Diastasis recti and exercise: what does the research suggest?

Diastasis recti (also known as DRAM) is a common and natural physical change that women experience during and after pregnancy. These changes occur in the abdominal wall as a result of the body accommodating for the expanding uterus, as well as due to the release of pregnancy hormones that affect tissue elasticity. Diastasis recti can resolve on its own during the postnatal period, but in some cases it can persist well after childbirth and may result in negative health outcomes.

What exactly happens to the body in diastasis recti?

Diastasis recti is a term used to describe widening and stretching of the linea alba, a fibrous tissue structure that runs down the middle of the rectus abdominis (“six pack” muscle) from the sternum to the pelvis. The linea alba not only holds the two sides of the rectus abdominis together, but it also serves as an attachment point for deeper abdominal muscles, such as the transversus abdominis (TrA), which makes it vital for abdominal wall support and core stability. Weakness of the abdominal wall or diastasis recti has the potential to lead to problems such as pelvic floor weakness and pelvic/lower back pain.

What can be done about diastasis recti?

You’ve probably heard the terms “exercise” and “core strengthening” when it comes to diastasis recti, but you might be wondering how much you should do or what areas you should target. Here are some tips for you to consider in your approach.

1. Exercise Goals

Firstly, as with any rehabilitation or training, we must clearly identify and understand the goals of our exercise in order to develop an appropriate plan. Exercises in diastasis recti have often been prescribed and performed with the objective to reduce the separation between the two sides of rectus abdominis or ‘close the gap’, with the assumption that this will restore function of the abdominal wall. However, there is emerging research that suggests reducing the gap alone doesn’t necessarily improve core stability because there may not be adequate tension generated along the linea alba, which is an essential component to the abdominal wall. Studies have found that generating strength and tension correctly in both the abdominal muscles AND the linea alba, even without ‘closing the gap’, is sufficient to achieve adequate abdominal strength. Therefore, it is recommended to focus on restoring proper function of the abdominal muscles rather than aiming to ‘close the gap’.

What if my goal is just to get a flatter and less “flabby”-looking stomach? Shouldn’t I focus on the separation? For many women, the appearance of the abdomen can be equally important as its function. Fortunately, with correct retraining and ongoing strengthening of the abdominal muscles, its return to function will be accompanied by better tone or ‘less flabby’ appearance and in most cases reduction of the diastasis recti width. However, the appearance of the stomach region will also depend on nutrition intake and energy expenditure. 

2. Core Muscles

To strengthen our core and target the linea alba, we need to begin gradual loading of ALL our abdominal muscles. Remember this is not just rectus abdominis or the “six pack’, but more importantly our deeper muscles like transversus abdominis (TrA). Following pregnancy, it is also recommended to target the diaphragm and the pelvic floor which are often stretched to accommodate for the growing baby and delivery. The diaphragm and pelvic floor are muscles that typically work together and activate with our core muscles and therefore can help with core activation.

With practice, activation of these muscles will improve and we can begin to combine this with movements to make the exercises more difficult. This may be just gentle movements to start with that will challenge your abdominal strength, such as a single leg raise. Later this can be progressed to even more challenging and functional exercises such as squats or lifting, depending on what you want to get back to doing.

3. Exercise Intensity

When working on your exercise program, it is important to progress the load or intensity of your exercises gradually. Particularly in the postnatal period when abdominal strength may be weak after pregnancy, we need to look out for exercises that increase the pressure in the abdomen (intra-abdominal pressure), such as sit-ups, crunches and double leg-raises. To determine if your exercises are right for you, always keep an eye out for your body’s response to the exercises you’re doing, both during and after your exercise session. You can ask yourself questions like “am I struggling to get to the end of an exercise set?” or “am I experiencing anything else other than normal muscle soreness after a session?”. Starting small and taking the time to progress your exercises will allow your body to adapt better to the level of activity you’re performing and will help prepare you to return to higher intensity activities such as gym, running or sports.

Will prenatal exercises help prevent diastasis recti? Unfortunately the answer to this question is ‘no’. All women going through pregnancy will experience different degrees of widening along the linea alba. Remember, this is a very normal and natural physical change to occur during pregnancy in order to accommodate for the expanding uterus (otherwise there will be no room for the baby to grow!).There is also no strong evidence that shows a correlation between prenatal core exercises and reduced diastasis recti size. However, this doesn’t mean we should not start our core exercises early. Starting or maintaining core exercises in the prenatal period is still beneficial as you will make gains in abdominal strength, and will have a better understanding of the basics of these exercises, which can carry over into the postnatal period.

Where can I get help with diastasis recti and exercise?

Diastasis recti can understandably be a concerning condition at first, particularly when it has an impact on your strength, function or appearance. It may also be difficult knowing how or where to start, particularly when also taking on the responsibilities of a newborn baby. Therefore, seeking advice and guidance from a health professional can be a helpful solution. Here at UniquePhysio, we have an excellent team of physiotherapists and exercise physiologists who are happy to support you and help manage your rehabilitation so book with us today!

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