Diastasis recti is a common condition that occurs when the rectus abdominis muscles (the muscles that make up the six-pack) separate along the linea alba, the connective tissue that runs down the centre of the abdominal wall (1). This separation can lead to a bulge in the midline of the abdomen, a symptom sometimes referred to as “coning”. Lower back pain, pelvic girdle pain, and poor body image can result. For fitness professionals, understanding diastasis recti and how to manage it is essential when working with clients who may be living with this condition. Care needs to be taken with exercise prescription as some movements can exacerbate symptoms.
What causes diastasis recti?
Diastasis recti can occur in anyone, but it is especially common during and after pregnancy meaning it is most prevalent in women. Pregnancy is the most common cause of diastasis recti as the growing uterus puts pressure on the abdominal muscles and stretches the connective tissue. However, diastasis recti can also be caused by factors such as obesity, repetitive heavy lifting, or even the chronic coughing that occurs in respiratory conditions like asthma and emphysema.
How is diastasis recti diagnosed?
A physical exam by a qualified healthcare professional, usually a physiotherapist, is the most common method for diagnosing diastasis recti. The physio or fitness professional will ask the client to lie on their back with their legs outstretched, then have the client lift their head and shoulders off the ground while palpating the linea alba both above and below the belly button, looking for any separation. A separation of more than two finger-widths is indicative of diastasis recti. In some cases, imaging tests such as ultrasound or magnetic resonance imaging (MRI) may be used to confirm the diagnosis or rule out other causes of abdominal bulge, for example, a hernia.
Photo by Gustavo Fring
How is diastasis recti treated?
The treatment for diastasis recti depends on the severity of the separation and the individual’s symptoms. In some cases, the separation may resolve on its own, over time. However, in more severe cases or instances where the client is experiencing symptoms such as lower back pain or urinary incontinence, treatment may be necessary. One effective treatment for diastasis recti is physiotherapy. A physiotherapist can provide exercises and techniques to strengthen the muscles of the abdominal wall and reduce the separation. These exercises may include pelvic floor exercises, transverse abdominal exercises, and diaphragmatic breathing. Surgical intervention may be necessary in severe cases of diastasis recti where conservative treatments have failed, but surgery should always be considered as a last resort. The surgical procedure involves repairing the separated muscles and tightening the connective tissue.
Can diastasis be prevented?
While not all cases of diastasis recti can be prevented, there are some steps that individuals can take to reduce their risk of developing this condition. These include:
- Maintaining a healthy weight: Excess weight can put additional stress on the abdominal muscles and increase the risk of diastasis recti.
- Avoiding heavy lifting: Repetitive heavy lifting can strain the abdominal muscles and cause diastasis recti.
- Proper posture: Maintaining correct posture can help support the abdominal muscles, reducing the risk of diastasis recti.
- Exercise: Regular exercise, especially that which strengthens the core muscles, can help prevent diastasis recti.
How does diastasis recti affect exercise?
For individuals with diastasis recti, certain exercises may need to be modified or avoided altogether to prevent excess pressure and further separation of the abdominal muscles. Exercises that put excessive strain on the abdominal muscles, such as crunches, sit-ups, and planks, should be avoided. Instead, individuals with diastasis recti should focus on exercises that strengthen the transverse abdominal muscles, such as pelvic tilts and bridging ensuring that the pelvic floor muscles are activated throughout. Recent research (2) has shown that gentle trunk curl-ups can help to reduce the gap between abdominal muscles if combined with pelvic floor activation.
Jen Dugard is the founder of MumSafe and spends her days educating exercise professionals in working with pre and postnatal women on her mission to raise the standard of maternal care in the fitness industry. We asked Jen about the most common issues she sees among fitness professionals where diastasis recti isn’t recognised or managed correctly.
