What is Diastis Recti?
This is a hot topic right now and there is some much information out there about what DR, diastasis recti, is and what is actually going on in there! DR in isolation, is the spreading or thinning of the linea alba, the connective tissue that connects the left and right rectus walls together. In technical terms, it is a separation of 2 or more fingers width between the left and right side. But depth may be more important than the width.
If you have a 3 finger width but can create tension in the linea alba (so when you press in, its not very deep), that means that the core muscles are firing correctly and fascia may still be healing. If you have a 2 finger gap but can sink way deep and feel organs, this may be showing the core muscles aren’t firing at all and there may be more work to do.
I find that rarely you can fix an issue in isolation, like spot training, we know that isn’t possible, and it rarely is in this case as well. Diastasis and Pelvic issues are a whole body problems and they are usually created over time and are usually connected to poor posture and kinetic chain imbalances.
Regardless, it is a pressure issue, your abdomen is like a canister that regulates intra abdominal pressure (IAP) from your diaphragm/ribs, to your core/back and into your pelvis/pelvic floor. The pressure we create is to stabilize the spine through breath, which we do subconsciously and sometimes consciously depending on the activity… for instance, when we step off a curb, a child jumps on our belly, sitting down or standing from a toilet and exercise, can either work in alignment with the canister or work against us. If we have poor posture, bad breathing patterns, muscle imbalances, or do repetitive moves daily without being conscious of how we are regulating that pressure, we can put strain on that connective tissue, pulling and stretching…ie a weak point. That weak point is going to be the place that the pressure is going to try to escape, unregulated pressure takes the path of least resistance, and over time it can create a hernia, diastasis or prolapse depending on where your weakness is. Pregnancy is a large percentage of the reasons that DR can happen, because of the stretching due to baby growing, but it is not limited to pregnant/postpartum women. Men, women who have never been pregnant, extremely fit people and even children can have it. If you have a young child or even a newborn, watch their belly when they lift both legs, you are likely to see a little ridge or bulge down the middle of their abdomen, that is the unregulated pressure escaping through that connective tissue, their organs are pressing up against it creating the doming effect. This should close as they get stronger, but for now they are babies and don’t have ab muscle control to regulate it and its normal!
How do you know if you have it?
Everyone has a little separation because there is connective tissue between the rectus walls, they aren’t fused together, so if you can fit a finger between, this is most likely very normal. Some degree of DR is normal during the last part of pregnancy, the stretching is normal and some women’s gaps will close without much work, as she heals postpartum. DR can create a slue of issues that you might not even think are connected.
Issues like: low back pain, urinary incontinence, fecal incontinence, painful sex, mom pooch (looking 5 months pregnant after having baby), loss of glute mass (mom butt), improper breathing patterns, as well as tight back muscles and ribs.
When you sit up out of bed, which I do not suggest doing while pregnant or newly postpartum because it creates a lot of IAP (intra abdominal pressure) you may notice a doming, coning or bulging happening down your midline. I can look like a loaf of bread is sitting under the skin. This is your rectus muscles straining to sit you up, without the Transverse abdominals (TA) and internal/ external obliques, as well as all that pressure trying to burst out of your weakened linea alba. So please, roll onto your side!
You can do a self check at home to see if you may have the condition. We will check three places for width and depth.
Lay on your back, knee bent, feet flat
1st place is between belly button and bottom of ribs, 2nd place is at the belly button and 3rd is between the belly button and pubic bone.
Without too much effort, lift your head and do a slight crunch up, not a full crunch & shoulders stay on the ground for the most part. Take your fingers facing down towards your toes and feel at all three places? What do you feel? Can you feel the separation of the two rectus walls, the left an right side? Did you feel your fingers squish way down into that space? Did you feel some recoil, like a trampoline bouncing your fingers back? Make note of how it felt in all three places, space above belly button, below or an open space along entire midline. If you have a space of more than 2 fingers, it is likely you have a degree of DR.
Now I want you to do the same thing in all three spot but now I want you fire your pelvic floor, think of holding gas and stopping flow of urine, lifting the pelvic floor up towards your midline, then lift your head and repeat the check in the 3 places. Feel a difference? Did you get more of the trampoline bounce back? Did the depth get shallower, the width close a bit? If yes, thats great! Fascia takes a long time to heal so give your body some time and grace and be patient when trying to heal this injury! If you felt no difference and it was just sinking or doming and there was no recoil, it is very possible you have DR and need to strengthen from the deepest core muscles.
What kind of dr/specialist/etc do you recommend to get help correcting it or get diagnosed?
