Studies have shown that up to 100% of pregnant women experience diastasis recti (1). But, don’t panic, we’re here to guide you through the how-tos of healing! The most important information is that diastasis recti, while perhaps sounding scary, is extremely common and, if managed correctly, shouldn’t deter you from getting back into returning to training or beginning to workout.
Diastasis rectus abdominis, also called diastasis recti or diastasis occurs during pregnancy as a woman’s rib cage expands and her abdominal muscles become longer and weaker as a result of her growing abdomen. The linea alba, which is the connective tissue that joins the two sides of the rectus abdominis (a.k.a. the six pack muscles), is the most affected tissue. Diastasis recti is the stretching and thinning of the linea alba, resulting in a separation of the abdominal muscle
As a result of its location, the linea alba is an essential part of transferring force between the abdominal muscles. When stretched and lacking tension, overall core weakness and instability can occur leading to compensatory patterns and a lack of support for the internal organs.Since the core is needed for almost everything you do— from reaching into the kitchen cabinets to bending down to pick up your child, and even getting up out of bed—normal everyday movements can feel more challenging than prior to pregnancy.
Without managing diastasis in the postpartum period other areas of your body, including the low back and the hip flexors, begin to compensate for the weakened core; jumping immediately into a training program without proper core function is unsafe and can lead to a longer recovery time. Remember, diastasis is completely normal and while cultural pressure to return to your pre-baby body is significant, it’s essential to allow your body time to heal and recover.
In general, diastasis recti is not a contraindication for exercise. However, in more severe cases of diastasis, categorized by a larger than 2 fingers wide gap and/or when the linea alba lacks tension, it’s important for you to work with a physical therapist that specializes in pelvic floor health in order to modify training. Check out this video from Girls Gone Strong on how to assess (and re-assess every month) for diastasis recti.
At 6-weeks postpartum, you can expect guidance from your doctor on returning to exercise. When cleared and in the initial stages, it’s important to check your breathing pattern and ensure that you have proper rib cage-to-hip alignment during training. An easy method to check for proper breathing is by lying in a supine (belly-up) position with the knees bent and feet planted on the floor. Place one hand on your belly and one hand on your rib cage. As you breathe in, there should be very minimal movement in the chest, but an expansion in your belly. Poor breathing patterns, characterized by chest breathing, can lead to neck and shoulder pain, increased anxiety as a result of over stimulating the vagus nerve, and mood swings (2).
During the initial stages of returning to the gym, practice what’s called a connection breath while using isolated core contractions. This video, from Girls Gone Strong, has more detailed instructions on the how-tos of the connection breath. During this practice you’ll relax your pelvic floor muscles on the inhale and contract them on the exhale to promote strong core function. [Note: While especially important for women in the peripregnancy stages, everyone will benefit from learning how to connection breathe.]
Once you’re able to engage your core muscles during a connection breath, you can start to integrate the breath with movements such as glute bridges, bodyweight squats, reverse lunges and farmers carries. During these exercises, make sure to monitor any doming or bulging of your abdomen (which means that the linea alba is protruding) or any symptoms of pelvic floor dysfunction such as leaking urine during exercise, while coughing, sneezing or laughing, an inability to make it to the bathroom, an increased frequency in urination, or any unusual pressure in the vagina.
Squats, lunges, rows, and farmers carries are all great exercises for postpartum women when performed correctly, with the appropriate load, and while maintaining your connection breath. These exercises help build strength to make activities of daily new-mom life easier and safer such as picking up a baby, putting a baby into a car seat, carrying heavy items, going up and down stairs, and pushing a stroller. When training with the connection breath and these exercises, you will build the needed core strength to have safer movement throughout your day.
As you progress through a training program and begin adding more weight and new or more difficult exercise variations, remembering to use your connection breath is essential. Postpartum women should avoid a valsalva maneuver (increasing abdominal pressure by holding your breath) and always start with proper rib cage-to-hip alignment. If at any point you experience any doming or bulging of your abdomen, reduce the load or remove that exercise entirely.
As always, we strongly recommend consulting with your medical professional before starting any new exercise routine. No matter the stage of diastasis rehab, always be aware of safe and proper exercise progression. Rushing through the postpartum recovery process can be tempting, so we recommend making decisions that align with your goals, values, and lifestyle. Being a healthy, happier, and stronger you means you’ll also be a healthy, happier and stronger mom.
Below we’ve included a sample warm up routine for weeks 7-18 post pregnancy. Give it a try and let us know if you have any questions. You can reach us at firstname.lastname@example.org.
Week 7-18 Post Pregnancy Warm Up Example:
*Always check with your doctor before starting any exercise routine.
Connection Breath x 10 breaths
Foam Roll any areas that feel stiff or that feels good
Dynamic Warm up (shown in video!)
Glute Bridges 2×10
Open Book 2×10 each side
Clam Shell 2×20 each side
Supine Floor Slide 2×10
Cat/Cow 2×10 Breaths
BW Split Squat 2×10
BW Squat 2×15
Deep Squat Hold w/ TRX 2×30 seconds
- Mota, PatrÃcia GonÃ§alves Fernandes Da, et al. “Prevalence and Risk Factors of Diastasis Recti Abdominis from Late Pregnancy to 6 Months Postpartum, and Relationship with Lumbo-Pelvic Pain.” Manual Therapy, vol. 20, no. 1, 2015, pp. 200–205., doi:10.1016/j.math.2014.09.002.
- Howland, R.H. Curr Behav Neurosci Rep (2014) 1: 64. https://doi.org/10.1007/s40473-014-0010-5