Diastasis Recti

Diastasis Recti has been historically defined by “the gap,” or the inter-rectus distance (the distance between the two sides of the abdominis rectus). During pregnancy, the linea alba, the connective tissue that runs along the midline of the abdomen from the sternum to the pubic bone softens and becomes more lax. The span of the connective tissue widens, and the rectus abdominis muscle bellies (the right and left sides of this muscle group) move wider apart to allow the abdominal wall to expand as the pregnancy develops. It is a normal response to growing a baby. It is how we stretch to make space for the baby, the placenta, and all that extra fluid. Research has shown that up to 100% of women have a diastasis recti of more then 16mm in the final trimester of pregnancy.

This natural separation of the abdominal muscles commonly occurs during the third trimester and persists for some time after childbirth.

Please read the below to understand how you can assess your own Diastasis Recti. Should you have Diastasis Recti, this isn’t anything to be concerned about, this is something you can monitor.

Firstly I would like you to lie down on your back on the floor with your legs bent, feet planted on the floor.

I would then like you to palpate your abdomen whilst resting. So using 2-3 of your fingers to press into your linea alba (which is the the midline of your stomach) starting at the sternum and working your way down to your belly button, and then carrying on from your belly button down to just halfway between your belly button and your pubic bone.

The 3 positions you will be looking at and monitoring are:

1. Halfway between your sternum and your belly button.

2. At your belly button.

3. Halfway between your belly button and your pubic bone.

   
   

Firstly, starting with position one - halfway between your sternum and belly button - using your fingers coming from straight down on top, feel if there is a gap between the midline of your stomach and whether there is a separation of your abdomen here. Measure the width of this gap by using your fingerbreadths - for example this could be 2 fingerbreadths wide. Make a note of this.

Again, do this same assessment at position 2 (at your belly button) and again at position 3 (halfway between your belly button and your pubic bone).

Once you have all 3 measurements I would then like you to go back to position 1 and notice how deeply you are able to push down along this area and whether your tissue feels spongy, medium supportive or feels taut (springing back easily). Again do this at position 2 and 3 again and note down your findings.

Lastly, I would like you to now use the connection breath (deep breath in filling the belly with air then exhaling then drawing the pelvic floor muscles up and in) which is engaging your core and pelvic floor. As you exhale and contract your pelvic floor lift your head and neck off the floor slightly and now measure the tension of the skin again at all 3 locations. Is there the same amount of tension or more tension when the core and pelvic floor muscles are connected?

Again, note down your findings.So here is a summary...You will have 3 positions to monitor on your abdomen:

1. Halfway between your sternum and your belly button

2. At your belly button.

3. Halfway between your belly button and your pubic bone.

   
   

The width at all 3 by using your fingers as a measuring tool, and then the tightness of the skin when relaxed and also when the pelvic floor and core are activated.

Compare your findings with the below:

Non Diastasis Recti - A separation of less than 2 finger breadths.

Mild Diastasis Recti - A separation of 2-3 finger breadths.

Moderate Diastasis Recti - A separation of 3-4 finger breadths.

Severe Diastasis Recti - A seperation of 4-5 finger breadths.

It may well be you may or may not have any pelvic floor issues and Diastasis Recti. This is why assessment is key before embarking on any workout program.

Should your findings show you have a Moderate Diastasis Recti or beyond or you have spongy tissue and a diastasis of more than 1cm deep at any of the 3 sites, then I would advise seeing a Pelvic Health Physiotherapist for check and guidance. A mild diastasis recti can be managed.

Should you have Diastasis Recti I recommend avoiding the following categories of exercise in early post partum (when you are least likely to be able to control intra-abdominal pressure effectively):

• Advanced abdominal exercises that put a lot of stress on the abdominal wall

• Plyometric exercises

• Intense exercises or exercise classes

  
  

  This is not to say that these exercises are “bad” and must always be avoided, but postnatal women should gradually progress toward these exercises, rather than start with them. Make sure that you avoid exercises that cause the abdominal wall to bulge outward (especially at the midline), cause any stress to the C-section incision, or cause leaking of urine.

  
  

  In exercises where the belly may be hanging toward the floor, for example a front plank, it may feel like your insides are spilling out and you cannot feel the tension in your belly. If this is the case this exercise needs to be modified to maybe an incline plank or on your hands and knees. You can then progress towards the full front plank when you have established more connection / tension in the area.

  
  

  You will need to start with your breathing patterns and pelvic floor activations which are more isolated core muscle contractions. This can then be built up and integrated with your connection breath and pelvic floor lifts. Do not hold your breath as this will create intra abdominal pressure.

  
  

  Starting with exercises such as low level supine exercises, side lying exercises and exercises on your hands and knees will make it easier for you to work on your connection breath. Examples include - glute bridges, scapular slider, clams, open book, bird dog and cat and cow.

  
  

If you are able to perform these without any bulging or doming and no pelvic floor dysfunction you can progress to kneeling, half kneeling seated, standing exercises. Examples include - half kneeling band press, seated banded row, bodyweight squat.

Always consider your posture when doing exercises. Always start with bodyweight exercises and then progress by adding weight when you feel comfortable with no symptoms or pain experienced.

When you feel confident in the above with your breathing and connection breath you can then progress to using this breathing in with your training. Exhaling on the most difficult part of an exercise and gently lifting your pelvic floor. This will recruit your core and pelvic floor to stabilise your trunk and create tension in the line alba during exercise. Eventually after practice, these will respond automatically without about it when doing an exercise.

Always monitor your Diastasis Recti when performing exercises and regularly every couple of weeks and note down your findings.