Are you pregnant and worried about your abs separating and wondering how to prevent it? Or maybe you are postpartum and feeling like your abdomen isn’t quite how it used to be? Maybe you worry about having diastasis but aren’t really sure how to know? Maybe you have even been told you have diastasis by a provider and now scared of exercise for fear of doing something wrong? If you are looking to prevent or heal diastasis recti; Education is your friend and we are here to help!

What is Diastasis?

So what is diastasis? The right and left side of our abdominal wall in connected via the linea alba, a thick layer of fascia. This layer of fascia is meant to stretch and thin as you progress through pregnancy. This is how your body makes space for you to carry a baby in your abdomen—amazing! As this thins and stretches, our rectus abdominus muscles [ our 6-pack muscles ] move apart from each other. Once baby is delivered, this space left between the rectus abdominus muscles is defined as diastasis recti. We are interested in how much space is left between those muscles after baby is delivered.

How to Know if You Have Diastasis Recti?

When checking for diastasis, we use finger widths to measure the amount of separation. We measure 2 inches above the navel, 2 inches below the navel, and at the navel. We are looking at the distance between those two rectus abdominus muscles as well as the firmness of that space between those muscles. Additionally, we want to see if there is doming or coning. Doming occurs when we aren't contracting our abs correctly; causing a bump to form in that space between the rectus abdominus muscles during a muscle contraction.

Here’s the deal though...EVERYONE will have abdominal separation during pregnancy. Those muscles have to separate to create space for baby. We care mostly about how that space heals or comes back together postpartum. The space should become more firm by 12 weeks postpartum. At this point in time, your body should be in the clear to begin healing its diastasis recti, in the meantime allow yourself the time and grace to rest!

Clinically, anything over 2 fingers of separation is considered a diastasis. But more importantly, it is the firmness of that space and the tendency for doming with activity. If you have 2 fingers of separation at 12 weeks postpartum but the space is really firm and there is not doming with activity, we aren’t going to be as concerned and is likely very functional.

 

What Does Abdominal Separation Impact?

Why do we care about the space that between the rectus abdominus muscles postpartum? If we think of our core as a canister with the diaphragm on the top, pelvic floor on the bottom, abdominals in the front, and low back muscles in the back. We are going to have a hole in our canister if we have a persistent space between rectus abdominus postpartum. If the front of our canister isn’t strong, it is going to place more stress on other structures. Often the pelvic floor mirrors what is happening with the abdominals. For example, if the abdominals are weak, leading to a separation, the pelvic floor might be tight to compensate.

 

Additionally, the linea alba helps transfer and distribute force from one side of the body to the other. Without tension on that tissue [ soft in the space between abdominals ], there is uneven distribution of load, which can place more strain on one side of the body This can lead to low back pain, pelvic pain, pelvic floor dysfunction and other annoying symptoms.  

Healing Diastasis Recti

If at 12 weeks postpartum you are still noticing a lot of separation or doming/softness in that space, there are things you can do at home to work on your diastasis recti.

Thoracic Mobility 

One of the things we want to think about is thoracic mobility and posture. Thoracic mobility can become limited during pregnancy as baby starts to take up more space in your abdomen. Additionally, baby pressed up into your ribs and diaphragm, especially in the last trimester; this can cause your ribs to widen and flair out. Sadly, they don't always automatically come back together. The problem is that the rectus abdominus attaches up the the bottom ribs. So when the ribs are wide, the rectus abdominus has a hard time coming back together. Additionally, if you lack thoracic mobility to reach above your head, without flaring your rib cage, every time you reach up you are going to pull on those rectus abdominus muscles and perpetuate the space.

This thoracic/shoulder rotation stretch is one of my favorite ways to work on thoracic and rib mobility. CLICK HERE to see the full demo! If you are looking to add rib-specific stretches and exercise to your daily healing routine, check out the Rib Pain Blog!

Addressing The Entire Core

The other thing to think about with healing diastasis is making sure that we are strengthening all abdominal muscles. There is a lot of fear around using and strengthening rectus abdominus when you have diastasis. People can have a really hard time finding the deepest layer of core muscles called transverse abdominus. Not to mention, people often forget to engage their obliques. We need to make sure we are working all of these muscles. Transverse abdominus helps create tension in the space between the abdominal muscles. When you contract and strengthen the rectus abdominus, it actually helps them come back together and narrow the abdominal seperation. External obliques also help to narrow the space above the navel, which is the hardest for most people to heal.

 

And finally we want to make sure we are managing pressures with daily activities. If we think about that core canister again, if we are holding our breath and bearing out against the sides of that canister [ abs, pelvic floor ] with daily activities, we risk continually putting pressure on the diastasis recti space which makes it hard for the tissue to heal and shorten again. Make sure with daily activities that require force [ lifting, carrying, even going from sit to stand ] you are using the candle breath to engage your core and pelvic floor to help resist these pressures.

The Best Exercises for Diastasis Recti

So, what are the best exercises for healing diastasis? Well... it depends. There isn’t any specific sets of diastasis safe exercises. It is going to be really dependent upon the individual and their baseline strength.

What we really care about when exercising for diastasis is your ability to manage your abdominal pressure. We don't want you to put pressure out onto that diastasis recti space. This is what we refer to as 'doming'. It's important to make sure to avoid doming or coning during exercises. We also want to make sure you are engaging your transverse abdominis rather than letting your rectus abdominus overpower. 

If you are getting a lot of doming and that dome is firm [ meaning you are bearing out onto it ], then whatever exercises you are performing is too difficult.

START HERE -- with this core strengthening playlist. Start from the beginning; the list of exercises go from easiest to most challenging. Monitor your diastasis recti as you progress through the playlist for doming or coning in your abs.

How to Get Rid of 'Mommy Pooch'

We often get asked if PT can help with the “mom pooch” or helping your abdomen get flatter again postpartum. There are lots of things that can impact how our abdomen looks including carrying extra weight [ which can be impacted by cortisol and other hormones ], stretch marks, skin integrity [ how stretched out your skin got ], as well as strength of the abdominal wall. Getting your core stronger, finding + strengthening transverse abdominus [ acts like an internal corset ], as well as connecting upper abs [ obliques and rectus abdominus ] with the lower abdominals [ transverse abdominus ] are all going to help with the aesthetic appearance of your abdomen postpartum.

We hope the one thing you learn from this is that diastasis recti is a very normal thing that happens during pregnancy and often just by getting generally stronger in the core, this is going to positively impact your symptoms. If you are feeling frustrated or are afraid that things aren’t getting better, getting an assessment done by a pelvic floor physical therapist can help to get you in the right direction!