Diastasis Recti DR is a very common condition that commonly occurs during pregnancy and can extend into the post-partum period. There has been a recent upswing in research regarding the best treatment practice for DR. 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.
Pregnancy is the most common cause of Diastasis Recti and risk/severity appear to increase with each pregnancy. Hormonal changes resulting in softening of the linea alba and increasing stretch placed on the abdominal wall during pregnancy is suggestive as to be a culprit of increased incidence in women during the 2nd and 3rd trimesters. During pregnancy inner-recti distance increased and the rectus abdominis became thinner, longer and wider compared to women who had never been pregnant. Pregnancies with multiple babies (ie: twins, triplets…) also increases the presence of Diastasis Recti. Age also appears to have an impact on DR as the inter-recti distance increases over the course of an individual’s life.
Symptoms of Diastasis Recti DR tend to progress gradually over a woman’s pregnancy and may extend to the post-partum period. While DR in and of itself may not be painful, the effects of DR can limit function and cause pain. Individuals with DR may experience palpable and visible separation of the Rectus Abdominis RA, altered mechanics of the pelvic floor leading to incontinence of the bladder and bowels, low back or pelvic pain, poor posture, a feeling of weakness in the abdominals and low back, and pain with sexual intercourse.
Women who have had cesarean sections may find that the scarring of the incision can worsen the symptoms associated with DR. Many women attribute these symptoms as “normal” and just part of life. However, these limitations should not be considered normal. You can return to normal daily and recreational activities without pain or fear of pain. It should be noted that DR is not the only cause of back and pelvic pain, incontinence, poor posture.
While we can address many of these symptoms through exercise, we ALWAYS recommend 1-1 attention with a physical therapist or physiotherapist.
There are specific activities you should avoid. In general, loading of the rectus abdominis, twisting of the trunk, traditional core exercises (sit ups, crunches, planks…) and heavy lifting are contraindicated (not recommended). That said this condition is unique to each individual. If you’ve had prior transverse abdominis training or diastais recti rehab, you know how to cue the TA during exercise. And it’s not just the half hour of exercise…is the other 23.5 hours a day that count (posture, picking up kids, twisting, etc.)
Activation of the transverse abdominis approximates the bellies of the rectus abdominis and strengthens the integrity of the linea alba (the tissue where the separation occurs). In general, research supports exercises focusing on core stability and strength before, during and after pregnancy. Research shows specific abdominal exercises prior to pregnancy may decrease the risk and severity of developing DR while pregnant. In other research, 90% of non-exercising pregnant women exhibited DR, while only 12.5% of exercising women had the condition. Another study found that there was no significant difference between women who started a core stabilization program focusing on reducing DR after delivery than women who performed the program during pregnancy.
In the past, plank exercises have been considered contraindicated in individuals with DR. However, a recent study by Walton, et al, 2016, found that a specific abdominal stabilization exercise program that included a traditional prone on elbows plank with the use of abdominal bracing was effective in reducing DR in individuals who were 3-36 months’ post-partum with presence of DR.
Candido, G., Lo, T., & Janssen, P. A. (2005). Risk factors for diastasis of the recti abdominis. Journal of Association of Chartered Physiotherapists in Women’s Health, 97, 49-54.
Chiarello, C. M., & McAuley A. (2013). Mind the gap: a comprehensive approach for the evaluation of and intervention of diastasis recti abdominis. Retrieved from http://www.womenshealthapta.org/wp-content/uploads/2013/12/2217-tues-3pm.pdf
Chiarello, C. M., Falzone, L. A., McCaslin, K. E. Patel, M. N., & Ulery, K. R. (2005). The effect of an exercise program on diastasis recti abdominis in pregnant women. Journal of Women’s Health Physical Therapy, 29(1), 11-16.
Boissonnault, J. S., & Blaschak, M. J. (1988). Incidence of diastasis recti abdominis during the childbearing year. Physical Therapy, 68(7), l082-1086.
Acharry, N., & Kutty, R. K. (2015). Abdominal exercise with bracing, a therapeutic efficacy in reducing diastasis-recti among postpartal females. International Journal of Physiotherapy and Research, 3(2), 999-1005.