Managing Diastasis Recti (abdominal separation)

By Nadine Adams MSPT, Physical Therapist, Personal trainer, Pilates instructor and Educator

First, let me tell you how and why I got into helping people manage their Diastasis. I have over 25 years of experience working as a Physical Therapist and over 30 years working in the fitness industry as a Personal trainer and group exercise instructor.  The past 10 years I have worked primarily with pregnant and post partum woman helping them rehabilitate their core strength, physical fitness and regain functional strength in their day-to-day lives. 

During my 2nd pregnancy at the age of 41 years old I found a 3 finger Diastasis at 29 weeks pregnant, coincidently enough in a workshop on Diastasis Recti. Knowing I was going to have to take care of a 2.5 year old toddler, a newborn infant, try to return to teaching Fitness classes and lifting patients as a physical therapist, I set out to learn all I could about managing Diastasis Recti.

I started testing all my clients for the separation and found that it is was much more common than I realized and unfortunately very under diagnosed.  Through my own personal experience living with Diastasis and learning how to manage it I knew I had to share with others what I had learned through my research and that is how my program Restore Your Core REHAB™ evolved.

Fast forward 8 years later, countless hours of research, taking courses from other professionals specializing in this area, and most importantly from my experience working with 100's of clients with Diastasis Recti, I have learned so much about managing this condition. 

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Common Questions about Diastasis Recti

 What is a Diastasis Recti?

A Diastasis Recti is a separation of the two sides of the Rectus abdominus muscle caused by a weakening and stretching of the abdominal connective tissue.  There are different ways to measure the size of the separation but a 2+ finger width separation or larger is considered clinically significant.  

Here is a video demonstration on how to check yourself for a Diastasis Recti.  https://youtu.be/woMH7NqJHlQ

What causes this Separation?

Intra-abdominal pressure most commonly from a growing baby inside mothers uterus, but can also be caused by other forces that stretch and weaken the tissue. In pregnant women the increase release of hormones that loosen your ligaments and connective tissue to prepare for labor allow this stretching to happen. 

An umbilical hernia can also develop due to the weakened connective tissue, but that is a topic for another blog. Make sure to check back on www.restoreyourcorerehab.com for future blog posts on other complications with Diastasis recti and the testimonial page to hear what my clients have to say about the program www.restoreyourcorerehab.com/testimonials

How Do I know I have one?

One of the more common signs post baby is a protruding belly and a woman still looks pregnant even after she has lost most of her pregnancy weight gain.

During pregnancy a doming effect can often be seen when leaning back or bending forward from the hips as seen in the pictures below. Other symptoms can include lower back pain due to a weakened core and improper posture and body mechanics, various kinds of pelvic floor dysfunction often causing stress incontinence, and/or constipation and other digestive issues as in the following client example.

Client Example:

I had a client who came to me complaining of bloating, difficulty moving her bowels, lower back pain and always feeling constipated.  She had tried doing an elimination diet and gave up gluten and dairy thinking that it was something wrong in her gut causing her digestion problems, but didn't have any relief.  Once she started working on healing her Diastasis and knew how to connect into her deep core and pelvic floor muscles her constipation and bloating went away.   Her functional strength improved significantly and she was able to return to a normal diet and back to her love of horse back riding and hiking with her 4 children without worrying about any unwanted discomfort or digestive issues.

What are the common exercises to Avoid? 

Temporarily avoiding crunches, oblique twists, side bending movements, front loaded planks, and for some early on even avoiding exercises in the hands and knees position might be recommended. These either increase intra-abdominal pressure or put abnormal forces on the connective tissue. Once healed, most of these exercises can be performed again if done correctly with good core engagement. No two separations are the same, just as no two individuals are the same and a person’s ability to control these abnormal forces is something that should be continually assessed while returning back to exercise and during day to day functional tasks.   

Can it be healed? 

Finding a qualified health care specialist who has experience   treating Diastasis Recti and can guide you through an appropriate exercise program, exercise modifications, splinting, postural re education and management techniques is the best way to heal your Diastasis.  

To further expand on this question, a sub question could be:
What is considered a healed Diastasis Recti?  The goal is to promote connective tissue healing and prevent putting abnormal forces on the tissue to allow the two sides of the muscle to come back together.  The connective tissue also heals from the inside out and improvement of both the size and depth of the separation are signs of healing. 

The ultimate goal is to regain functional use of your core and pelvic floor to support your spine and pelvic girdle and minimize the abnormal forces on the connective tissue during day-to-day functional activities.   The goals and functional needs will vary from person to person, but managing Diastasis Recti needs a whole body treatment approach for successful functional use of the core and optimal performance.

Correct alignment, proper breathing to retrain the deep core muscles to support how the body moves and protecting the connective tissue from abnormal forces during day to day activities are some of the techniques used in Restore Your Core REHAB™ Diastasis Recti treatment and management program. 

To learn more about the author and the program please visit www.restoreyourcorerehab.com