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Diastasis Recti during Pregnancy

Diastasis recti is a very common condition that commonly occurs during pregnancy and can extend into the post-partum period and affect women and men in varying stages of life. There has been a recent upswing in research regarding the prevalence, risk factors and best treatment practice for DR. DR has a significant impact on the structural integrity of the abdominal wall and can lead to issues with back/pelvic pain, poor posture, incontinence, pain with intercourse and an overall decrease in satisfaction with body image. Specific abdominal exercises, regardless of whether they are started before, during or after pregnancy have been shown to decrease the risk, severity and improve the overall reduction of DR. You can successfully retrain your abdominal muscles, address posture and prevent/correct compensatory strategies with our pregnancy programs modified for diastasis recti.

Diastasis Recti Do’s & Don’ts during Pregnancy

You might be asking yourself how to exercise with diastasis recti?  I have two specific exercises for this abdominal separation.  But first let’s chat about why diastasis recti occurs and a list of do’s and don’ts.

HOW DOES DIASTASIS RECTI OCCUR?

Diastasis Recti occurs in 33-60% of pregnant women.[1][2] You are more prone to this abdominal gap if you have a weaker abdominal wall, if you are carrying a large baby, if you are carrying more than one baby, if you have a narrow pelvis, if you have more than one child and had them close together, or if you’re over 35 when you get pregnant. After that long list of predisposing factors, you can see why 33-60% of mamas have diastasis recti during the second half of pregnancy.  That said our bodies are made to bear children and are also resilient in getting back to their prior self.

This abdominal separation occurs when the tissue between the right and left recti is distanced more than 2 finger widths. You can’t change the pressure on your abdominal wall – you’re pregnant! But there are a few things you can change: posture, functional moving in daily activity, strength in the transverse abdominis and pelvic floor and stopping exercises that can make it worse.

Generally, women don’t have this ab separation during the first trimester, but if you experience any discomfort in this area, you may want to modify your core exercises. If you have had diastasis recti with previous pregnancies you may or may not have it with this pregnancy.

Lisa, mom of 3, healed her diastasis after her second pregnancy and was able to go through her third pregnancy without the diastasis reoccurring.  You can read more about her story here.

HOW DO I EXERCISE WITH DIASTASIS?

Tip #1 Correct your posture

It sounds simple, but years of habit can take a bit to correct.  In fact some studies show it takes thousands of repetitions to correct bad habits.

From a standing position, stack your rib cage over your pelvis and keep your pelvis stacked neutrally over your feet.  Or as I like to call it “close your ribs”. Don’t stand with a swayback and open rib cage. This exacerbates the issue. The smallest of changes – closing the ribs and stacking the pelvis over the feet – takes pressure off the linea alba (where the recti separation occurs).  And to be honest…it’s the 23.5 hours of care that occurs outside of your workout that count the most!

Tip #2 Activate the Transverse Abdominis & Pelvic Floor

You will want to start training the pelvic floor and transverse abdominis – these muscles act as a sling to support the baby and are extremely important both during pregnancy and after pregnancy. It will also help in getting a flat stomach after the baby is born.

 

The first exercise is the Transverse Abdominis (TA) breath –

Abdominal muscles help move the diaphragm and give you more power to empty your lungs. So why is this helpful in women with diastasis recti? Think of your mid-section, or your core, as everything but your limbs. It’s a powerhouse that needs to work in harmony for healthy and resilient muscles.

But wait its hard to breathe during pregnancy! As the uterus continues to expand there is a flaring or widening of the lower ribs, and an upward displacement of the diaphragm by approximately 4cm. the diaphragm widens when the uterus overtakes its domain. This adjustment, combined with the chest’s adjustment, allows more air to flow into and out of the lungs. Rib cage remodeling occurs so that the thoracic cavity is not reduced in pregnancy. Because of these adaptations, the total volume of air moving in and out of the lungs is not compromised in normal pregnancy.

Whoa…mind blown…it was for me too!

Here’s how to do the TA breath. It’s a simple and natural process that will soon come second nature.

Note: When you first learn the TA breathing technique, it might be easier to make the connection lying down. Then move to a seated position or standing position. If you have diastasis recti – and don’t necessarily have all the posture pointers mastered from above, try it from the lying position. It is best not to be in the lying (or supine in anatomical terms) position for too long as the pressure of the baby restricts blood return.

