If you’ve recently been pregnant, you’re probably itching to feel like yourself again.
Unfortunately, for many folks post-pregnancy, that’s not as easy as it sounds.
After pregnancy, there are a number of core and pelvic floor conditions that can impact a new parent’s sense of well being.
One of the most visible of these conditions is Diastasis recti, a stubborn separation of the abdominal muscles.
There is is no single exercise that will “fix” every Diastasis recti. I wish I could tell you otherwise.
However, the principles of healing a Diastasis are straightforward:
1) Become aware of your posture, both when sitting and standing.
2) Connect to your deep core muscles through your breath.
3) Coordinate your breath with your movement.
4) Progressively load your muscles and connective tissue over time.
A cocktail of postural awareness, mindful breathing and exercise are an important and EFFECTIVE part of every rehabilitative strategy.
In my role as a personal trainer and a pregnancy and postpartum fitness specialist, it is outside my scope of practice to diagnose or treat Diastasis Recti. But it is within my scope to offer exercises that improve abdominal wall strength and function, which will support any Diastasis Recti rehabilitative program.
In this post, it’s my goal to may sure you understand exactly WHAT a Diastasis Recti is, what it means to “heal” a Diastasis and what steps you can take at home to improve your abdominal wall function. I’ll also offer you 6 exercises that have been really effective for my Diastasis Recti clients.
What Is Diastasis Recti?
In my experience, folks have a lot of confusion around the difference between Diastasis Recti and abdominal separation.
Abdominal separation is a normal part of pregnancy. Diastasis Recti is a pathology diagnosed when that abdominal separation persists long into postpartum and doesn’t heal on it’s own.
The rectus abdominis muscles (the “six pack”) are connected at your midline by a line of tissue called the linea alba. In nearly every pregnancy, the linea alba thins and stretches to accommodate your growing baby. The tissue stretches like pantyhose. If an actual hole is formed, that is called a hernia and it is a different condition.
Most of the time, the stretched connective tissue rebounds between 6-8 weeks postpartum.
Abdominal separation is a normal part of pregnancy. It only becomes problematic when It doesn’t resolve on it’s own in an expected window of time.
Diastasis recti is the condition in which the tissue remains stretched long after pregnancy. Along with a wider gap between abdominal muscles, the tissue is often less able to generate tension and transfer load through the core. This can lead to feelings of weakness or instability.
You can self-assess your own abdominal separation. For step-by-step instructions, check out this blog post.
It’s important to note that everyone has at least a small gap between their ab muscles. If you’re less than 8 weeks postpartum, expect to have a gap larger than two finger widths.
Diastasis is (typically) only diagnosed by a medical provider when the gap is larger than about three fingers wide and can’t generate tension appropriately.
What Does It Mean To “Heal” Diastasis Recti?
A Diastasis is diagnosed via a combination of the width of the abdominal separation and the functionality of the tissue,
When we talk about “healing” a Diastasis, we’re first and foremost talking about restoring function to the connective tissue between the abdominal muscles. It must be able to generate tension and transfer force. Typically, the width of the gap will decrease as this happens.
The gap will never be zero. It never was. It’s pretty normal to have a healed Diastasis with a gap of 2-3 centimeters (or maybe a little more).
Pelvic Floor Physical Therapists For Diastasis
If you are concerned about your Diastasis recti, please book an appointment with a pelvic floor physical therapist. These providers will be able to help you assess your specific situation.
If you’re new to pelvic floor physical therapy, check out this blog post to learn more about what a pelvic floor physical therapist does, who they help and what to expect at an appointment.
But… I know you’re not here to just be told you need to make yet another appointment. You want to know what you can do for yourself in the meantime. I gotchu!
So on to the juicy part:
How To Heal Diastasis Recti
1) Bring awareness to your posture, both when sitting and standing.
Your first step in healing your Diastasis is to take a hard look at your postural alignment. Why? Because your postural alignment plays a key role in the way your core muscles fire and how easily they can recover from pregnancy.
While there is no one “perfect” posture, there are alignment variations that give your core muscles a biomechanical advantage. Spending more time in these positions may speed the healing your abdominal separation.
Aim to find a neutral, or stacked, posture. Align your ribcage over your pelvis so that your ears, shoulders, hips, knees and ankles are in one vertical line.
You should feel your weight balanced just in front of your ankles, where you would tie your shoe laces.
This stacked alignment is your starting position for subsequent breathing exercises and higher level movements.
