Never heard of diastasis recti? I hadn’t either, until a well-meaning friend suggested that I might have it.
Turns out, I’d had it for over a year and a half without knowing it. And I still do.
And no, it’s not a dinosaur, even though it sounds like something off Jurassic Park.
It’s a separation of the abdominal muscles, and while it’s not life-threatening or particularly debilitating in my case, it can cause physical complications (some serious), as well as a whole host of emotional ones.
If you’re pregnant or have had a baby, there’s a relatively good chance you have diastasis recti to some degree.
THE PSYCHOLOGY OF DIASTASIS RECTI
So…about a year and a half after the birth of my first child, a friend of mine delicately broached a subject that may have offended some people — my pooch, a.k.a my mommy tummy, a.k.a my baby buddha. Granted we were running partners, so fitness was a well-versed topic in our friendship, but I was still a little taken aback when she gingerly said:
“So, I have this friend who is super skinny but still looks like she is three months pregnant because she has this thing called diastasis recti…And don’t get me wrong…you are in super good shape…But do you think you have it too?”
My initial reaction was to take offense (“Your mom looks three months pregnant!”), but it was no secret to me (and clearly everyone else) that even though I’d lost the baby weight, my stomach still popped out like it did in the early months of pregnancy. It wasn’t soggy or flabby, it just stuck out.
I appreciated her candor, and honestly, I was slightly excited that there could be a medical reason that was preventing me from getting rid of my mummy tummy.
After doing some research, I quickly discovered I had a classic case of diastasis recti.
I was frustrated to discover, however, that somewhere between 30-80% of all post-partum women develop diastasis recti after pregnancy and childbirth, yet it was never even mentioned by my midwife. It is RIDICULOUSLY common but almost COMPLETELY undiagnosed.
Why did I care?
Because like most women, pregnancy did absolutely horrendous things to my body; don’t get me wrong, my kids are worth every stretch mark and I plan on doing it again eventually! But as a person who was always fit, it was psychological torture seeing the numbers creep up on the scale at every prenatal appointment. After months of not exercising like I did pre-pregnancy, it was emotionally difficult to not recognize my body when I looked in the mirror, and to not feel athletically connected to my body. Stretch marks, soggy everything, leaky breasts, the sneeze/pees, and a labor that failed to progress on its own all combined to make me feel as though my body had turned on me; it didn’t look like it used to and it couldn’t even operate like it was supposed to.
Suffice it to say, the struggle is real!
All new moms deal with some degree of post-partum body image issues.
And while I didn’t need to get the 6-pack back, what was with the 24/7 food baby?! Why did I still look slightly pregnant? No matter how much I worked out, how clean I ate, or how many crunches I did (FYI…I shouldn’t have been doing crunches at all — more on this later), it never got better.
Gaining control over my weight and body was less about aesthetic vanity and more about regaining confidence in my new body; it may never look like it did before I had a baby, but I could at least make it the healthiest it could be.
Healing my diastasis recti became part of that process, and after doing the research, I’m 100% confident that I can heal it.
Before you read on, know that I’m not a doctor or a medical professional — I’m just a fitness-minded person who did a crap ton of research on diastasis recti and the anatomy of the core after I found out I had it and traditional ab work wasn’t fixing it (and after a couple years of not taking it seriously, I am currently in the process of healing it properly).
If you think you might have diastasis recti, here is some knowledge that has helped me in the rehabilitation process:
WHAT IS DIASTASIS RECTI?
Diastasis recti is the weakening and/or thinning of the connective tissue (the linea alba) that connects the parallel sides of the rectus abdominis muscle, causing the rectus abdominis to separate. This muscle isn’t actually “splitting in two” as some people believe.
Visually, diastasis recti belly is pretty distinctive, although not all women have any outward symptoms of it. In my case, when standing, my belly protrudes and has a clear dome shape…and I have a SERIOUS outtie belly button; this is because the internal organs are able to push through my very thin, and very stretched, linea alba (yummy…see picture above for a visual). Similarly, while in a crunch position, my abdomen bulges and is almost conical, and the skin is very loose.
WHAT CAUSES DIASTASIS RECTI?
While diastasis recti can be caused by surgery (ie: c-section or abdominoplasty), the main cause is persistent intra-abdominal pressure.
