4 Exercises to Heal Diastasis Recti
Your core is the center of a strong, powerful you. But, as any woman who hasn't been able to see her toes past her baby bump can attest, pregnancy does a number on the core -- specifically, through diastasis recti, or DR.
That's when the two panels of your rectus abdominis, or "six-pack" muscles, separate, "caused by a stretching of the linea alba, the ... tissue that connects the two panels together in the middle," explains Karen S. Weeks, physical therapist with the Northwestern Medicine Integrated Pelvic Health Program in Chicago.
While this most often occurs during the last trimester, as the fetus rapidly puts on size, she notes that women who deliver large babies, twins or are pregnant multiple times are at an increased risk of experiencing the condition. Research from the University of Oslo in 2016 found that 45.4 percent and 32.6 percent of women have DR at six months and 12 months postpartum, respectively. Although separation between the muscles narrows significantly immediately after childbirth, most women who have a gap eight weeks following pregnancy still have it a year later, explains prenatal and postnatal fitness specialist Jessie Mundell, Girls Gone Strong advisory board member.
[See: 7 Things You Need to Know If You're Pregnant With Twins.]
"I like to describe it super simply in that the connective tissue that runs down the midline of your belly becomes like a pair of yoga pants you can see through when you bend over," Mundell says. "That stretch, that thinning of the fabric, that's what diastasis recti is like."
And just like see-through yoga pants, a thinning linea alba is not ideal. "Unfortunately, the abdominal canister and pelvic floor muscles don't just automatically go back to their ideal positions postpartum, and they need to be trained as a system in how to work together again," Weeks says. "And it's not just aesthetics or the 'mummy tummy' that is concerning about DR. I regularly see first-hand the effects of [DR] on a woman's ability to function, whether it be leaking urine while she lifts weights in the gym or struggling with daily tasks like lifting her toddler or running to catch a cab."
In fact, a full two-thirds of all DR patients suffer from at least one support-related pelvic floor dysfunction, such as stress urinary incontinence, fecal incontinence and pelvic organ prolapse, according to research from the Washington University Medical School in St. Louis. And, for active female athletes, a decline in core function can significantly affect the ability to transfer forces throughout the body when running, control intra-abdominal pressure during lifts and result in umbilical hernias, explains Los Angeles-based women's health physical therapist Julie Wiebe.
[See: 8 Signs You Are Made to Be an Athlete.]
Do You Have Diastasis Recti?
Most women with DR "report a feeling of their abdominals being 'too loose' or that they feel that their abdominals just aren't supporting them," Weeks says. "Some women feel low back or pelvic pain, while others have urine leakage or a feeling of bulging, either in the abdomen or in the pelvic floor."
Sound familiar? While your OB-GYN or a women's health physical therapist can evaluate your core for DR using calipers or an ultrasound -- whether you are a few weeks or a few years postpartum -- you can also get a sense of any separation with a simple at-home test.
Here's how: Lie on your back with your knees bent and your abdomen easily visible. Place your pointer and middle fingers together and pointing down directly over your navel. Lift your head and shoulders off the floor as if you were performing an abdominal crunch. While carefully holding the lift, press your fingers down into your stomach, feeling the distance between the left and right sides of the muscles and the gap they may or may not form, explains physical therapist Lauren Tadros, supervisor of outpatient physical therapy at NYU Langone's Joan H. Tisch Center for Women's Health. Work your way up and down the midline of your stomach, feeling from about 2 inches above to approximately 2 inches below your navel. If you notice a gap greater than two finger-widths along any point, then it's likely that you have DR.
[See: The 10 Most Underrated Exercises, According to Top Trainers.]
4 Exercises to Heal Diastasis Recti
Hold off on your usual core work. "Exercises like crunches or situps can actually worsen the DR if the muscles aren't first taught to sync up in the best way with the pelvic floor and respiratory muscles," Weeks says. "We used to be concerned about narrowing the DR, but the latest research actually focuses more on this 'syncing up' of the muscles and how a 'tensioning' of the abdomen is likely more important than actually 'closing the gap.'"
"The quality, tension and density of the connective tissue is what's important in assessing the healing process. You can still have a gap with a healed diastasis. We're looking for function," Mundell says. "This means when you're assessing yourself for DR, you'll feel strong, taut tissue under your fingers when you press into your belly, exhale and lift your head. You should not have tissue doming or bulging out."
Start by performing these rehab exercises daily. (While you should always talk to your doctor before beginning a post-pregnancy exercise program, these moves are designed to be gentle enough to begin even one to three weeks postpartum.) Try reassessing your DR every two to three weeks to gauge your progress.
1. Abdominal Drawing In
When getting in and out of bed, lifting or carrying your baby or getting up from a chair, pull in your stomach as if you were trying to fit into a tight pair of jeans. You should be able to hold this abdominal muscle contraction and breathe normally for 10 seconds. This exercise will safely start to engage and strengthen your abdominal muscles without compromising them, Tadros says.
2. Belly Breathing
Lie flat on your back on a mat. Take a deep inhale, allowing your belly and then your chest to fully inflate. Then, slowly and forcefully exhale, drawing your abdominal wall in as if you had a corset on as you do so, says certified strength and conditioning specialist Jacquelyn Brennan, co-founder of Mindfuel Wellness in Chicago.
3. Heel Slides With Alternating Arms
Lie flat on your back on a mat, with your knees bent and feet flat on the floor. Straighten your arms and raise them directly over your shoulders. Exhale, and slowly extend one leg out in front of you, letting it hover a few inches above the floor, and simultaneously extend the opposite arm back above the head, just off of the floor. Inhale and slowly return to start. Repeat on the opposite side. Work to keep your hips and core stable through the entire movement, Mundell says.
4. Quadruped Abdominal
Get on all fours (hands under your shoulders and knees under hips) and pull your shoulders wide and away from your ears to form a flat back. From here, take a slow, deep inhale, allowing your abdominal wall to relax and expand toward the floor. Then exhale, drawing the muscles up and in while maintaining a flat back, Brennan says.
K. Aleisha Fetters, MS, CSCS, is a freelance Health & Wellness reporter at U.S. News. As a certified strength and conditioning specialist with a graduate degree in health and science reporting, she has contributed to publications including TIME, Women's Health, Men's Health, Runner's World, and Shape. She empowers others to reach their goals using a science-based approach to fitness, nutrition and health. You can follow her on Twitter or Instagram, find her on Facebook or the Web or email her at kafetters@gmail.com.
