The gist: What is Diastasis Recti?
Also known as: Diastasis Rectus Abdominis (DRA), Mummy tummy, abdominal separation, "my abs split apart"
Diastasis recti is the separation of the rectus abdominis (RA) muscles, which are the "six-pack" muscles that sit on the outermost layer of the abdominal wall.
The separation is caused by the stretching of a piece of connective tissue between the RA muscles called the Linea Alba (LA), not the muscles themselves.
Diastasis recti is very common and occurs in pregnancy and postpartum. Physical therapy treatment is mainly focused on deep core strengthening exercises to regain tension in the LA. Advanced core exercises like planks and crunches can be doable again if you have a diastasis recti, but you must do the necessary rehab first.
Who gets Diastasis Recti? When does it occur for women?
Diastasis recti is very common during pregnancy and postpartum. It has been shown that 75-100% of women in their third trimester and 32% of women 1 year postpartum will have a DRA. This is because the abdominal wall has to stretch to make room for a growing baby. As the abdominal wall stretches, the muscles may separate. However, it is not the muscles themselves that are stretching, but rather the connective tissue in between called the linea alba (LA). The LA is made up of fibrous connective tissue, similar to a tendon (like the Achilles tendon). After delivery, the abdominal wall shrinks, but the LA may not return to its former tautness. Just imagine a piece of taffy or an old rubber band being overstretched; that's the LA after delivery. It is this laxity in the LA that causes the DRA. The majority of natural tissue healing will happen in the first 6-8 weeks after delivery, so any separation that is present past that time typically needs physical therapy intervention.
The telltale sign of diastasis recti is known as "doming" or "coning" which can be seen during pregnancy or after delivery. This is typically seen when doing a crunch-like movement which causes increased pressure in the abdomen that the LA is too lax to control. What is seen then is a bulging out along the LA, known as doming.
Other signs of diastasis recti include a general feeling of looseness or weakness in the abdominal wall postpartum and a "mommy tummy" or "pooch" that won't go away.
The Origin Way: Physical Therapy for Diastasis Recti
At Origin, we take a holistic and preventative approach to treating diastasis recti.
To treat diastasis recti postpartum, we need to put tension back in the LA. To do that, we activate and strengthen the transverse abdominis (TrA). The TrA is the deepest of the core muscles, and its fibers are more horizontal. Basically, it is your built in back brace. The fibers of the TrA attach into the LA, so as TrA activation improves, more tension is generated in the LA. Once adequate tension can be generated, we can start to strengthen the RA muscles. This will thicken the muscle bellies and continue to improve the separation. Over time, the resting tension in the LA will hopefully improve.
We can also start treating diastasis recti proactively during pregnancy. TrA strengthening exercises are perfectly safe to do during pregnancy and are helpful to potentially decrease the severity of the DRA postpartum. Your physical therapist will also give you tips to help improve your posture and how to lift things properly to decrease excess strain on the abdominal wall during pregnancy.
There are a lot of myths out there about diastasis recti, particularly about what you can and cannot do. The one movement that should not be done by anyone who has a DRA is a crunch or anything that looks like a crunch. This type of movement will typically cause doming to occur and therefore is not recommended while your DRA is still healing. Your Physical Therapist will show you alternative ways to avoid crunching in your daily life - like rolling over to your side first before getting out of bed. As for other exercises such as planks, your PT will periodically check your ability to do those certain activities without doming and with proper form so you are able to resume your regular daily activities and exercise routine safely.
In addition to TrA strengthening exercises and activity modifications, your PT may also recommend a belly support or kinesiotape to be worn temporarily to facilitate approximation of the RA muscles. Manual therapy techniques to the LA and abdominal wall can also be used to facilitate tissue mobility and healing.
How long does it take?
It typically takes about 6-8 weeks of physical therapy to reduce a diastasis by half a finger width, so it can take 4-6 months to achieve the results you want. This timeline assumes good compliance with your home exercise program.
What to expect in the future
The ultimate long term goal for treating diastasis recti is to regain tension in the LA. This does not necessarily mean a complete closure in the separation. In fact, for a LA to be of normal width, it just has to be <2 finger widths wide. When tension in the LA is improved, that means the abdominal wall is ready to work normally again!
At Origin, we want you to be able to safely do all your necessary tasks and activities without having to worry about your DRA. We work with you to create those goals specifically for you whether you sit at a desk to work, stay at home with your child/children, run, hike, spin, dance, do yoga, or anything else in between.
Will I ever be able to do crunches or planks again?
Yes! Crunches and planks are always included in a DRA rehab program not only because they are very popular core strengthening exercises, but because they are necessary functional movements as well. You need to be able to do a crunch safely to get out of bed and your core has to be able to work properly against gravity like a plank so you can bend over for a period of time (for example: changing diapers). You will gradually work your way up to these advanced exercises with careful supervision from your Physical Therapist.
Additional reading and sources
Mota, P. G. F. D., Pascoal, A. G. B. A., Carita, A. I. A. D., & Bø, K. (2015). Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual Therapy, 20(1), 200 - 205. doi: 10.1016/j.math.2014.09.002
Sperstad, J. B., Tennfjord, M. K., Hilde, G., Ellström-Engh, M., & Bø, K. (2016). Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine, 50(17), 1092 - 1096. doi: 10.1136/bjsports-2016-096065