early days postpartum, you need to move carefully and focus on starting your recovery process with the pelvic floor and the deep muscles of the abdomen, rather than trying to use situps or crunches or other ab-focused exercises to close the gap.

Think: Start small. Fishman said you should start by limiting any extra stress or strain to your diastasis. For instance, instead of sitting up straight in bed, which places pressure through your core and along your linea alba, roll to your side and press yourself to sit. Likewise, learning to engage your deep core muscles (the transverse abdominis, which lies under the rectus abdominis) to offer support to your core can help you handle increases in intra-abdominal pressure.

"This occurs with things like coughing, sneezing, lifting and exercising," Fishman stated. If your deep core muscles engage and these normal actions place less strain on your rectus abdominis or linea alba, you're in a better position to continue to heal.

Likewise, Vopni pointed out you should stay away from exercises or movements that place pressure on the diastasis. "Avoid static forward-loaded positions, such as bird dog and plank," she said. This makes sense—even though these exercises are designed to strengthen the core, the very position itself places more stress on the rectus abdominis and linea alba through gravity, and could actually cause the diastasis to worsen over time.

When it comes to exercises that can help address the condition, Vopni said you need to work on a "gradual progression back to fitness and a variety of exercises with a focus on the execution of each exercise you perform, rather than restriction of exercises."

In other words, some people say certain exercises, like crunches and planks, should be avoided altogether. But according to Vopni, it's not that they should be completely restricted, but they should be added into your routine at the appropriate time and you should have the strength necessary to perform the exercise correctly and in a way that won't worsen the diastasis.

"You should optimize your breath and pelvic floor first, then add pelvic floor activation into movement," she advised. "Once the pelvic floor is autonomous again, gradually adding load in a variety of movements is essential. The body needs load in order to strengthen."

Exercises to address diastasis recti

In the first weeks postpartum, you really shouldn't be engaging in any strenuous exercise. Moving around, adjusting to life as a new mom, and going through your daily routine is what you should be focused on. But after the first few weeks, Vopni suggests adding in restorative exercise, starting with the pelvic floor.

Kegels are an excellent first step, followed by breathing exercises to strengthen the transverse abdominis. Then, as your pelvic floor and transverse abdominis strengthen, you can start adding other non-front-loaded pelvic and abdominal exercises to your routine. And remember, give yourself time. It could take weeks or months before you start seeing results.

Kegels

Kegels can be done anywhere, anytime, but after childbirth, it's really important to focus on making sure you're doing them right. Add them to your routine before you get up in the morning, then do them periodically throughout the day.

Lie on your back with your knees bent. Imagine you're desperate to pee, but you have to hold it—engage all the muscles in your pelvic floor you would tighten to prevent yourself from urinating. Imagine your pelvic floor as though it has four points and is shaped like a diamond—try to pull all four points "up" and hold them in place for 5 to 10 seconds. Repeat 10 times. Complete a total of two to three sets.

Vacuums

Vacuums are a great way to identify and work your deep transverse abdominis as you breathe. Lie on your back on the floor, your knees bent. Imagine you're wearing a corset. Inhale and imagine the corset loosening as you fill your lungs with air, allowing your abdomen to expand. Then, as you exhale, imagine you're "tightening" the corset, drawing your deep abdominal muscles as tight to your spine as you can. Repeat 10 times. Complete a total of two to three sets.

Bridge

The bridge exercise works your glutes, hamstrings and core, including your pelvic floor muscles and your transverse abdominis. Lie on your back on a mat, your knees bent, feet flat on the floor. Engage your core, drawing your deep abdominals close to your spine. Inhale and engage your glutes, hamstrings and pelvic floor as you lift your glutes from the ground, pressing them as high as you can toward the ceiling. Hold for a second at the top of the movement, then, as you exhale, lower your glutes back toward the floor. Stop just before your glutes touch the ground, then continue the exercise. Aim to complete three sets of 15 to 20 repetitions.

Bent knee lift

The bent knee lift is another exercise designed to strengthen your abdominals without placing undue pressure on your rectus abdominis or linea alba. Lie on your back on a mat, your knees bent, feet flat on the floor. Inhale and engage your deep abdominals, drawing them close to your spine. As you exhale, use your abs to lift your feet from the floor, drawing your knees upward, until you have a 90-degree angle at your hips and knees. Focus on keeping your low back in contact with the mat the entire time to keep your transverse abdominals engaged. As you inhale, slowly return your feet back to the ground, simply touching your toes on the mat lightly before you continue the exercise. Complete 10 to 15 repetitions and two to three sets.