This can come from pregnancy (duh…), obesity, chronic constipation, and most notably poor posture and alignment. While anyone (male or female) can develop diastasis recti, moms are particularly at risk for it for several reasons:
- Growing uterus during pregnancy
- Relaxin, the hormone responsible for softening muscles, joints and ligaments in preparation for childbirth, can also relax your already vulnerable linea alba
- Second stage labor (pushing) puts excessive “down and out” force on the abdomen
- Common post-partum activities that are commonly performed with collapsed/rounded posture and alignment (ie: holding baby, breastfeeding, lifting baby from crib, diaper changes, etc.)
Additionally, performing ab exercises (or really any type of movement) improperly can lead to diastasis recti; weak or inactive transverse abdominals place a ton of pressure on the linea alba, causing it to weaken and thin over time.
Even if you have an 8-pack, you can still develop diastasis recti, like this seriously jacked dude (please focus on his diastasis and not the banana hammock…I swear this picture was meant to be educational):
WHAT ARE THESE TRANSVERSE ABDOMINALS YOU SPEAK OF?
If you have diastasis recti, you will need to become well-acquainted with your TVA.
TVA…I’d like you to meet my friend, Awesome Reader. Awesome Reader…TVA.
Here’s a bit of an anatomy lesson for you. Don’t worry, it won’t last long.
While most of us only care about the 6-pack, the abs are actually composed of four main muscles (from innermost to outermost):
- Transversus abdominis (TVA)
- Internal obliques
- External obliques
- Rectus abdominis (the “6-pack”)
Your TVA is the deepest muscle in the ab group and is the most crucial in terms of core stabilization. It runs horizontally and acts as a girdle around the waist, abdomen, pelvic area, and lower back; like a corset, it cinches our insides up and in. It is integrally linked not only to core stability, but also the proper functioning of the pelvic floor (which also takes quite a beating during pregnancy/delivery). This article does a great job explaining the vital function of the TVA and its connection to the pelvic floor.
Many people struggle figuring out “how” to activate the TVA–after all, if you haven’t been using it, it’s hard to know what it feels like when it’s fired up. This article can help you “find” your TVA and pelvic floor muscles.
In terms of diastasis recti, strong TVA are critical when it comes to displacing the abdominal and pelvic pressure which causes the separation. Unfortunately, most traditional ab exercises fail to strengthen the TVA, and simply place more pressure on the rectus abdominis.
Which is why, if you have diastasis recti, you should NEVER do any ab work that causes your abs to push up or out, including:
- full plank
- straight leg lifts
BUT I WANT TO DO PILATES/CROSSFIT/YOGA/RUN ETC…
You should do whatever form of fitness you enjoy, but I’d be careful to avoid doing any movements that were mentioned above.
I’d also be sure to explain to your trainer/coach not only that you have diastasis recti, but what it is and what moves you can’t do (I have found that most are completely unfamiliar with diastasis recti and therefore can’t assist you properly if they don’t know what types of movements need to be modified).
I LOVE CrossFit but felt many of the moves exacerbated my diastasis recti (including toes to bar, knees to elbow, sit-ups, floor release push-ups, burpees, KB swings…yeah, pretty much everything). I decided there was too much to modify so I chose to simply take time off until I heal my core completely.
Similarly, be cautious of straight leg lifts and Pilates 100s, as well as any yoga moves that require a plank or place excessive stress on the abdominal wall. Rule of thumb is listen to your body, and avoid anything that causes your abs to bulge or dome.
And if you pee your pants while doing it (all you moms know what I’m talking about), you should probably skip that activity as well until you’ve strengthened your pelvic floor.
HOW DO I KNOW IF I HAVE DIASTASIS RECTI?
Testing for a diastasis is easy.
- Lay on your back with your knees bent, shoulder width apart
- With your palm facing you, place your index finger just above your belly button.
- Lift your shoulder blades off the floor slightly (if you have separation, you’ll feel the rectus abdominis muscles close around your finger)
- If you have a gap, try the same procedure using two fingers. Try again with three fingers, then four, etc.
- Try this along the entire length of your rectus abdominis (above the bully button, at the belly button, below the bellow button).
Diastasis recti is typically measured in finger widths (ie: one finger gap, three finger gap, etc.), and may vary along the length of the abdomen. For example, after the birth of my second baby, I had a three finger gap above the belly button and one finger gaps at and below the belly button.
Anything more than a one finger gap is considered diastasis recti.
HOW SERIOUS IS DIASTASIS RECTI?
For most people, diastasis recti is painless and doesn’t impact their day to day life–this is probably why it is so often ignored and undiagnosed. The problem, however, is that it’s kind of a ticking time bomb; if uncorrected it can lead to bigger problems down the road.
Because the biggest problem isn’t the gap itself, it’s the underlying causes of the gap.