Check out the embedded post below for a few tips to help you easily find a stacked alignment.
2) Connect to your deep core muscles through your breath.
An essential step in healing Diastasis recti is re-connecting to your deep core muscles and learning to engage these muscles using the breath.
Your deep core is composed of your diaphragm, deepest abdominal muscles (the transverse abdominis), pelvic floor and back extensors. These muscles are meant to work together in a coordinated and reflexive manner to manage pressure in your core and create stability through your torso.
The Connection Breath
The Connection Breath is a fantastic tool to help re-establish the connection between all the components of your core. And, it’s pretty simple! It is essentially a diaphragmatic breath combined with a kegel.
To perform this breath:
1) Inhale into your ribcage, keeping your shoulders down. Your rib cage should expand in 360 degrees (like an umbrella opening) and your belly should gently expand outwards. If you have good pelvic floor awareness, you will also note a relaxation and lengthening in your pelvic floor muscles.
2) On exhale, gently contract your pelvic floor (–> kegel). Your belly should draw in gently on inhale.
3) Repeat.
Practice this breath from an upright, stacked posture, or lying on your back with your knees bent.
For detailed cues and demonstrations, check out The No B.S. Guide to a Stronger, Drier Pregnancy and Postpartum (a free resource!). It contains detailed instruction on how to connect to your deep core muscles.
3) Coordinate your breath with your movement
Your core is your body’s stability mechanism. When your core is firing in a coordinated and reflexing way, you’ll feel stronger and more stable. To fully take advantage of this strength and stability, you’ll want to coordinate your breath with your movements.
As an added bonus, bringing intention to how you breath when you move will reinforce the diastasis-healing breathing patterns you’ve been working so hard to learn and implement.
It’s one thing to practice the Connection Breath a few times a day. It’s next level to incorporate it into your activities of daily living and exercise. That’s a whole lot of diastasis-healing reps.
The most simple strategy I like to teach is exhale on exertion (the hard part of any given exercise). Using a squat as an example:
1) Inhale as you lower into the squat.
2) Exhale, with a pelvic floor contraction, as you stand.
There are additional strategies, which you can explore in this blog post.
4) Progressively load your muscles and connective tissue over time.
Rehabilitation of a diastasis will start with gentle exercises: deep abdominal exercises, coordinated breathing and isolated movements. But one should quickly graduate to full body exercise and higher load activities. In particular, the tension encourages the linea alba to heal, so don’t be afraid of adding challenge.
Gravity can be a great tool to help encourage re-connection and healing of the deep core muscles.
Get off the ground. Gentle, ground-based exercises like glute bridges and heel slides have their place. But unless you live your life in a bed, you’ll need to get up and practice moving in ways that reflect your activities of daily living.
Start with light weights or exercises and increase the intensity gradually as you feel stronger.
As bodyweight exercises begin to feel easy, load them up with resistance from bands or free weights. Then, increase those loads slowly over time; don’t let yourself stagnate. If you aren’t challenging your muscles, they aren’t going to get stronger.
Postpartum Diastasis Recti Exercises
As I already mentioned, there’s no one exercise that’s going to eliminate your Diastasis. It’s likely to take a variety of exercises and different exercises will be more or less effective in different bodies. Nonetheless, here are 6 exercises that I commonly offer my Diastasis Recti clients and these clients very often see improvement in their abdominal wall function with time and consistent exercise.
1) Pallof Press
To perform a Pallof press, set up in a half kneeling position with a neutral spine: rib cage stacked over your hips. Exhale through pursed lips to press the band in front of you, inhale to bring it back in. You should feel your deepest abdominal muscles engage as you exhale and press. Repeat on both sides.
2) Half-Kneeling + Rotation
From a half kneeling position, extend a light weight in front of your body. Exhale to rotate the weight over your forward leg, inhale to return to center.
3) Suitcase Carry
Choose a weight that is heavy enough you have to work a little to resist bending to the side. Hold the dumbbell or kettlebell by your side, setup in a stacked alignment, and take 24 steps before switching sides. Walk slowly, breathe intentionally and actively resist the pull towards the weight.
4) Straight-arm Pull Down
Anchor a resistance band overhead. Set up in a stacked alignment and maintain this throughout the exercise. Grasp the band with both hands. Exhale as you pull the band down with stick straight arms. Inhale as you raise it back to the starting position. As you pull the band down, you should feel your core muscles activate and lats engage.
