Lacey SoaresLet's Talk Diastasis Recti (DR)
Unless you’re a second time mom, the mother of twins, or your doctor specifically mentioned it, chances are you may not have even heard the term diastasis recti. It’s actually a pretty common occurrence of pregnancy.
First we should probably talk about what it is. Diastasis Recti (DR) is referred to as the separation of the rectus abdominis muscles, also known as the “6-pack muscles”, down the midline of the belly (that’s made up of 2 halves). The actual separation is a result of the linea alba (the connective tissue) becoming stretched and more lax as the baby grows throughout pregnancy. As the baby grows, the abdominal wall needs to stretch further to accommodate the baby. This connective tissue becomes stretched, widened, and thinned, which can impair the ability of the abdominal muscles to function most optimally.
So what does the research say?
A study found 100% of women in their 35th week of pregnancy to have diastasis recti. The prevalence of DRA decreased to 35-39% at 6 months postpartum. Interestingly they found that while diastasis recti was prevalent at 6 months postpartum it was not linked to lumbo-pelvic pain. Another study reported that 66% of women in their 3rd trimester of pregnancy have diastasis, while over half of immediately postpartum women do (Boissonnault & Blaschak,
1988). 53% of women immediately postpartum have DR (Boissonnault & Bleschak, 1998).
Further, Coldron et al (2008) measured the inter-recti distance in postpartum women
from Day 1 through the first year and found that with no intervention, such as exercise training or physical therapy, there was no reduction in the gap by one year.
Again, DR is a fairly common occurrence in pregnant and postpartum bodies, but you don’t need to worry if you do have it. You likely will! This is why I specialized in Prenatal and Postnatal fitness...to help moms heal their bodies from the inside out.
So how do you know if you have diastasis recti or not?
If possible, you should ask your doctor to check you at your 6-8 week postpartum appointment. Don’t stress if you’ve already had this appointment though, and weren’t checked. You can absolutely check yourself, or have someone who knows what to look for, check for you...though I recommend waiting until 10 days to two weeks postpartum to do the first assessment.
To check for DR yourself:
Step 1: Lay down in a supine position (on your back, facing up) with your knees bent and your feet flat on the floor,(as if you were about to perform a glute bridge).
Step 2: Walk your hand down along the midline of your belly to get a sense of the
tension in the linea alba. You can start from just under your sternum and work your
way down towards your pubic bone, straight down the line.
Feel if there are areas that are squishier than others. Can you press your fingers way
down into your belly? Does the tissue feel supportive when you press into it?
Step 3: Using the three middle fingers of one hand, press straight down into your belly
just above your belly button. Tuck your chin towards your chest and slowly lift your head off the floor. Only your head should come off the floor. Keep your shoulders down.
(*EXTREMELY IMPORTANT: This isn’t a crunch, just a “head lift.”)
Repeat a couple of times if needed, adding or taking fingers away to get an accurate
measurement with the same, very small head lift (no full crunches).
Step 4: Repeat Step 3 above your belly button. Measure 3-fingers wide above your belly
button and do the head lift test at this site.
Step 5: Re-test below the belly button, with the same 3-fingers wide spacing.
Step 6: Re-test at all three measurement sites, but now gently do
an exhale breathe and focus on doing a gentle “kegel” action, or lift your perineum to
the crown of your head, and then re-do the head lift test.
Do you feel a separation? How many finger widths apart is it? If it’s less that two finger-widths apart, you are fine and do not need to stress. There are plenty of things you can do to bring the small gap back together. For a gap larger than two finger-widths apart, then you should let your doctor know. There is still no need to stress. You may just need more options, outside of exercise alone, in order to bring the gap back together.
As I mentioned earlier, there are many exercises that you can do to bring the gap back together, and you can do them at home. We'll talk about those is a second. First though, please STOP doing crunches if you've been doing them! Also AVOID planks, sit-ups, leg drops, roll-ups, oblique (twists); anything that twists the body and places strain on the abs – like straight leg lifts or anything that causes the belly to bulge outward, like sit-ups. NO heavy lifting and no front loading baby carriers because they place additional strain on your abs. Also, any posture that requires you to be on your hands and knees can place additional strain on your already compromised abs.
Think of your abs as a corset that goes from the hips up the ribs, and think of what you would do to tighten the corset: Both hands pull towards the center from the sides, like the obliques do. What you can do several times a day at home to help close the gap is to lay flat on your back (legs bent) and imagine a string pulling the center of your abs into the floor. Exhale as you tighten them towards the floor and hold for at least 20 seconds and do this 3 to 4 times. Repeat at least twice a day. Also when you’re getting up from laying down, don’t just sit straight up. Be sure to roll to your side first and then sit up from that side position. Think of yourself as a burrito and you don’t want all the good stuff to fall out. You wouldn’t just bend a burrito in the middle and sit it up. It’d bulge and spill out the goodies. Think of your body the same way.
Your uterus can take up to 10 weeks to go back to normal size and your body can take up to 18 months to heal. Don’t be hard on yourself or pressure yourself to get back to pre pre-baby body too fast. Let your body heal.
Let’s start with some easy stuff to help your DR. Here’s some exercises you can do safely at home…
Single leg lifts
Lying on your back with your knees bent and feet flat.
Slowly lift one leg up so the knee is directly above the hip.
Ensure the heel is in line with the knee so you are creating a 90 degree angle at the knee.
Keep that same angle as you lower the leg back down.
Repeat on the other side.
To advance, add leg extension.
Single or Double Knee Drops
Lying on your back with your knees bent and feet flat.
‘Drop’ either one or both knees to one side. If you do single, ensure the other knee stays still.
Gently engage your abdominals to lift the knee (or knees) back to the starting point.
Pelvic Tilts with Gentle Abdominal Activation
Start by lying on your back.
Gently engage your deep abdominal muscles. To feel this, place the heel of your hands on your hip bones and have your finger face down towards your pubic bone. Then gently think about drawing your belly button inwards and feel your lower belly gently draw back.
Stay with just this, or add pelvic tilts by flattening your back and engaging your deep abdominals and pelvic floor, then gently arching your back and relaxing all muscles.
Leg Slides
Lying on your back with your knees bent and feet flat.
Slide one leg away from you, keeping the heel on the ground.
Slide it back in, keeping your pelvic floor and deep abdominals gently activated.
Alternate sides.
Once you are ready to advance (remember not to rush into advancements!) you can lift the foot off the ground and lengthen it long without the heel touching the ground.
Diastasis recti doesn’t have to be something to stress about. It should however, be something we talk more about.