There are a million excellent reasons to adopt proper core engagement while exercising and throughout daily life. But the one that often stops women in their tracks and truly motivates them is diastasis recti. Many women are horrified to learn that their abdominals may not return to normal after pregnancy.
Fortunately, knowledge of diastasis recti is growing, and pregnant women are gaining awareness so they may do their part to prevent it. It seems counterintuitive, but the best time to address diastasis recti is during pregnancy! As baby grows within your abdomen, learning to activate the right muscles of your core in a functionally sound way will better protect the elastin and collagen that make up your linea alba, which connects your rectus abdominis down your midline.
What Is Diastasis Recti?
Diastasis recti is the result of excess pressure in the abdomen, leading to a damaged linea alba. Every woman will experience some separation of her abdominals during pregnancy, and many women’s abdominals will return to normal 6 to 8 weeks after pregnancy without any intervention. However, 45 percent of women will experience some injury to their linea alba, where the damage to the connective tissue creates the iconic “mummy tummy,” a soft abdomen that protrudes several months after baby is born. Diastasis recti also can lead to low back pain, pelvic or hip pain, incontinence, prolapse, and an overall weak core.
Even so, diastasis recti can be repaired post birth, and for most women, this is when they take action. It takes commitment to specific exercises that work on restoring proper core function and thus tension in the linea alba.
How to Prevent and Heal Diastasis Recti
You may have heard the best way to prevent diastasis recti is to avoid certain exercises like planks and crunches. This is certainly true for those who are not activating their core in a functional way, and there are safer options so that you don’t have to stress over whether you’re performing the exercise correctly.
However, if you’re using your core properly, these exercises can be safe. The key is managing intra-abdominal pressure by engaging the pelvic floor with the transversus abdominis (TVA), especially when pregnant.
What does proper core function look like?
Find a neutral spine position.
Inhale and imagine air filling up your abdomen. Feel the muscles in your pelvis drop and lengthen.
Exhale, lift the muscles at the base of your pelvis (your pelvic floor), and imagine a corset cinching your torso as you activate your transversus abdominis (TVA).
Repeat this extension on your inhale and contraction on your exhale.
When lifting heavier weights and/or needing more spinal stability, contract your core muscles and hold this position as you continue to breathe with your diaphragm. Focus on the breath expanding your rib cage 360 degrees versus inflating your belly.
Lifting your pelvic floor and wrapping your transversus abdominis (TVA) will diminish the pressure in your abdomen, creating less strain on the linea alba, giving you more strength, stability and spinal protection.
Common Mistakes That Increase Risk for Diastasis Recti
The Desperate TVA: Have you ever wondered why some super fit gym-goers have bellies? This is due to using your TVA eccentrically versus concentrically. In other words, when you contract your abs, they should knit together and move inward (concentrically). They should not pop outward (eccentrically). This is a common mistake people make while doing crunches and planks, which is why many pregnant women are told to avoid these exercises. Moving your TVA in this way creates strain on the linea alba, deteriorating collagen and elastin.
Pulling Navel to Spine: When you suck your belly button to your spine without engaging the pelvic floor and TVA, you send pressure down into your pelvic floor and pinch your abdomen at a singular point (your navel), weakening your linea alba and increasing risk for diastasis recti.
Contracting Your Abs All Day: Fully releasing your pelvic floor and TVA is just as important and contracting these muscles. Firstly, your muscles build greater strength by contracting from an extended position. Secondly, if your core is constantly engaged, it must compete with your uterus while the baby grows rapidly inside it. Eventually, your linea alba will become compromised at the mercy of your uterus.
How to Check for Diastasis Recti
If you’re pregnant, look out for any doming or coning along your midline as you engage your abdominals. Pay close attention as you sit up from a chair, rise out of bed and, of course, while exercising. This doming or coning signals a weak point in your linea alba; however with proper engagement of the pelvic floor and TVA, you can diminish the injury over the course of your pregnancy, stimulating collagen growth within your connective tissue.
If you’re postpartum—whether months or years post birth—you can heal your diastasis. A “tummy tuck” doesn’t have to be the answer. It comes with proper core awareness and function—not just while exercising but in day-to-day life. For a proper diagnosis, see a pelvic floor physical therapist, but to gauge whether you may have a diastasis injury, you can perform a check at home. Wait at least 6 weeks postpartum to do so.
Lie down on your back: Roll from your side to your back to protect your core as you lie down. Rest with your knees bent and feet flat on the ground.
Assess your linea alba at rest: Take note of how the tissue feels up and down your midline.
Exhale and gently lift your head one inch above the ground: With one hand behind your head, lift your head one inch off the floor just enough to feel your rectus abdominis engage.
Assess the width of your linea alba while engaged: Holding that position, feel with your other hand along your midline for the width between your rectus muscles. Check at your navel, halfway between your navel and sternum and halfway between your navel and pubic bone. A gap larger than two fingers may signal a need to rehabilitate the diastasis, although width is not the most important indicator.
Assess the depth of your linea alba while engaged: Also feel how deeply your fingers can press into the linea alba tissue. Does it feel soft and squishy or shallow and springy? Weaker integrity in the connective tissue may mean rehabilitation is necessary.
For additional instruction on how to perform a diastasis recti assessment, watch this video created by PROnatal Fitness, an evidence-based, on-demand fitness platform for pregnant and postpartum mothers.
If you believe you have diastasis recti, please reach out to a pelvic floor physical therapist in your area as well as email us at hello@navewell.com for personal fitness coaching to guide you through rehabilitation. The sooner you take action, the easier diastasis recti is to heal.
References
Goodlatte J, Fit for Birth Pre and Post Natal Diastasis and Core Consultant Manual, 2019.
Sperstad JB, Tennfjord MK, Hilde G, et al. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine 2016;50:1092-1096.