Your OB or Pelvic floor physical therapist are the only ones that can diagnose you will this condition or any pelvic floor or core dysfunction. So I recommend if you think you have it, even if you aren’t sure, please find one. Most Doctors don’t even check at your 6 or 8 week post op check up and Mamas need more support than that, more support than being told at 8 weeks that they can resume their “normal activites”, what the heck is “normal” anyways?! Be your own advocate. Ask the questions and seek a professional for a diagnosis and then find a personal trainer that is specialized in Postpartum fitness to work with your Physical therapist to help you heal. Check out www.pelvicrehab.com
to find a PT in your area.
What are some exercises to help fix it?
Take a big deep breath right now… did your chest come way up, belly button suck in, shoulders rise to your ears? This breathing pattern is especially common in postpartum women because of what our body just had inside of it! Big ole baby pushing up against your diaphragm, out on your abdominal wall and putting a lot of pressure down on your pelvic floor. If you’ve been pregnant you know it seems impossible to take a deep breath. So we learn to shallow breath and get stuck in this pattern. Again not restricted to pregnant women. Ask a man in your life to take a deep breath and see what happens with their upper chest and shoulders, they come way up usually. This is a stress response and with how stressful our society can be, it no wonder we have forgotten to “take a few deep breaths and relax”. There is so much truth to that!
What we want to see with our breathing is a little chest, a little belly and a little back expansion and a lot more lateral rib expansion! Belly breathing can actually do more harm postpartum especially if you have DR. Remember what I said about the pressure taking the path of least resistance, DR is the stretching and thinning of the connective tissue, so why would we want to breathe big into that space creating more stretching! So put your hands on the bottom of your ribs, thumbs on the back and other fingers in the front, take a big breath, did your ribs move into your hands sideways? If not, you may need to work on rib mobility and back stretching! Grab a foam roller and roll it out!
Practice while laying down flat, with knees bent, on your side (both sides) and then sitting and standing. Start with a relaxed body, good neutral posture if sitting or standing(head inline with spine, ribs down over core, pelvis neutral, feet forward), Inhale slow- ribs expand, back, chest and belly rise slightly, pelvic floor is relaxed. Exhale with haaaaa or ssssss (audibly, helps engage TA)- lift from bottom to top, pelvic floor (imagine lifting a blueberry into rectum, vagina & urethra or stopping gas or urine), low abdominals, wrap TA and bring ribs down and together. You can start connecting to your breathing before you are cleared for activity, just ask your doctor.
Exercises to start after you have done a bit of breath work include Heel Slides, Marching on back, and Arm raises on back. All of these are done in coordination with the Conscious Core Breath inhale (relax muscles) and exhale (hardest part of exercise, contraction). These aren’t meant to be a killer traditional ab workout, we are working the subtle, deep core muscles here. Its more mental work!
Heel Slide: Lay on your back, knees bent, feet flat, spine neutral or against ground. Inhale-relax muscles, Exhale-lift Pelvic floor, contract and wrap abdominals and slide heel away from body until leg is straight and then back towards the body to bent knee while holding contraction.
Marching on back :Lay on your back, knees bent, feet flat, spine neutral or against ground. Inhale-relax muscles, Exhale-lift Pelvic floor, contract and wrap abdominals and lift knee up without bulging or doming, if this is happening try only lifting heel up while keep toes on the ground.
Arm raises on back: Lay on your back, knees bent, feet flat, spine neutral or against ground, arms down by sides fingers pointing down towards feet. Inhale-relax muscles, Exhale-lift Pelvic floor, contract and wrap abdominals and lift arms up and over head to touch ears. If you notice your ribs flaring, try doing more of a “snow angel” arm movement, keeping them on the ground and slides up. You can work towards bear planks, 90 degree toe taps, and others eventually when you master these!
Is it fixable?
In most cases yes! Like I said it is a whole body issue, which is why I think surgery is the last resort. Because even after surgery, the movement patterns, muscle recruitment and breathing patterns will be the same and could lead to a DR in the future again. It is best to address the muscle imbalances and take on this dysfunction with a “whole body” approach! You can do your 30min-1hr of “core” exercises but its really what you are doing for the other 23 hours in a day that matter most!
Other relevant information?
Be patient and be consistent! The exercise program that works the best is the one the ONE YOU STICK WITH. So find a physical therapist and personal trainer you love, because its going to be a long road ahead. I know it can be frustrating, especially if you were very fit before and through pregnancy, to be told this. You will want to jump right back into the hard stuff, but just because you CAN doesn’t mean you should.
Create a fantastic foundation and you’re less likely to create an injury and set back.