PostPartum Core: Diastisis Recti

You’re an active mom. You have a beautiful 10 month old baby whom you have carried for 9 precious months. Now it is time to hit the gym and get rid of that mummy tummy. You blast through intense cardio routenes, crunches, and countless ab “scuplting” machines. That should do the trick…right? Not necessarily. It’s an often frustrating postpartum problem. If you find that you have hit the gym religiously, worked on your diet and you still notice that unseemly bulge around your stomach; you may have what is known as diastasis recti.

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Diastasis recti is the separation of your rectus abdominus; one of your abdominal muscles commonly known as the “6 pack.” Approximately 50% of women postpartum acquire this separation of the rectus abdominus.³ Increased intra abdominal pressure from a growing uterus causes a stretching of the linea alba (figure 2), a ligament that holds the RIGHT and LEFT portions of the rectus abdominus together. ¹ If the abdominal wall is not strong enough to withstand this constant pressure of carrying a baby the line alba will tear causing a postpartum diastasis recti (figure 3).

Aside from the unwanted appearance of diastasis recti, there are harmful effects that can precipitate from this condition. Your rectus abdominus is part of your core musculature; including your transverse abdominus, internal and external obliques, and muscles that attach to your spine including: multifidus, quadratus lumborum and erector spinae. These muscles when working in harmony create a brace for your spine. Yes, these muscles serve a greater purpose than simply looking good on the beach. When the core is functioning properly said muscles provide stability to your spine during movement. When activated, the core also improves force generation of your upper and lower extremities. A stronger core translates into swing clubs and rackets faster, too!

A diastasis recti is a disruption to the abdominal system. It weakens the overall structure often leading to low back pain, hip, pelvic, and SI dysfunction. In fact, a weakened core can cause lower and upper extremity injuries during sport as the appendages work harder to compensate. Continuing the scary trend, a weak rectus abdominus can lead to abdominal hernias if you engage in high intensity exercises too soon.

Check for Diastisis Recti

check, for, diastisis, recti
1. Lie on your back with your knees bent
2. Place your 2nd through 4th fingers along your belly button, pointing down towards your feet.
3. Then lift your head off the ground and feel where the RIGHT and LEFT halves of your rectus touch your fingers.
4. Repeat several times and determine how many finger widths your separation is.
5. A width of 2-2.5 fingers is considered diastasis recti.¹

If you have determined you have diastasis recti, what’s next? Well you have to retrain and strengthen your core. Most people think strengthening your core translates into hammering crunches. However performing crunches actually can make a diastasis worse. It is important to avoid certain common core exercises that increase intra abdominal pressure and could potentially worsen a diastasis recti. These include:

Crunches
Sit ups
Planks on hands and knees
Push ups
Ab exercises involving raising/lowering a straight leg. 4

Now if you love planks or pushups don’t worry, you can resume the exercises as soon as you learn to engage your core properly. The key is to learn abdominal bracing. To do so, place one hand on your stomach and the other hand along your lower back. Now squeeze/tighten your abdominals as if someone is going to punch you in the stomach. If done properly, you should be able to feel your abdominals contract as well as your low back muscles.² There should be no movement of your pelvis, rounding of your shoulders, or lifting of the head.

Hand Position to Feel Abdominal Bracing

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Holding an abdominal brace is important for positional changes: i.e. rolling, moving from sit to stand, and bending. Bracing retrains your core musculature to stabilize the spine during movement. Maintaining an effective brace during daily tasks is only the beginning. Eventually you’ll be looking to sustain an abdominal brace while performing squats, step ups, lunges, etc. With practice and time, you’ll notice the gap in your diastasis recti closing, signaling a safe transition to recreational activities, sports, and higher functioning activities (pushups).

If you are unsure if you have diastasis recti or have difficulty engaging your core; you can always be evaluated by a physical therapist who can teach you how to retrain your core and progress you back to your recreational activities.

References

1. Dutton, Mark. Orthopaedic Examination, Evaluation and Intervention 2nd Edition. United States. The McGraw-Hill Companies Inc. 2008.
2. McGill, Stuart. Low Back Disorders. 2nd Edition. Champaigne, IL. Human Kinetics. 2007.
3. Chiarello, Cynthia M. PT, PhD1; Falzone, et al. The Effects of an Exercise Program on Diastasis Recti Abdominis in Pregnant Women. Journal of Women’s Health Physical Therapy. Volume 29 Issue 1. Spring 20005. P 11-16.
4. Pelvic floor safe exercises. Continence Foundation of Australia. http://www.pelvicfloorfirst.org.au/. Updated 2013. Accessed April 23, 2014.

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