In my practice, I’ve treated women recovering from diastasis recti or abdominal separation after pregnancy for years, however I did not truly understand the process until I started to develop this myself during my pregnancy. I’ll never forget the day I began to experience diastasis recti at about 5 months along. I was just starting to get a little baby bump and I was so excited to finally look pregnant versus just like I was getting fat. I was in an exercise class and we were getting to a section for abdominal work. I chose not to work my abdominal muscles very much because I was trying to prevent diastasis recti from happening to me. I was laying on my back and I went to sit up; I actually thought I had a small hernia. It looked as though I had a little dome or bulge protruding from my upper abdomen when I lifted by head and shoulder blades up off the floor. Of course I freaked out and I just happened to have an appointment with my doctor the next day. Long behold, my abs were just starting to split. No big deal right? Well to me it was. Not only had I worked so hard for my abs prior to pregnancy, but as a Physical Therapist I know just how important your abdominal muscles are for everything! To make a long story short, I learned how to prevent diastasis recti from worsening as my pregnancy progressed and I have outlined my best tips below.
So what is diastasis recti?
Here’s a quick anatomy overview. The rectus abdominus is one of four layers of abdominal muscles; you also have the transverse abdominus (TrA) ( the deepest layer) and the internal/external obliques that form your waist. When the rectus abdominus separates, the midline is stretched and it weakens along with the other abdominal muscles as well. This in turn leaves the front of the abdomen unsupported and unstable.
The good news is that diastasis recti is very treatable, however there are many misconceptions associated with this condition. First of all, diastasis recti does not cause permanent bulging in the abdomen ( aka the mommy-pooch) and it does not require surgical repair ( of course in severe cases this does happen). It does not necessarily cause pain and it does not mean that your abdominal muscles will always be weak after childbirth.
So how do you know if you have diastasis recti? Try this simple yet effective test. If you are still unsure or concerned, consult with your doctor!
- Lay on your back with your knees bent and feet flat on the floor.
- Relax your head and shoulders and place two fingers just above your belly button (palm facing you). Place your other hand behind your head.
- Lift your head and neck slightly off of the floor and press down with your fingertips, as though you are performing a crunch, making sure your ribcage moves closer to your pelvis
- If you feel a gap; that is the separation or diastasis recti
- You can then perform the same test just above and below the belly button
- The gap is measured in fingerwidths. You are aiming for a 1-2 finger gap or less, but have no fear it can be fixed if it is more!
Ok so you feel a gap, what do you do now? I think it’s important to point out that pregnancy alone does not cause diastasis recti. What actually causes the separation is the increased load and shifts in pressure from changes in alignment that pregnancy brings on. This leads to increased or excessive intraabdominal pressure which is what eventually causes the separation.
So what can you do during pregnancy to prevent this from worsening? I understand that every woman is different and every body is unique. I know some women that did work their abs during pregnancy and had no problem. I was in great shape before I became pregnant, but I was just not able to work my abdominals as it was uncomfortable for me and obviously because my abs began to split. However, I was able to prevent this from worsening post partum and was left with just a small lower abdominal pooch. With some hard work and a good diet, I was able to get my abs back in about 5 months. I’m still not exactly where I was before in terms of strength, but know that with a some persistence and hard work I will get there.
Here are my top tips and what really helped me the most!
- Avoid exercises that significantly increase intraabdominal pressure such as: crunches, sit ups, twisting movements and full push ups( without adequate abdominal support).
- Avoid yoga postures that put more of a stretch on your abdominals such as upward facing dog, backbends and be careful with the “cow” portion of cat/cow pose. It’s also important to avoid any deep twists to avoid putting excessive pressure on your abdomen.
- Watch your posture!. Pregnancy significantly changes your alignment and posture which can cause increased stress to your lower back and your abdomen. I found myself constantly watching my posture, especially when I was at standing at work all day. Keep your shoulders down and back, draw your shoulder blades together and think about drawing your navel in towards your spine all the time. Because of the increased load to the front of your body, this will cause your back to arch significantly more than normal. By practicing drawing your navel in towards your spine, it decreases the stress to your lower back and can also help decrease back pain.
- Do not perform any exercises if you notice your stomach bulging out along your midline
- Practice good body mechanics. For example, try not to get straight out of bed when laying on your back. This puts quite a bit of stress on your lower back and abdomen. Instead, try rolling to your side first and then using your upper body to push up into a sitting position. I found that by my third trimester this was my only option anyway!
- Wear some support, just not constant. Let me explain this a little further. It’s important not to rely on support garments too much because this can in turn “shut off” your deeper abdominal muscles when working to support your spine. However you may find that by the end of the day (like me) or more so towards the end of your pregnancy, that you just need a little extra support. I purchased the Upsie Belly by Belly Bandit on a recommendation from a friend during my third trimester and it was a life saver for me. I wore it to work and also found it very helpful when doing cardio. It gave me the just the right amount of relief so I didn’t feel such a strain on my lower abdomen and my back. This also helped me not to feel as though I had to pee every 10 minutes which was a blessing!
- Perform a safe exercise that targets your transverse abdominus ( also know as the TrA). Think of this muscle as your internal support system, as it works to stabilize your spine thus helping to prevent/decrease back pain, pelvic pain or instability. I normally teach patients how to perform TrA activation exercises initially in a supine position, however after the first trimester, it is best to avoid exercises laying flat on your back. You can simply modify this by propping your back and shoulders up with pillows so you are not flat. The reason for this is as the weight of the uterus increases during pregnancy, spending too much time flat on your back may compress your vena cava. This can sometimes cause you to become dizzy, lightheaded or nauseated and could briefly reduce blood flow to baby. Again, this is in most extreme cases and I felt fine laying on my back for brief periods of time to exercise throughout my pregnancy. Of course always consult with your doctor first and listen to your body! To perform, lay on your back with your knees bent and feet flat on the floor. Take a deep inhale; on your exhale draw your belly button in towards your spine. Do not “suck it in.” You should feel your abs and waistline tightening. I also like to engage my pelvic floor muscles when I do this. Think about tightening the muscles around your pelvis as though you are trying to draw a marble up into you. Hold this contraction for 5 seconds. Repeat 2-3 sets of 10. Work your way up to 15-20 second holds as you get stronger. This exercise can also be performed standing with your back against a wall. Here’s how to properly perform this exercise. Stand about one foot away from the wall, feet hip width apart, toes facing slightly outward and knees just slightly bent. Lean your torso gently back onto the wall. Keep your spine in a neutral position, make sure to have a small gap between your waist and the wall, resting your head against the wall. Inhale through your nose, expanding your ribcage. As you exhale slowly, pull your belly inward as much as you can maintaining a neutral spine ( think of drawing your belly button towards your spine). Repeat this for 10 repetitions.
- Perform this exercise with a pelvic tilt. I found pelvic tilts really helped to decrease my pain when my lower back was hurting. To perform simply assume the same positon as outlined above. Inhale through your nose, expanding your ribcage. As your exhale you want to think about drawing your navel in towards your spine and pressing your lower back into the wall. Try not to use your legs or squeeze your butt during this exercise, as we want the focus to be on the abdominals and spine. Perform 10 repetitions.
- Perform total body functional exercises such as my favorite……..THE SQUAT. Why squat? It’s a functional movement that works most muscle groups of your body and completely engages your core and your back.
Again, these are my tips for what helped me during my personal pregnancy journey. Always consult your doctor before trying any exercises during your own journey. I hope you find these tips helpful as they truly helped me!
You can check out my post on how I got my abs back after baby for some great exercise tips here.
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Dr. Allie Flower, PT, DPT, RYT