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There’s no single exercise that will fix Diastasis recti every time, but exercise is an important part of every rehabilitative strategy.
Every individual is unique, there is no one “diastasis recti exercise” that is going to heal every case. Muscles and connective tissue need load to regenerate and heal. If your Diastasis is lingering after the Fourth Trimester (the first 12 weeks of the postpartum period) make sure that you are 1) challenging yourself appropriately and 2) working with a pelvic floor physical therapist. Although there’s no one-size fits all solution, exercise is part of every rehabilitative strategy and personalized guidance from a pelvic floor physical therapist and qualified exercise professional is essential.A few tips and reminders:
⦿ Exercise selection is second to breath strategy and managing pressure through your abdomen.
Apply a coordinated breathing strategy to all these exercises. Exhale during the hard part of the exercise and keep an eye out for doming along your abdominal midline.
Doming is your body letting you know you need to tweak your pressure management and breathing strategy, not a cause for panic.
If you’re not familiar with the Connection Breath (coordinated diaphragmatic breath + pelvic floor contraction), check out The No B.S. Guide to a Stronger, Drier Pregnancy and Postpartum (Free!).
⦿ Notice we’re addressing multiple layers of your abdominal muscles and working in multiple planes of movement.
Rehabbing your Diastasis recti involves requires tapping all of the layers of your core and pelvic floor muscles (not JUST your deepest abdominal muscle layer). It also requires working them in multiple angles.
⦿ As you get good at managing your abdominal pressure in these lower intensity movements, take that good strategy and load it.
Don’t fear lifting loads, twisting and doing front loaded abdominal work.
Just make sure you master the basics first. Strategy and progressive overload are key!
***
If you’re experiencing any symptoms related to diastasis recti, please consult your health care provider. They can help refer you to a pelvic floor physical therapist or other specialist who can help create a personalized rehabilitation program for you.
Although there is no one-size-fits-all exercise program that will heal every diastasis recti, performing exercises that engage your transverse abdominals and coordinate your breathing with movement can help encourage re-connection, healing and core strength.
If you’re looking for at-home exercises to start rehabbing your diastasis recti, give the exercises above a try. Be patient and consistent with your efforts, and consult with a specialist if you notice any complications. A little effort can yield big results!
References
Dufour, Sinéad, et al. “Establishing Expert-Based Recommendations for the Conservative Management of Pregnancy-Related Diastasis Rectus Abdominis: A Delphi Consensus Study.” Journal of Women’s Health Physical Therapy, vol. 43, no. 2, Apr. 2019, pp. 73–81. DOI.org (Crossref), https://doi.org/10.1097/JWH.0000000000000130. Mota, Patrícia Gonçalves Fernandes Da, et al. “Prevalence and Risk Factors of Diastasis Recti Abdominis from Late Pregnancy to 6 Months Postpartum, and Relationship with Lumbo-Pelvic Pain.” Manual Therapy, vol. 20, no. 1, Feb. 2015, pp. 200–05. DOI.org (Crossref), https://doi.org/10.1016/j.math.2014.09.002. Qu, Enze, et al. “The Ultrasound Diagnostic Criteria for Diastasis Recti and Its Correlation with Pelvic Floor Dysfunction in Early Postpartum Women.” Quantitative Imaging in Medicine and Surgery, vol. 11, no. 2, Feb. 2021, pp. 706–13. DOI.org (Crossref), https://doi.org/10.21037/qims-20-596. Sperstad, Jorun Bakken, et al. “Diastasis Recti Abdominis during Pregnancy and 12 Months after Childbirth: Prevalence, Risk Factors and Report of Lumbopelvic Pain.” British Journal of Sports Medicine, vol. 50, no. 17, Sept. 2016, pp. 1092–96. DOI.org (Crossref), https://doi.org/10.1136/bjsports-2016-096065. Jessen, Majken Lyhne, et al. “Treatment Options for Abdominal Rectus Diastasis.” Frontiers in Surgery, vol. 6, Nov. 2019, p. 65. DOI.org (Crossref), https://doi.org/10.3389/fsurg.2019.00065.Your first step towards healing your Diastasis recti👇🏽👇🏽.
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Laura Jawad holds a PhD and a personal training certification (NASM). She’s a Certified Prenatal & Postnatal Coach, Pregnancy & Postpartum Athleticism Coach, and Pregnancy and Postpartum Corrective Exercise Specialist. You can check out the rest of her alphabet soup here.
