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What is Diastasis Rectus??

There’s a lot of misinformation out there about diastasis – some of it can be pretty scary! Exercising regularly can be hard enough as it is without adding fear to the mix. Here are five questions (and answers) you might have about this common diagnosis.

1. What is Diastasis?

Diastasis (short for Diastasis Rectus Abdominis or Diastasis Recti), is a stretching of the linea alba, often to make room for a growing baby. The linea alba is connective tissue that helps hold the rectus abdominis (i.e. the 6-pack muscles) together. When the linea alba gets stretched, this can lead to the appearance of a “gap” between the rectus abdominis muscles. Don’t worry, your muscles are still connected! The tissue connecting them is just looser so they seem more “separated”. This is normal and needs to happen during pregnancy so that the baby has space to grow.


Although there are various ways of measuring diastasis and some debate about what should be measured, the most common one used in the clinic is by measuring the number of finger widths you can fit in this “gap” between the borders of the rectus abdominis during an abdominal contraction. Anything more than 2 finger widths at the belly button is considered a diastasis. Diastasis often improves on its own1,2:


TIME

% with Diastasis

Gestation week 35

100% (it's normal, it needs to happen!)

6-12 weeks postpartum

50-60%

6 months postpartum

40-45%

12 months postpartum

32%




2. Will diastasis cause back pain, pelvic pain, or other pelvic health disorders?

The short answer is: no.

You can have a severe diastasis and none of these problems, or no diastasis and all of these problems. Women with DRA tend to have weaker abdominal muscles and are more likely to report abdominal pain, but they are no more likely to have back/pelvic pain or other pelvic health disorders than women without DRA2,3,4,5,6. That said, if you don’t like how it looks/feels and have a tendency to pull in or suck in your tummy all the time, this could potentially contribute other pelvic health symptoms.


3. Is it safe to exercise with a diastasis?

Yes - you can get back to the exercises you enjoy doing!

If it’s been a while since you’ve done them, just make sure to start easy and build up gradually. If your core feels weak when you’re engaged in those activities then it would probably help to strengthen it. There is no evidence that any specific core exercises will make your diastasis worse. Crunches have a tendency to be vilified but if you look at the studies that test the effectiveness of exercise with diastasis, most of them actually involve crunches, sit-ups, and/or trunk twists in some form7,8,9. None of them reported the participants’ diastasis getting worse; if anything, they got better!


**The following are signs/symptoms to watch out for that may be an indication you are doing too much and may need to scale it back: not able to maintain good form for your exercise, pelvic floor symptoms (e.g. leaking, heaviness/pressure), pain, hard doming of the linea alba.**

Talk to your pelvic physio if you are having difficulties with this


4. What exercises can I do to help with my diastasis?

Research can be murky and it’s unclear if abdominal muscle strengthening exercises can help to “close the gap” or if some exercises are better than others10,11. Given the variety of exercises that are often used in clinical trials for diastasis, it seems like the more important part is to just load the muscles in some way. We know that from a physiological view, exercises that target all your core muscles are what’s going to make physical changes to your muscles and connective tissue. Therefore, core exercises are what is most likely, besides surgery, to change how things look. Worst case is, you still have the gap but you’re a lot stronger and feel better!


You will need to train the muscles relatively intensely in order to make changes to how your abdominal wall looks. For muscle growth to happen, you need to take the muscles to fatigue. For muscles to get stronger, you need to challenge them with progressively harder exercises. When you’re first starting core exercises, they may feel different than before you were pregnant. Remember that your body has gone through a lot! It’s okay, it doesn’t mean that you are broken, and it doesn’t mean that you can’t get stronger. It might just take some time. See the Q/A above on signs/symptoms to look out for when getting back into exercise.


5. So I know a diastasis isn’t harmful for me, but what if I still don’t like how my diastasis looks?

It’s OK to not like how your diastasis looks! We’re told explicitly to love our bodies even though implicitly much of our culture still says otherwise. And then we feel guilty when we don’t love our bodies, and it’s a real shame cycle that we put on ourselves! Give yourself some compassion and give yourself permission to feel what you feel. It’s okay to want to have a tummy tuck surgery. It’s also okay to not want to have surgery and feel good about your postpartum body! Either way, whether or not you choose to have surgery, strengthening your abdominal muscles will help your abdominal wall function and feel better. Contact your physio if you’d like some guidance with this.


Sources:

1. Sperstad JB, Tennfjord MK, Hilde G, Ellström-Engh M, Bø K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med. BMJ Publishing Group; 2016 Sep;50(17):1092–6.


2. Mota PGF da, Pascoal AGBA, Carita AIAD, Bø K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther [Internet]. 2015 Feb; 20(1):200–5. Available from:

3. Doubkova L, Andel R, Palascakova-Springrova I, Kolar P, Kriz J, Kobesova A. Diastasis of rectus abdominis muscles in low back pain patients. J Back Musculoskelet Rehabil. 2018 Feb 6 ;31(1):107–12.


4. Keshwani N, Mathur S, McLean L. Relationship Between Interrectus Distance and Symptom Severity in Women With Diastasis Recti Abdominis in the Early Postpartum Period. Phys Ther. Oxford University Press; 2018 Mar 1;98(3):182–90.


5. Gluppe S, Ellström Engh M, Kari B. Women with diastasis recti abdominis might have weaker abdominal muscles and more abdominal pain, but no higher prevalence of pelvic floor disorders, low back and pelvic girdle pain than women without diastasis recti abdominis. Physiotherapy. 2021 Feb 13:S0031-9406(21)00018-3. doi: 10.1016/j.physio.2021.01.008. Epub ahead of print. PMID: 33691943.


6. Bø K, Hilde G, Tennfjord MK, Sperstad JB, Engh ME. Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: Prospective cohort study. Neurourol Urodyn. 2017 Mar;36(3):716–21.


7. Gluppe SL, Hilde G, Tennfjord MK, Engh ME, Bø K. Effect of a Postpartum Training Program on Prevalence of Diastasis Recti Abdominis in Postpartum Primiparous Women: A Randomized Controlled Trial. Phys Ther. 2018 Jan 17.


8. Walton LM, Costa A, LaVanture D, McIlrath S, Stebbins B. The effects of a 6 week dynamic core stability plank exercise program compared to a traditional supine core stability strengthening program on diastasis recti abdominis closure, pain, oswestry disability index (ODI) and pelvic floor disability index score. Phys Ther Rehabil. 2016;3(1):3.


9. Thabet, A. A., & Alshehri, M. A. (2019). Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial. Journal of musculoskeletal & neuronal interactions, 19(1), 62–68.


10. Benjamin DR, Frawley HC, Shields N, Peiris CL, van de Water ATM, Bruder AM, Taylor NF. Conservative interventions may have little effect on reducing diastasis of the rectus abdominis in postnatal women - A systematic review and meta-analysis. Physiotherapy. 2023 Jun;119:54-71. doi: 10.1016/j.physio.2023.02.002. Epub 2023 Mar 5. PMID: 36934466.


11. Berg-Poppe, Patti & Hauer, Michaela & Jones, Cassandra & Munger, Mattison & Wethor, Cassidy. (2022). Use of Exercise in the Management of Postpartum Diastasis Recti: A Systematic Review. Journal of Women's Health Physical Therapy. 46. 35-47. 10.1097/JWH.0000000000000231.

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