Diastasis Recti – What is it?

Diastasis Recti (DR), or split abs, is a condition that is most commonly known in and after pregnancy, but can occur in anyone! I wanted to spend a little time discussing DR and what it really is to help people better understand why they have it and hopefully, what they can do to prevent and treat it!

In every pregnancy, our bodies do a great job and adapting and changing as this new baby grows and makes our uteruses (uteri? Uteren? Uterus-es?) their home. Our ligaments stretch out and lengthen as our bellies grow. So, we all have “split” abs when our babies are in our bellies, but this should return to a normal resting state after delivery.

Sometimes, for some (most) mommas, this is not the case.  All of the tendons that stretched initially to make room for your babies, stay stretched out.

Here is an AMAZING drawing by a wonderful artist and massage therapist, Julie, that gives you a perfect example of what diastasis recti really is:

A common misconception of DR is that tissue is actually torn in our bellies. As you can see from the image, DR is really just your ab muscles sitting further apart from each other than normal. With DR, there is no “split” or tearing of tissue (this would be a hernia). The connective tissue (linea alba) between the muscles is a tissue that is made up of elastic fibers that should recoil after being stretched. But just as rubber bands can lose their elasticity if overstretched, so can our linea alba.

The severity of your split can be measured in length, width, and depth. Commonly, a split down the middle greater than 2 cm in width is considered significant. Your OBGYN can test for this, but a lot of the times does not.   See below for an easy self-check you can perform yourself to measure your split.

Other signs/symptoms of DR is joint pain in hips/back, incontinence (peeing in your pants), bowel/GI issues (bloating, cramping, constipation) and a pudgy stomach (thats a medical term, right?.

So we know what it is, but why do we get it?  There are a few things that can contribute to diastasis recti that need to be considered.

1. Genetics – maybe you are predisposed to more “stretchy” tissues than others. You can thank your mother for that.
2. Anatomy – (long torso’s/body composition) Women with shorter or smaller torsos have less room for growth. As their baby gets bigger, their tissues might require more stretch to make room! You can thank your mother for this as well.
3. Poor positioning/mechanics – managing pressure throughout our abdomen is one of the most important aspects to decrease excessive stress on the front of our abs. If a momma has poor motor patterns or less than desirable mechanics in everyday movements like picking things up from the ground, bending over, getting up from out of bed then every time she goes to do these things, increased stress is placed repetitively on our abdomen. This, unfortunately, is not your mother’s fault.

As a therapist, my job is to help women address #3 as best they can to not only help decrease the severity of DR but to help treat and recover during their postpartum months to return to safe and effective movement as they heal.

So how do I avoid diastasis recti?  Well, since you asked, there are a couple of things that I tell each patient I see that may help.

1. Roll like a log – the muscle that is compromised in DR is your rectus abdominus (your sit up or crunch muscle). So as we allow time to heal, we want to avoid sit-ups/crunches or things that mimic this movement. As opposed to sitting up out of bed leading with your shoulders (like a sit up), I encourage women to “log roll”. Starting on your back, you will roll to your side first, then, allow your feet to slide off the bed and at the same time, use your arm to push your shoulders up. The momentum of your legs coming off the bed will allow you to rise up like a pendulum. To lay down you will reverse this technique. Start sitting on your bed. Lay to your side allowing your shoulders to lower while your legs rise to the bed. Once you are safely on your side, you can then roll to your back. This is a good technique to use anytime you lay down or get up from a bed or the floor.
2. Avoid the cone – Coning or doming of your abdomen around your belly button is a sign of diastasis recti. I use this is a quick and dirty way for women to decide if an exercise or movement is appropriate for them. If you are unable to perform a movement without a coning of your abdomen, simply put, this might not be a great exercise for you to perform. Coning tells us there is extra stress and poor recruitment of supporting muscles during abdominal contraction.  I would suggest an evaluation from a therapist to check pressure/integrity of your abdominal wall as well as help program a core routine for safe healing if you notice this frequently.

Here is a picture of “coning” of an abdominal wall with just lifting a foot off the ground.

Luckily, diastasis recti can be treated with modifications, education and an intentional and specific core routine. Being mindful of return to activity and taking part in postpartum specific programming is a great way to heal after you have had your baby. A simple list of “do’s” and “don’t”s when it comes to DR is simply not enough.

Occasionally, surgical repair for DR is indicated. A quick checklist if surgery is right for you is:

• >1 year post-partum?
• are you done having babies?
• have you seen a physical therapist?

These are the absolute basics before surgery should be considered.

As always, each mother, each pregnancy and each season is different. Diastasis recti is extremely common and does not mean the end of the world! Knowing your body and learning specifically how to maintain adequate strength and pressure through your abdomen, specific to your goals is paramount in recovering from pregnancy!