Diastasis recti (Di-asta-sis rec-ti) in pregnancy & postpartum
Before I dive lightly into this, I wanted to note that while diastasis recti has been a popular topic amongst pregnant and postpartum women recently, it is not something you must fear or feel ashamed of. Diastasis recti is a common condition that can affect women AND men and can often be treated with strengthening exercises. What is it? A woman’s body goes through many physical and physiological transformations during pregnancy. An important region that is very much affected during this gestation period is the abdominal muscles. More specifically, the rectus abdominis muscles, or what we all refer to be the “6 pack” muscles. There are two bellies that construct this muscle that are connected together by a fascia tendon which is called the linea alba. Pregnancy more often than not, causes diastasis recti (DR). Diastasis recti is the separation of these two bellies along the linea alba. It occurs due to hormonal elastic changes of the connective tissue caused by the relaxin hormone, the growing fetus, and the displacement of the abdominal organs. As the baby grows, the bellies of the rectus abdominis muscles elongate and curve round as the abdominal wall expands leaving a separation between the two bellies. DR is very common and affects between 60-100% of pregnant women. Studies also show that 60% of postpartum women have some degree of abdominal separation months after delivery.
What’s the problem with diastasis recti? It’s important to know that DR doesn’t spontaneously resolve for many postpartum women and may even persist for many years if not properly rehabilitated. Since the abdominal muscle, along with the rest of the core, play an important role in trunk control and function, the presence of DR can diminish its functions and present discomfort such as lower back pain. Posture, trunk stability, respiration, trunk flexion and rotation, and pelvic stability are all affected by DR which leaves the lumbar spine and pelvis vulnerable to injury (hence the importance of a healthy pelvic floor!). It also increases the difficulty in engaging the rectus abdominis muscles leaving the abdomen region weak and the management of intra-abdominal pressure difficult. Lastly, DR ranges from mild to severe, depending on the width and depth of the abdominal separation. Prevention and rehabilitation Closing the “gap” as you may have heard is no longer the only indication that a DR has healed. The ability of the fascia to create tension is more important than just closing the width of the separation. If you do have a DR, know that there are health professionals that can help with healing your abdominal separation such as pelvic health physiotherapists and post-natal exercise specialists. Exercise has shown to be an important tool in diastasis recti prevention and rehabilitation. While some exercises are best to avoid until you’ve been evaluated (planks, crunches, push-ups, pull-ups), exercises such as breathing techniques, and those who recruit the pelvic floor and transverse abdominis muscles are usually recommended. If you suspect that you have an abdominal separation, I highly recommend you see a pelvic health physiotherapist and/or a post-natal exercise specialist. They will be able to evaluate your diastasis recti and guide you towards a proper individualized rehabilitative program. It’s important to know that all diastasis rectis are not identical and should be treated according to the severity of the separation and lack of tension and to the individual’s strengths and weaknesses.
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