Diastasis Recti (Abdominal Separation)
NEVER ask a woman if she’s expecting – this should seem like common sense to most, but a lot of women are asked this question, only to become offended, embarrassed and ready to make a change.
Up to 60% of pregnant and postpartum women experience Diastasis Recti (DR), the separation of the rectus abdominus muscles (or the ‘six pack muscles’, we all dream of flaunting again, one day).
Although the rectus abdominis muscles naturally have a slight separation, when a woman is pregnant, the body releases a hormone, called relaxin, which softens the fascia and allows the connective tissue between the rectus abdominis muscles to stretch. This is great for allowing the body to accommodate a growing baby, but not so great for the health of your postpartum abdomen.
After baby is born, some women experience prolonged separation and, depending on the severity of DR, may require treatment.
How do I know if I have DR?
Indications of DR could include:
· Bulging along the center of the abdomen when you increase your intra-abdominal pressure (e.g., straining, doing a sit up or plank, lifting something heavy, etc.)
· Low back pain
· Stomach looks like it’s protruding
· Abdominal weakness
Can DR be treated?
Traditionally, Physiotherapists have discouraged patients with post-partum DR from performing movements/exercises that involve too much intra-abdominal pressure. These include exercises such as:
· Forward planks
· Heavy lifting and Twisting
It has been long believed that these activities would put too much pressure on the connective tissue and potentially prevent healing or worsen the DR.
Although this may still be the case for some, recent studies have revealed that this may not be true for everyone. The research has found that it is important to progressively challenge and overload the core muscles in order to achieve a change in the DR. There have been numerous studies looking at the effects of different types of core strengthening programs on the DR. By avoiding intra-abdominal exercises, we may not be able to strengthen the abdominals well enough to experience much improvement.
With that being said, it is important that each DR exercise program is specifically tailored to each individual since there is such a broad spectrum of severity and location of DR. A Registered Physiotherapist will develop a program suitable for you.
Bottom line: In order to heal the DR, it is not about avoiding specific exercises but discovering what exercises each individual body responds to positively and slowly progressing from there.
Exercises for DR:
· Start on your forearm and hold yourself up in a side plank (either from your knees or from your feet). Ensure that your body is being held in a straight line.
Toe Taps (with or without Scarf)
· Start on your back with your legs bent and your feet on the ground. Inhale and relax your muscles, exhale and raise your legs up to ‘table top’ (hips and knees bent to 90°). While maintaining control of the abdomen, take one foot and tap it on the ground then return it back to table top. Repeat with the other leg.
· If there is bulging, wrap a scarf around your waist and pull it tight as to cinch your waist. Now perform the exercise above.
Posterior Pelvic Tilt
· Start by lying on your back, knees bent, feet flat on the ground. Inhale and relax the muscles, exhale and tilt your pelvis backwards so that your lower back and tailbone are flat on the ground. Inhale and relax back to neutral. Repeat.
Isometric Abdominal Contraction:
· Inhale and relax the abdomen, exhale and draw the belly button to the spine. Hold for 5s while breathing out, relax and rest for 10s and repeat.
· Starting on your hands or forearm, hold yourself up in a forward plank (from your feet or knees).
· Alternative: Perform a plank against the wall or on a table to reduce the pressure along the abdomen.
Rotation with Weight
· Start by lying on your back with your knees bent, feet flat on the ground. Lift your head up while keeping your shoulders on the ground.
· Lift a weight up in front of you to start then slowly lower it down to your left hip, then back to centre and down to the right hip. Repeat.
**Prior to starting a new exercise program, book an appointment with a Pelvic Health Physiotherapist to ensure the program is right for you. The program should be discontinued if an abdominal bulging is noticed, as the exercise regime is likely too intense and needs to be adjusted accordingly.