Feel free to practice this first round while sitting up and reading this article!

  • Lie on your back on a flat surface or in bed, with your knees bent. Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move as you breathe.
  • Breathe in slowly through your nose so that your stomach moves out against your hand. The hand on your chest should keep as still as possible.
  • Tighten your stomach muscles, letting them hug your baby as you exhale through pursed lips. Keep the hand on your upper chest as still as possible. Another cue is belly button to baby or saying the word “haaaaa” or “ssssss”.
  • Repeat for 30 seconds. Rest. Repeat 2-3 times.

It sounds simple, but it is hard to train our brain this way. So practice, practice, practice, and we will do it again after your baby is born. We get into diastasis recti after pregnancy here in a bit.

 

The second exercise is Pelvic Floor activation – because it’s the bottom of your core (see illustration below).

Your core cannot function without the work of the pelvic floor. You can activate the pelvic floor by controlling the flow of urine or performing a kegel. If you are not familiar with activating the pelvic floor please read this article on pelvic floor exercises.

Now perform the TA breath again.  This time as you exhale activating the transverse abdomins, I want you to think about also activating the pelvic floor. It’s not your traditional way of ab training, but it is the most beneficial, I promise!

pelvic-floor-pregnancy

Tip #3 Stretching and strengthening

It kind of goes without saying, but if we take care of our body it will more than likely take care of us. Daily exercise is essential. And that doesn’t mean a solid 40 minute exercise routine everyday, it can mean moving 20 minutes a day. In your first trimester I know you are green to the gills. In your second trimester you feel like superwoman. And in your third trimester all those aches and pains can kick in.

As you move daily – in exercise and in daily activity – you will want to work “functionally” with your diastasis recti. Usually this means you need to see a physical therapist or physiotherapist for some 1-1 attention. In addition, making a few postural adjustments, activating the transverse abdominis and doing functional exercises that don’t make your diastasis recti worse are LARGELY beneficial. Healthy (from toning) and supple (from stretching) muscles will treat you well!

While including overall strength and stretch exercises, there are some modifications to your overall exercise routine, like not doing planks.  We cover this full list of don’ts in Tip #5.

I recommend using a comprehensive workout that does not load the abs – like our pregnancy workouts. Anytime your abdominal wall is “loaded” i.e. putting extra pressure on the tissues by doing pushups or planks, you can worsen your diastasis recti. We still do pushups, but in a functional way so as not to load the abs.  You can read more about the Don’ts during Pregnancy Exercise below.

 

Tip #4 Exercises you shouldn’t do

There is no universal list of don’ts in the diastasis recti world. But because it is usually the the intra-abdominal pressure that causes the recti muscles to have a bigger gap between them, our direction is to stay away from applying extra intra-abdominal pressure.

In addition to abdominal exercises for diastasis recti, you should also include overall strength and stretch exercises. That said, there are some modifications to your overall exercise routine.  So we will cover a general list, as well as a program modified for diastasis recti.

In the postnatal period this list is different – you will want to read up on postnatal diastasis recti.

You should refrain from twisting and spinal flexion (crunches). We also recommend you don’t do planks, push ups,  and most traditional abdominal exercises.  These are very general recommendations.  If you have the body awareness and know how of activating your transverse abdominis you can perform these exercises (although the most benefit will be seen after the intra-abdominal pressure – your baby – is out!)

safe-exercises-diastasis-recti-pregnancy

Exercise Programs modified for Diastasis Recti

This separation has a significant impact on the structural integrity of the abdominal wall and can lead to issues with back/pelvic pain, poor posture, incontinence and the feeling of “flabby abs”. Specific abdominal exercises, regardless of whether they are started before, during or after pregnancy have been shown to decrease the risk, severity and improve the overall reduction of DR.

We have a program designed for diasasis recti, try it free!  Not ready to dive right in?  Download our Prenatal & Postnatal Starter Pack.
Please note that Moms Into Fitness is not a medical facility.  Anything that your doctor recommend or does not recommend should supersede anything on this page!

[2] http://bjsm.bmj.com/content/early/2016/06/20/bjsports-2016-096065.full , accessed August 1, 2017.

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