Healing and Strengthening with Diastasis Recti:
What is Diastasis Recti?
Diastasis Recti is the separation of the Rectus Abdominis. A split down the middle of these abs creates a separation in the left and right sides that can cause “poochy tummy appearance”, weakened core, unstable hips. Diastsis Recti usually occurs during pregnancy, although it can be seen with severely obese individuals.
How to Check if you have Diastasis Recti (and how severe it is)
- Lie on your back with your knees bent and your feet flat on the ground.
- Relax your tummy and place the fingers of one of your hands right above your belly button in the middle of your waist.
- Lift your head and “crunch” your upper body up slightly. Your ribcage will move towards your hips.
- Use your fingers to feel for the separation in the middle of your abs between the left and right sides. **Your abs will be fully contracted during this exercise.**
If you feel a gap of more than 2 finger-widths in your abs, you most likely have DR. A gap of more than 3 finger-widths may require a doctor or specialist’s observation.
Some Types of Movement to Avoid
- Movements where the upper body twists and the arm on that side extends away from the body, such as “triangle pose.”
- Exercises that require lying backward over a large exercise ball.
- Yoga postures that stretch the abs, such as “cow pose,” “up-dog,” all backbends, and “belly breathing.”
- Abdominal exercises that flex the upper spine off the floor or against the force of gravity such as: as crunches, Obliquecurls, “bicycles,” roll ups/roll downs, etc.
- Pilates mat and reformer exercises that utilize the “head float” position, upper body flexion, or double leg extension.
- Any exercise that causes your abdominal wall to bulge out upon exertion.
- Lifting and carrying very heavy objects.
- Quadruped exercises without adequate abdominal support.
- Intense coughing without abdominal support.
Exercises for Diastasis Recti:
- Kegel: Start with a basic kegel. Lying on your back or sitting in a chair, squeeze your pelvic floor muscles together as if you are stopping the flow of urine when you pee. Try different kegels that work different muscle fibers. 1. Fast kegel: squeeze your muscles for a count of two and then release for a count of two. Repeat 10x. 2. Slow kegel: squeeze your muscles and hold for account of 5-10. Release for 10-30 seconds. Repeat 5-10 times. 3. Elevator kegels: Squeeze your muscles, then harder, then harder (you should feel more muscles engaging). Release and relax for 5 seconds. Repeat 5-10 times.
**It is best to perform kegels 3-4 times throughout the day. Complete a set of 10 every 3 or 4 hours.
**Why Kegels? The pelvic floor and inner ab muscles work together to create a strong core. By strengthening both you progress more effectively in healing from DR.**
- Kegel with Abdominal compression/hollowing: Lying on your back, bend your knees and place your feet flat on the ground. Engage your pelvic floor muscles, then/simultaneously, draw your belly button “into your spine”. This is engaging your TvA muscles. When you engage these inner ab muscles it may feel like you are brining your belly in as if buttoning up a tight pair of pants. Don’t suck air in to perform this, just engage the muscles. Hold for a count of 5-10 seconds (breathing while you do this) and then release. Your kegel may release before you are done engaging your abs, that is fine as long as you start with a kegel.
3. Kegel, abdominal hollowing, maintain while performing pelvic tilts: Perform the same sequence above in an either lying position or with your back against the wall in a shallow wall sit. When your TvAs are engaged, press your low back into the ground (as in the “finish” diagram) and draw your belly button in. Release your ab muscles and arch your low back, tilting your pelvis forward (as in the “Start” position). Complete 10 reps for 3-4 sets.
4. Kegel, ab hollowing; maintain while performing partial curl-ups: Lie on your back you’re your knees bent and your feet flat on the ground. Follow the sequence of engaging your pelvic floor muscles and then engaging your TvAs. Then, with your abs engaged, bring your upper body up slightly so you shoulder blades lift off of the ground in a curl-up motion. Keep your chin tucked in to protect your neck. **Your low back will stay pressed against the ground during this exercise. If you can’t keep your low back pressed against the ground, splint your abs to begin with for the curl-up…splinting mentioned below.
Splinting your abs: Using a towel, place it around your waist at belly button level. Pull either end of the towel to bring your abs together, splinting them like a corset. Complete exercises with this assistance until your abs are strong enough to complete the exercise alone.
5. Continue with above sequence with crunches, reverse crunches, heel slides, bridge, and toe touches
***These exercises are a progression. If at any time you are unable to complete the exercise without keeping your low back on the ground and your TvAs engaged (belly button pulled into spine), STOP the exercise and continue with the previous ones until you are strong enough.
Complete these exercises daily to get optimal results!
It can take weeks to months for DR to heal based on the severity of the separation. If you do not see any difference after completing these exercises for 2 months, it might be worth seeing a specialist (doctor or PT who specializes in core strength).
Other Notes for DR:
- It is important to have correct posture as much as possible. Make sure you don’t sway your low back, your pelvic is not tilted backward too much, and your inner abs are engaged during most activities. This will take practice and intention to learn proper posture and perform it automatically.
- Engage your TvAs and you Pelvic Floor muscles when you lift your baby (or other objects if you don’t have a baby). Use correct forms of squats and split squats to lift objects.
- Complete pelvic tilts in a lying, sitting, standing position throughout the day to help alleviate back pain that is often due to week TvAs and DR and to help strengthen the TvA muslces.
- Be cautious when performing exercises that end up aggravating hips or back (such as running, side to side movements, etc). Pain from these exercises could be due to inadequate strength in core.