“When diastasis isn’t managed well, there can be a range of issues that may become apparent either at the time or down the track. A woman could experience an umbilical hernia due to the connective tissue at her linea alba being stretched and weakened. She may also be very dissatisfied with the aesthetics of her abdominal wall as often when we don’t properly know how to support a woman with diastasis we may offer her too many exercises that create intra-abdominal pressure or further strengthen her obliques which may actually put further pressure on her linea alba and create a pressure or ‘pot belly’ look. Although it is not research-driven, there is also the possibility that a diastasis can contribute toward back pain as she has less stability and control at her abdominal wall.”
Fitness professionals working with clients with diastasis recti should be aware of this condition and modify exercises accordingly. They should also encourage clients to seek medical advice if they suspect they have any abdominal separation.
Here are some exercises that can be recommended for individuals with diastasis recti:
- Pelvic Tilt: Lie on your back with your knees bent and your feet flat on the ground. Place your hands on your belly button. Inhale and allow your belly to expand, then exhale and draw your belly button toward your spine. Hold for 5 seconds and release.
- Transverse Abdominal Exercises: Lie on your back with your knees bent and your feet flat on the ground. Place your hands on your lower abdomen. Inhale and allow your belly to expand, then exhale and contract your lower abdominal muscles. Hold for 5 seconds and release.
- Modified Plank: Start on your hands and knees with your hands directly under your shoulders and your knees directly under your hips. Step your feet back, one at a time, until your body forms a straight line from your head to your heels. Hold this position for 10-20 seconds and then relax.
- Side-Lying Leg Lifts: Lie on your side with your legs straight and your head supported by your arm. Lift your top leg without letting your hips rotate backward or forward. Lower the leg and repeat for 10-15 repetitions before switching sides.
- Bridging: Lie on your back with your knees bent and your feet flat on the ground. Inhale and press your feet into the ground, lifting your hips off the ground. Hold for a few seconds and then release.
It is important to note that individuals with diastasis recti should consult with a healthcare provider or a physiotherapist before starting any new exercise routine. They should also monitor their symptoms and adjust their exercises as necessary. In addition to exercise modifications, individuals with diastasis recti may also benefit from using a support garment, such as compression tights or a postpartum binder. These garments can provide additional support to the abdominal muscles and help reduce separation.
In conclusion, diastasis recti is a common condition that can have a significant impact on an individual’s quality of life. For fitness professionals, understanding diastasis recti and how to manage it is essential when working with clients who may have this condition. By modifying exercises and encouraging individuals to seek medical advice, when necessary, fitness professionals can help their clients manage diastasis recti and achieve their fitness goals safely.
Jen Dugard’s advice for fitness professionals working with clients who may have this condition is to get educated;
“Further your learning in specific pre and postnatal training and then partner with a women’s or pelvic health physiotherapist. As exercise professionals, we can learn how to check for abdominal separation (and we should), we can learn about depth, width and also abdominal control. We can help our client to begin to understand how to activate their pelvic floor and transversus abdominus – all starting points for clients with separation. However, we do really need the support of our women’s or pelvic health physio to be our ‘eyes on the inside’. If they can share with us (and our client) exactly what is happening with her body from the inside out, we can use this knowledge and our further education to provide the best possible exercise prescription for the women in front of us.”
Follow Jen on Instagram and for further education in this space, check out Safe Return to Exercise.
References:
- Mota, P. G., Pascoal, A. G., Carita, A. I., & Bo, K. (2015). Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual therapy, 20(1), 200-205.
- Depledge J, McNair P, Ellis R. Exercises, Tubigrip and taping: can they reduce rectus abdominis diastasis measured three weeks post-partum? Musculoskelet Sci Pract. 2021 Jun;53:102381.
Thanks to Caroline Jones for this article.
Caroline is a physiotherapist who is passionate about using exercise as medicine and getting patients moving, especially those living with chronic conditions.
She is currently undertaking postgraduate research, studying the effects of exercise on women following treatment for gynaecological cancer and consequent lymphoedema. She also holds a Level 3 Certificate in Personal Training, owns a CrossFit box with her husband, and enjoys being a below-average runner.
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