Exercises for Diastasis Recti

exercises for diastasis recti

Diastasis Recti (or abdominal separation) is very common in pregnancy. We know statistically that 100% of women will have some degree of abdominal separation by the end of their pregnancy 1. And while it sounds horrible, it’s nothing to be scared of – no matter how bad your diastasis recti is, with the right support it can be improved and you can get back to doing normal activities.

In this article, I will share what we know about diastasis recti from scientific research and share my tips as a physiotherapist to help you recover as effectively and quickly as possible.

First, it’s important to remember that diastasis recti is a normal, healthy part of pregnancy. Second, it can’t be avoided, no matter how many pregnancy exercises you do! And third, it’s important to know that most women recover from diastasis recti and can resume sports like running and weight lifting without ongoing issues.

From the research, we know that at 6 months postpartum, 39% of women still have some degree of diastasis recti. However, those statistics are from women who did not follow a structured physiotherapy rehab program post-birth.

From my clinical practice, I see that women who begin gentle core and pelvic floor training early on in postpartum and gradually rebuild their strength over those first 12 months postpartum, recover really well and resume sport confidently with no pain.

Of course, it is also worth noting that there are some women who experience extensive complications in labour and need more support from their medical team. However, in the majority of cases, the most effective treatment for diastasis recti is exercise.

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Exercises for Diastasis Recti – The Why

There’s no denying that pregnancy and childbirth cause traumatic injury to the body, but for some reason as a society, we don’t view child-rearing through this lens of trauma. Yes, it’s a beautiful, miraculous event, but it’s also a very intense and traumatic experience for the human body.

Let me put it this way – if you were an athlete who sustained a knee injury playing sport you would be expected to spend months doing physical rehabilitation to regain strength and function. Why then as a postpartum mother are you expected to recover spontaneously within a mere 6 weeks?

Recovering from growing and birthing a human child isn’t that quick and easy – our bodies need a lot more time and rehabilitation to ‘bounce back’!

Through pregnancy and childbirth, your muscles weaken, ligaments stretch, and joints move. These are all significant injuries! None of this is to say that our bodies can’t handle it – they absolutely can! The female human body is crazy resilient, but I think we often underestimate the amount of change that happens in this relatively short time and it actually takes a lot to recover from it all.

One of the biggest changes that happen during pregnancy is in the anatomy of the abdomen. In pregnancy, your uterus expands from the size of an orange to the size of a watermelon to accommodate the baby. This forces your abdominal muscles – particularly the rectus abdominus which runs along the front of your stomach in two halves (left and right side) – to stretch and move apart. This separation of the left and right half of the rectus abdominus is what is referred to as diastasis recti.

Note – the rectus abdominus never completely disjoins. This is a common misconception and concern for women. However, the left and right half of the muscle remains connected by connective tissue called the linea alba. So nothing actually completely disjoins or tears, the linea alba just gets stretched and the two halves of the muscle move further apart.

Before pregnancy, the linea alba is narrow and tight, and the space between the left and right side of the rectus abdominus is quite small.

During pregnancy, the stomach expands out and the linea alba stretches out increasing the distance between the left and right half of the rectus abdominus.

This stretching out of the linea alba and distancing of the two halves of the rectus abdominus reduces the muscle’s ability to contract strongly. This means the front wall of your core is much weaker.

To add to that, underneath the rectus abdominus are many more core muscles that also stretch and weaken as your belly gets bigger. Plus, your pelvis shifts, and the muscles of your pelvic floor and glutes also weaken.

Basically – everything from your boobs to knees weakens, including your most significant anatomical supports – your pelvis, spine, and core muscles. Hence why postpartum women need strengthening and rehabilitation!

Women who want to resume sport and high-intensity activities like running will need to rebuild a lot of strength! That doesn’t happen overnight, but with the right rehab and exercises for diastasis recti and all the other core muscles, you can absolutely feel strong and confident to do sport well and pain-free.

Exercises for Diastasis Recti – Key Principles

1. You can’t force the linea alba to tighten or the rectus abdominus muscles to come back together. Unfortunately, the linea alba isn’t a muscle itself and therefore there are no exercises you can do to strengthen (or tighten) it. But, the body is a very smart natural healer. Once your uterus shrinks, your body will slowly start tightening the linea alba on its own and bringing the left and right half of your rectus abdominus back together

2. The best way to optimise your recovery is to strengthen the muscles surrounding the rectus abdominus (i.e. all the other core muscles).

3. You want to do a variety of core exercises that challenge your core strength in different movements and positions

4. Start with simple, fundamental exercises and slowly increase the difficulty as you learn to control your body better and feel your core getting stronger.

5. You should never experience pain when doing exercises for diastasis recti – not in your lower back, not in your abdominals and not in your pelvis. No pain is normal.

6. You shouldn’t experience any incontinence or feeling of vaginal ‘bulging’ when doing these exercises.

Exercises for Diastasis Recti – Level 1

 

1. Core Hold Leg Lifts off Chair

2. Core Hold with Heel Slides

Exercises for Diastasis Recti – Level 2

 

3. Tabletop Leg Lifts

4. Bird Dog Slides

Exercises for Diastasis Recti – Advanced

 

5. Tabletop Core Hold

6. Side Plank on Knees with Leg Lift

About the Author

Alina Kennedy

Alina Kennedy

Alina Kennedy is the founder and lead Physiotherapist behind The Runners Physio.

Alina is a physiotherapist and strength & conditioning specialist based in Adelaide, Australia. She graduated from the University of South Australia in 2011 and works as a sports physiotherapist focusing on running performance and injury rehabilitation. She’s developed training and rehab methods based on years of clinical experience and up-to-date scientific evidence. Her simple but effective approach has successfully helped thousands of runners overcome repetitive injuries and get back to running faster and healthier.

References

1. Andrade Dinis Carita, Kari Bø 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, Volume 20, Issue 1, 2015, Pages 200-205

2. Michalska et al. Diastasis recti abdominis — a review of treatment methods, Ginekologia Polska, vol. 89, no. 2, 2018, Pages 97–101

4. J.B. Sperstad, M.K. Tennfjord, G. Hilde, M. Ellstrom-Engh, K. Bø, Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain, Br J Sports Med, 50 (17) (2016), pages 1092-1096
5. D.R. Benjamin, A.T. van de Water, C.L. Peiris, Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review, Physiotherapy, 100 (1), 2014, pages 1-8
6. A.G. Pascoal, S. Dionisio, F. Cordeiro, P. Mota, Inter-rectus distance in postpartum women can be reduced by isometric contraction of the abdominal muscles: a preliminary case-control study, Physiotherapy, 100 (4), 2014, pages 344-348
7. S.L. Gluppe, G. Hilde, M.K. Tennfjord, M.E. Engh, K. Bø, Effect of a postpartum training program on prevalence of diastasis recti abdominis in postpartum primiparous women: a randomized controlled trial, Phys The, 98 (4), 2018, pages 260-268

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