Crappy posture, poor abdominal tone, a weak pelvic floor, and performing movements without engaging the TVA are the issues that caused the gap, which is why people with diastasis recti are likely to develop:
- Back pain
- Pubic area pain
- Bulging or doming of the abdomen
- Pelvic floor dysfunction (urinary/fecal incontinence, pelvic organ prolapse, etc.)
- Abdominal discomfort with movement (ie: rolling over, getting out of bed)
- Difficulty lifting heavy objects
HOW DO I FIX DIASTASIS RECTI?
I’m not a healthcare provider, so I would first recommend talking with your OB/GYN, midwife, GP, or see a physical therapist. To be honest though, I didn’t have much luck getting help from two different midwives or my GP for my diastasis recti. My first midwife never checked me for it, and while I was sure to point it out to my second midwife after the birth of my second baby, he told me I could correct it by just doing crunches and sit-ups (a HUGE no-no for anyone with a diastasis).
I opted to attempt to heal the diastasis on my own before spending the money on a physical therapist, but I would guess a PT who specializes in women’s health or pelvic floor function would be a great bet if you want a professional.
Currently, I’m two weeks into the MuTu System by Wendy Powell. It’s a 12 week program that focuses on strengthening the TVA and pelvic floor, while also providing the science to help you correct the underlying causes of diastasis recti (ie: posture, the way you move, etc.). Annnnnd their website says it’s backed by a bunch of PTs and health professionals, so apparently a slew of credentialed people have vouched for it (the internet says so, so it’s good enough for me!).
What I can tell you is that I have gone from a three finger gap to a two finger gap above my belly button in two weeks. While I can’t physically see a change yet in the appearance of my stomach, I am FAR more conscious of my posture, actively engaging my TVA, and doing the little things to relieve the internal pressure in my core throughout the day.
I was also very opposed to wearing a splint or binder (mainly because I don’t think they address the main causes of diastasis recti ie: fixing your posture, alignment, and continually keeping the core engaged), which was why I went with MuTu over the Tupler Technique (the other main diastasis recti treatment program).
While I’m not going to disclose the exact exercises from the program (I’m guessing they frown on that since it costs $70…), it mainly consists of daily exercises to strengthen the TVA, pelvic floor, and glutes in sets of 20, coupled with a variety of stretches to be held for at least 30 seconds.
I’ll do an update post when I’m finished with the program to let you know how it has worked for me.
This workout is pretty similarly structured. You can also check out this video by a physical therapist with some good TVA exercises for diastasis recti.
From all of the research I’ve done, the key takeaways for rehabbing a diastasis are:
- Look beyond the gap: As I said before, the gap isn’t the problem. It’s easy to get caught up in thinking your life is over until the gap is closed, however, the gap is just a symptom of other problems — a weak core and poor posture, which may still be present even after the gap closes. This is why surgery isn’t necessarily a great option for everyone, and why the binders and splints won’t fix your diastasis long term (many women report their stomachs look flat for a few days after wearing the band, but start to protrude again shortly after). Which brings me to my next point:
- Strengthen your TVA and pelvic floor (keggles don’t cut it): I’ve already beat this dead horse, but it can’t be overstated that a strong, active TVA is the key to relieving the internal pressure that’s causing diastasis recti! And while some prengnant/post-partum women may enjoy doing 300 keggles a day (one of the few core/pelvic floor exercises recommended to pregnant women…), I certainly don’t. Here are a few more stretches and exercises (these are from Wendy Powell, creator of Mutu).
- Relieve the pressure: Be cognizant of the pressure you’re placing on your abdomen–be good to your core! Don’t sit straight up out of bed (roll to one side, then press up). When lifting (especially your kids), lift with your legs from a squatted position and exhale as you lift. And for crap’s sake, stand/sit up straight (I have absolutely awful posture…). Activating your TVA will naturally create an internal vacuum that elongates the torso, expands the rib cage, and rolls the shoulders back.
- Patience: This is the hardest principle for me. I want a quick fix, and I want it now. If the problem isn’t solved after two days, I write it off as a hoax and am on to the next thing. Which is why I have seriously challenged myself to stick with a course of rehab for the entire duration (12 weeks in my case). After all, my diastasis recti was developed over years, it shouldn’t come as a surprise that it may take months (or more) for it to heal. I’ve ultimately come to realize that deep core strengthening (TVA and pelvic floor) need to forever be a part of my fitness routine, because they support every other movement I perform. Whatever method you use to heal your diastasis, stick with it.