Postnatal Care – what is Diastasis Recti and what exercises can I do to help

Diastasis recti is common after having a baby, however many people have no idea what it is…

What is diastasis recti?

Diastasis recti is the separation of the abdominal muscles and commonly happens in pregnancy.  This is due to stretching and thinning of the linea alba, which is the tissue that connects the left and right abdominal muscles. 

It’s incredibly common but advice out there can be conflicting and confusing. After the birth of my son I ended up worsening my diastasis recti with the wrong exercises and not understanding how to properly engage my core. It has been suggested that approximately more than 2 fingers width above, around and below the belly button is considered greater than normal. This gap can reduce on its own within a couple of months postpartum, however sometimes the gap can remain and has be linked with low back pain and a post ‘baby belly’ that won’t reduce.

Is Diastasis Recti only about the gap?

Leading women’s health specialists have reported that improving diastasis recti should NOT just focus on the size of the gap, but should concentrate on improving the depth of the gap. To do this you want to increase the tension in the linea alba and you can achieve this by strengthening the transverse abdominal muscle – one of our deep core muscles. This will help to improve strength, appearance and core control. 

How can I tell if I have it?

  1. Lie on your back with your knees bent and the soles of your feet on the floor.

2. Using two fingers, gently press your stomach at the level of your belly button in the middle (your palms are facing towards your head and your fingertips are pointing down into your stomach).

3. Lift your head and shoulder blades off of the mat. As you press down, feel how your muscles close in around your fingers. Note how many fingers wide any gap is and also note how far down your fingers sink into your belly (which tests the tension in the connective tissue). You want to be able to feel tension underneath your fingers as you lift your head.

4. Repeat the above approximately an inch above your belly button and then again just below between your belly button and pelvic area.

If possible, we recommend seeing a women’s health physiotherapist who can provide an assessment. If you are unsure if you have diastasis, think you have a very large or deep gap, have pain or bulging through the gap then you should see a women’s health physiotherapist for an assessment and treatment plan.

What exercises can I do? And is it safe?

These exercises are safe and can be started as soon as day one post birth once you have passed your first urine. They are designed to simply activate the correct core muscles without exerting your body too much, as the main focus at this time is rest and the nurture and care of yourself and your new baby.

In the following exercises, when we refer to engaging the core we are referring to using the diaphragm in synergy with the pelvic floor muscles, multifidus and transverse abdominals. You engage these muscles by doing the following on an exhale (which involves the diaphragm):

1. imagine gently pulling up your front and back passages like you are trying to stop yourself passing urine and flatulence without clenching your buttocks. If you feel a pushing down sensation, this is incorrect. Take a few deep breaths into the stomach to relax, and try again.

2. At the same time, imagine your hip bones are magnets and are being drawn in towards each other and pull in your stomach gently as though you are trying to put on a pair of tight jeans.

Please ensure that as you perform the exercises below, there is no doming (bulging) of your stomach muscles, pain or a pushing down sensation in your pelvic floor area.

1) CORE ACTIVATION LYING DOWN

  • Lie on your back with your knees bent and a natural curve in your lower back.
  • Inhale to prepare, then exhale to engage your core muscles (see above)
  • Continue to breathe normally for 5-10 seconds whilst keeping your core engaged.
  • Relax and then repeat x 10 aiming for at least once per day.

2) CORE ACTIVATION IN SIDE LYING

  • Lie on your side with your knees bent in a comfortable position.
  • Inhale to prepare, then exhale to engage your core muscles lifting your waist away from the floor.
  • Continue to breathe normally for 5-10 seconds whilst keeping your core engaged.
  • Relax and then repeat x 10 aiming for at least once per day.

3) SCISSORS

8 reps on each leg, 2 sets, 1-minute break between sets

  • Lie on your back with your knees bent.
  • Inhale, and as you exhale activate your core and lift your right leg up to reverse tabletop (knee at 90 degrees with the shin parallel to the floor).
  • Inhale holding the position. Exhale and slowly lower the leg back down.
  • Inhale and relax the core. Repeat on the left side.

4) HEAD LIFT (RECTUS ABDOMINAL STRENGTHENING)

10 reps, 2 sets, 1-minute break between sets. For this exercise ensure you are not doming your stomach. There is no rush to start this exercise so please take your time with the previous exercises.

  • Inhale to prepare. As you exhale activate your core and lift your head and the top of your shoulder blades as if looking between your knees.
  • Inhale and hold the position. Exhale and slowly lower back to the floor.
  • Inhale and relax the core.

For further postnatal advice, we have designed a 16-week postnatal programme that is evidence-based, co-written by a physiotherapist and has been reviewed by medical professionals.  Strength Through Yoga is a postnatal eguide that ensures a safe and effective journey to restoring strength, and to support you in both body and mind.

The ebook includes six weeks of physiotherapy based exercises followed by ten weeks of yoga-inspired circuits designed to increase full-body strength and flexibility in just 25-30 minutes, 3 times a week.

Additionally we have included information and advice on the core and other essential muscles, mindfulness and meditation techniques, and common postpartum issues – shedding some light on issues which can be hard to talk about and giving you information on what you can do to help. If you take one thing away from our ebook, know that you are not alone and help is out there.

What do I do if it’s not getting better?

We recommend seeing a women’s health physiotherapist for an assessment, and they can then guide you with an individually tailored programme. Everyone is different and strengthening exercises take at least a couple of months before seeing the effects, so don’t worry if you don’t see an immediate change.

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