Thursday, September 1, 2011

Diastasis Recti – What Is It and How To Correct It?

Diastasis Recti is also known as abdominal separation and is most common in postpartum women and newborn infants. I am really only going to get into the postpartum women for today. The two sides of the rectus abdominis muscle are normally attached down the middle at the linea alba... the midline of the body. During pregnancy, due to the stretching of the abdominal muscles from the growing uterus, these muscles can become separated. Some women have such a small split, they can go through life not even knowing it has happened to them. Others, like myself, can end up with a split going from the xiphoid process (bottom of your sternum) to the belly button. This may be gross for some of you... but, I was able to stick my hand through my stomach muscles after the birth of my second little girl. No fun. I also ended up with two hernia's. So, until these hernia's were corrected by surgery (I highly recommend the Shouldice Clinic in Toronto... but, that could be a whole other post), I could not even correct the split. I had to make sure I did not strangulate the hernia's. Once these corrected, I was able to begin the rehab for my abdominals. Although the two sides will never re-attach, you can train the muscles back to be side by side again.

So, how do you know if you have split your abdominal muscles? Start by laying on your back with your knees bent. Place four fingers of one hand above your belly button and the other hand below your belly button. Raise your head and shoulders off the floor and feel to see if there is a separation of the rectus abdominis muscle. Is there a gap or bulge? Is it above or below your belly button? Lower your head and shoulders back down to the floor and start the next part of the test... if there was a separation. Stay on your back with your knees bent, place four fingers of one hand across the separation, pointing down towards your feet. Raise your head and shoulder off the ground. How many fingers can you fit in the separation? Being able to place one or two fingers in the gap is normal, any more than that, you have diastasis recti.

So, now what? It may seem like it is impossible to correct this split and at times, you will get discouraged. That is natural with any kind of rehabilitation. Here are just a few things you need to know...

What to avoid...
Crunches... that's right, DO NOT do crunches to correct an abdominal split. This will force the muscles out to the side and train the muscles incorrectly.
Anything that jack-knifes the body – v-sit, straight leg lifts, some pilates, etc.
Getting straight up from a laying position – turn onto your side and push up from there.
Laying on your back over a Stability Ball.
Yoga poses that stretch the abs – up-dog, cow pose, ect.
Core exercises that require you to lift your head off the ground – modify these to keep your head down
Anything that causes your abdominal wall to bulge out.
Lifting / carrying heavy objects.

What to do...
Example Exercise for the Transverse Abdominis
Tummy Vacuum – there are many different versions of the tummy vacuum. This can be done on your hands and knees, with a ball behind your back, while standing and brushing your teeth, etc.
Table Top Single Leg Lowers – just be sure to hold your belly button in your spine. Do not let your lower back and abdominals release.
Leg Slides – begin with feet on floor, then work up to lifting them 2”-3” off
Side Plank
Side Plank Raises
Crunches with Stability Ball or Bender Ball ***depending on the stage of your rehabilitation***
Table Top
Reverse Crunches
Plank ***depending on the stage of your rehabilitation***

With all of the above mentioned exercises, it is EXTREMELY important that you are constantly aware of your abdominal wall and you make sure that you are pulling your belly button up and back, into your spine. This will ensure that you are actively engaging your Transverse Abdominal muscles and that you are on your way to a speedy rehab.

There is some question out there as to whether plank is safe to do with Diastasis Recti or not. All the research I have done comes down to this... as long as you are doing plank properly, yes, plank is safe. I personally did plank daily as part of my abdominal rehabilitation and it worked! That being said, you should make sure to properly support your stomach and really think of pulling your belly button up into your spine. This ensures that you are engaging the Transverse Abdominis. Plank will actively engage all the muscles of your midsection, including the rectus abdominis, external & internal obliques, transverse abdominals as well as the lower back... not to mention the glutes, lats, delts and pecs! This exercise truly a full body workout and I highly recommend it be added to all programs... again, as long as it is done properly. This is where a trained professional becomes necessary. Certified Personal Trainers are able to help you maintain proper posture and ensure safety throughout your workout. When dealing with Diastasis Recti, make sure you find a trainer that has the experience dealing with this specific problem. Not all Pre and Post Natal Specialists have dealt with Diastasis Recti and without the knowledge and experience necessary, they could cause more damage to the abdominals.

I am constantly researching Diastasis Recti and Postpartum Fitness. At this time, I am actively researching the affect of plank and diastasis recti. If I do find any strong evidence that plank should not be done while correcting an abdominal split, I will add a new post right away. The world research on postpartum fitness is still so new. Recommendations are changing constantly. It is important that you find a trainer that can work with you and is actively up to date on all things related to postpartum fitness. It is too easy to get certified and then just fall behind the times. If you are thinking about getting a personal trainer, meet with them first. Talk to them and see how you feel at the end of the meeting. Go with your gut and make sure they are properly qualified. This can be a whole other post... maybe it will be one day!

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  1. This comment has been removed by the author.

  2. Hi Stephanie - The fibres will never re-attach, but you can return to normal exercise once you have corrected the split. Depending on how bad the split was, you may just need to monitor it and make sure you maintain all the hard work to correct it. They will split again after each pregnancy, and each pregnancy may make the split worse.