One of my friends, whom is also in the fitness industry, recently approached me asking me for some advice on how she could help her client who suffered from Diastasis Recti. Since it is a common condition in pregnant women, I though it would make a good post on this blog. I will go over some basic anatomy, discuss why Diastasis Recti occurs and how you can assess the severity of the separation, how to prevent it, and give you some exercises and modifications that can be performed if the condition occurs. NOTE ~ if you believe, or are not sure, if you or your client have Diastasis Recti, you should consult your physician before continuing or starting a new exercise program.
The abdominals consist of several different muscle groups; Rectus abdominis (your “six pack”), External and Internal obliques and Transverse abdominis. While the Transverse abdominis muscles “wraps” around the front of the trunk horizontally from side to side, the Rectus abdominis and the Obliques are vertically separated along the midline of the abdomen by a fibrous connective tissue called Linea alba. During pregnancy a hormone called “Relaxin” is released causing bodily tissues such as ligaments to “loosen up”, allowing for necessary changes in pregnant women’s bodies due to the growing uterus. One of these changes is the shift of the abdominals as the uterus grows and starts putting pressure on the abdominal wall. The Rectus abdominis and the Oblique muscles are stretched out and shifts laterally (sideways) from the midline of the body as pregnancy progress. This may cause a separation of the Linea Alba which is called Diastasis Recti.
A slight separation is considered normal, and a commonly used technique to evaluate the severity of the separation is to place your fingers horizontally on your abdomen (belly) right above you umbilicus (belly button) while lying in a supine (on your back) position with bent knees and the feet flat on the floor. If you are able to fit 3 or more fingers within the separation while performing a crunch, lifting the head, shoulders and shoulder blades off the floor, you should have it evaluated by your physician and make sure to modify your abdominal exercises until the gap is less than 3 fingers in width.
Although Diastasis recti can happen to any woman, studies has shown that the abdominal muscles and the Linea alba of women who exercise before and during the first trimester of pregnancy seemed to handle the stress better then those of sedentary (non-active) women. Since strengthening exercises also strengthen other tissues (not just the muscle itself), tissues such as the Linea alba would be more equipped to resist and prevent a separation in women with adequate abdominal strength and endurance before and during pregnancy.
Since a pre and postnatal woman with more that 3 fingers separation should consult her physician before continuing or beginning abdominal exercises, she should check for abdominal separation on a regular basis during and after pregnancy, no matter how long it has been since the delivery. Diastasis Recti usually starts to appear in the second trimester, but is most common in the third trimester and directly after the delivery. In most women the separation will return on its own as the uterus shrinks, but it has been shown to return sooner in women that perform modified abdominal exercises. Since a separation may increase trunk instability, which may lead to conditions such as low back pain, it is important that Diastasis recti is addressed.
After a woman with Diastasis recti has been evaluated by her physician, it is essential that she has sufficient strength in her “deeper” core muscles (such as the Pelvic floor muscles and the Transverse abdominis) before she progresses to a more advanced abdominal exercise (such as a modified crunch) that requires more trunk stabilization. It is important that she is able to master the first exercise (#1) before she moves on to the next exercise (#2) and so on.
- Kegel Exercises (I will go through Kegel exercises more in detail in future post)
- Kegel with abdominal compression/hollowing*1 (see below)
- Maintaining Kegel with abdominal compression/hollowing while performing a Pelvic tilt
- Maintaining Kegel with abdominal compression/hollowing and Pelvic tilt while performing other abdominal exercises such as a modified/assisted Crunch*2 (see below)
(Reference 6)
*1 Abdominal compression/hollowing is an isometric (non moving) activation of the Transverse abdominis, by engaging the abdominal muscles by thinking “in and up”. A great cue for pregnant women is that they should imagine that they are hugging their baby with their abdominal muscles.
*2 Modified/Assisted Crunch is necessary for women with Diastasis Recti to stabilize the now much more unstable trunk (due to the separation), provide support for the Linea Alba and to bring the Rectus Abdominus closer together through its contraction. This can be done by crossing a towel or your arms and hands around the trunk as the crunch is performed.
The Sahrmann abdominal exercises (will include more info in a future post) has also been recommended to safely strengthen the abdominals when experiencing Diastasis Recti.
The exercises mentioned above (#1-3) can be performed in different positions such as; standing, sitting, hand and knee, sidelying, and with the back diagonally on a stability ball. Make sure not to do any exercises in the supine (on your back) position after the first trimester since that can cause Supine Hypotensive Syndrome (compression of a major blood vessel which may decrease blood circulation).
It is also important to recognize that as pregnancy progress the growing uterus is causing more pressure on the abdominal wall and increasing the shift of the abdominal muscles which will make it more difficult to perform abdominal exercises. It might be necessary to “go back” and start over with exercise “#1″ and to modify the position in which the exercise is performed in, so that it will be executed correctly.
Other activities that may increase the separation due to increased abdominal pressure are;
- Getting up from a lying position ~ > make sure to first roll to the side and then use your arms to push yourself up
- Coughing & Sneezing ~ > create support by Abdominal hollowing and crossing your arms and hands around your belly
- Valsalva Maneuver (holding of your breath during an exercise or activity such as a bathroom visit when constipated) ~ > make sure to keep breathing and exhaling (breathing) out during the concentric (“pushing”/”hard”) phase of the exercise or activity
Please feel free to contact me if there is something else related to this topic that you would like me to expand on. This post may be updated, and new information along with pictures may be added.
(References 1,4,5,6,7)
