Diastasis Recti can be a scary postpartum issue for women.  The right and left walls of the frontal abdominal muscles spread apart at the midline due to a softening of connective tissue during pregnancy and pressure from the uterus on the abdominal wall.   The risk is greater for women who are smaller framed, have weak abdominal muscles, or who had twins.  Fortunately, diastasis recti is not all that common, but for moms who discover they have it during or after birth, it can be discouraging without understanding how to deal with it.

Small degrees of diastasis that need no treatment actually happen often.  In these minor cases, the abdominal walls return to their original position with no special assistance.   But severe diastasis recti can negatively affect the strength of the abdominal wall, aggravate or create lower back pain, and can put you at risk for a ventral hernia.  Because of the risk, it’s a good idea to do a simple self test a week or so after giving birth to make sure you are good:

Simple Diastasis Self-Check

  • Lie on your back with your knees bent with the soles of your feet directly on the floor.
  • Place one hand behind your head and the other hand on your abdomen. Your fingertips should be parallel with your waistline and at the level of your belly button.
  • Make sure your abdominal muscles are relaxed and then gently press your fingertips into your abdomen.
  • Roll up into a crunch position while making sure that your ribcage moves closer to your pelvis.
  • Move your fingertips back and forth across your midline, feeling for the right and left sides of your rectus abdominis muscle.

Assessment

How many fingers can you place in the gap with your abs contracted?

Placing one to two fingers in the gap right under your rib cage is normal. If you feel the gap down near or below your belly button and can place more than two fingers in the gap, you have diastasis recti. There may also be a noticeable small mound protruding at the midline.

Correction

It is typically contraindicated to begin treatment of diastasis recti until the uterus has shrunk down at least half way to the pubic bone. But when you are ready, there are easy ways to treat this muscular separation with physical therapy (as long as the gap is less than 4 fingers apart). Diastasis correction should be undergone with an exercise trainer or physical therapist who is skilled in the treatment, as certain abdominal exercise can make it worse. Crunches, sit ups, planks, even exercising on your back or lying on an exercise ball may need to be avoided for a while.  Certain yoga moves can be contraindicated, as well as any activity that overly expands the abdominal wall, so it’s important to work with an expert.

Under the supervision, a common treatment exercise is a head lift technique with minimal shoulder involvement (to not overuse the rectus abdominis). You will start with a kegel exercise to stablizie the pubic symphysis, then lying flat on your back, cross your arms over your belly in an X right across your belly button to hold your sides together, and exhale as you raise your head (not your whole upper body, just a slight neck flexion) and exhale. It will take practice to isolate the transverse abdominal muscle as you exhale, which will ultimately close and restore the abdominal wall. This kind of simple technique has been used to successfully close separations completely over about six weeks.

A knowledgeable physical therapist/trainer will be able to feel the closure changing by holding their fingers inside the diastasis and feeling the muscles closing around their fingers as you lift your head. Your trainer will need to feel the diastasis to make sure that the exercise you’re doing is actually closing it–and not making it worse.

Supervised pelvic floor exercises have also been known to fix diastasis and your trainer or therapist might recommend these, along with abdominal isolations (ie, pulling your stomach in and away from your waist band), scapular retractions (squeezing your shoulder blades together), and light daily walking.

If you find yourself having to deal with this issue, don’t feel discouraged.  You will recover completely.  If you don’t have a physical therapist or personal trainer, your doctor can make a referral.  Don’t hesitate to ask.  There are also many personal trainers that have specialty skills in the area of pregnant and post-pregnant issues.  Make sure this one is under your belt before proceeding with any other exercise regiment to get back in shape.

 

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