What is Diastasis Recti?

Diastasis Recti is when your rectus abdominis (or your “6 pack abs”) separate in their midline. During pregnancy all women, yes ALL WOMEN, will have this separation, without it their will be no room for your baby! But not all women’s will return to their original position.

Diastasis Recti can also happen outside of pregnancy – it’s often in newborn babies and can continue on for life.

Diastasis Recti Diagram

 

How bad is my Diastasis Recti?

The obvious sign with diastasis recti is a large space in the mid-line of your abdominal wall. When you do sit up movements you can often (but not always) see a doming in between these muscles.

So the width between your rectus abdominis is obviously important and can be measured. The width of the gap however really only tells us how well your “6-pack-abs” or rectus abdominis is working.

BUT

Measuring the depth of this gap is almost more important – this measures how strong your lower abdominal muscles are.

And when we talk about lower abdominals or lower core we’re mainly referring to your pelvic floor and transversus abdominis.

 

I think I have Diastasis Recti – can I heal it without surgery?

You have diastasis recti and you’ve been told you need have surgery to fix this. First of all – it is possible to heal this conservatively (such as physiotherapy). And you won’t know until you try! Depending on severity conservative treatment may not always heal your separation but a lot of the times it can! You at least have to try to begin with!

You may also hear that this needs to be fixed within the first 3 months postpartum, but this recovery can happen even years down the track, given the right rehab and the right opportunity.

 

Ok, so how do I heal Diastasis Recti?

This is the million dollar question! And I must start by saying; every body is different and responds in varying ways so each “rehab” will look different for each individual. I also need to say that the steps below are generalised and not tailored to your individual needs, therefore it is really important to ensure these are right for you and that your completing them correctly.

At Sport and Spinal Physiotherapy we utilise real-time ultrasound to help teach and guide you through the early stages of your rehab post-partum. And it’s also really cool for you to see your progress!

 

Problem Areas for Diastasis Recti and How to Fix them

 

Number 1: Lower Core and Glute Weakness

Your lower abdominal muscles – namely your transversus abdominis play a massive role in diastasis as explained above. Improving your strength in this area will help your standing posture, your lifting ability and ultimately your diastasis recti! Keeping your glutes strong will also assist your TrA and your pelvis position.

TIPS TO FIX:

The two exercises below are good starting points to strengthen your lower core and glutes. Just remember for you personally, this may be too easy or too hard. Ensure your completing them properly by checking in with your physio.

 

Dead Insect: Lower Core Strengthening

Dead Insect Core Exercise

 

Clamshells: Gluteus Medius Strengthening

Glute stretch clams

 

 

Number 2: Rib flaring

Your tummy, including your ribs have to expand to accommodate for your baby! This is often called rib flaring. Sometimes this flaring (or increased width) doesn’t magically return after birth. If you can imagine your ribs being wider than normal, you may also be able to imagine that this can increase the gap at your midline.

 

Rib Flaring to fix Diastasis Recti Rib Flaring to fix Diastasis Recti

This can be tricky to correct but try placing your hands on your rib-cage while lying down. With your breath try lifting your head slightly – you should feel your rib-cage ‘slide’ or lower towards your pelvis. If it tends to stay where it is or ‘flare’ even more the following tricks may be beneficial.

TIPS TO FIX:

  • Physically push on your rib-cage with your hands as you lift your head slightly
  • Ensure you thoracic spine (middle of your back) isn’t stiff
  • See Number 3 (below)

 

Number 3: Poor Breathing Patterns

This often happens post-partum due to the widening in our ribs (see Number 2 above). When our ribs are wide our diaphragm doesn’t work optimally. Usually when breathing our exhale is passive (that is, the diaphragm does the work). But when this isn’t working well we have to recruit our abs to actively exhale.  This results in really tight abdominal muscles which pull our midline further apart. This can obviously lead to an increase in your diastasis!

Check by placing your hands on your ribs. You should feel your hands expand with every inhale. If you’re an upper chest breather you will see or feel your chest rise and fall rather than feel your hands expanding. This is not what you want.

TIPS TO FIX:

  • Breath slowly in through your nose and out through your mouth
  • Try having both hands on your ribs. When you inhale think about breathing into all parts of your hands and ribs – that is the front, sides and back. OR
  • Try having one hand on your tummy and one on your chest. Think about inhaling deeply into your lower hand. You should feel your tummy rise and fall, not your chest.

 

Number 4: Rib-cage and Pelvis Position

Especially after growing a human inside of yourself and your tummy growing outwards,  your centre of gravity a pelvic posture will definitely change. We tend to begin to stand in a position of anterior pelvic rotation, increased lumbar lordosis and increased thoracic kyphosis. What does that even mean?? Essentially, your two hip bones are sitting further forward than they should and to counteract this we increase the curve inward in our lower back and tend to become rounded through our shoulders. Like image #3

correcting posture through physio exercises

So that means every time we’re in a standing position or walking we have immediately disadvantaged our core. This stretched position for our core means we are unable to contract and use our core optimally.

TIPS TO FIX:

A nice cue to help you stand more optimally is to imagine a connection from you pubic bone (the bone at the front of your pelvis) to the back of your skull. From here imagine standing up taller by lifting your pubic bone to the back of your skull. Ideally your standing taller, but you should feel this tallness coming from lengthening your back, not lengthening your front any more. Some things you should avoid:

  • Don’t tilt your pelvis forward anymore. I.e. DON’T stick your bottom out
  • Avoid sticking your chest out
  • Try not to increase the arch in your lower back any further

A good example of a great position is the second image above. Can you see the connection between her pubic bone and skull? Can you still see her glute definition even though she isn’t sticking out her bottom? Try doing this in front of a mirror at home – it gives true feedback!

 

Remember -there is no time limit in trying to heal your diastasis recti. The above tips are a general guideline. Book your appointment with Sport and Spinal Physiotherapy today on 6262 4464 for further guidance.

 

About Jenna Cartwright

Jenna graduated from the University of Canberra with a Masters of Physiotherapy after completing a Bachelor of Applied Science in Human Biology. Her special interests include the rehabilitation of sporting injuries, post-operative rehabilitation, women's health and pilates. Jenna is a keen hockey player and is a current member of the ACT Academy of Sport and represents for the ACT Strikers. Outside of work and training she also enjoys reading, knitting and surrounding herself with family and friends.