At STAVE OFF, we have a lot of women coming into the clinic for physiotherapy at various stages in their pregnancy. Being pregnant is HARD! It is hard on the body during pregnancy, labour and post-partum. Many women struggle with some of the issues that result from labour and delivery and it can make it hard for them to feel like they “have their body back”. One of these things is called diastasis recti.
Diastasis recti is a separation of the abs at the middle point. If you think about the six-pack ab look, it is that centre line that goes down the middle. There is now a space there that wasn’t there before.
A recent study estimated that the prevalence of diastasis recti changes through pregnancy and after with estimates of 33% during the third trimester of your pregnancy, 60% at the six week post-natal mark, 45% at the six month mark and 32% at the 12 month mark.
These numbers seemed crazy to me!
Almost HALF of women at six-months post-baby still have a separation in their abdomen.
From a function perspective, what this means is hard to say. Some think that the separation in the abs can cause an increase strain on the low back, causing an increase rate of low back pain. However, other studies have not seen this pattern. Basically, the jury is still out on that one.
For others, it is a looks thing. The separation in the abdomen from the diastasis recti can make it harder to lose the post-partum belly fat. Many women struggle with this weight, especially lower in the belly.
There is very little research (which actually surprised me) on what it means to have a diastasis long term and on the normal rates of recovery for women.
Many physiotherapists can do an assessment to see the amount of separation or sometimes you can perform it on yourself. It is usually assessed by number of finger breadths between the two ab muscles.
Mild diastasis is 2-3 fingers between the two ab muscles. Moderate is 3-4 fingers and severe is more than 4. You check this at just under 5 cm above and 5 cm below the belly button. Another sign of a diastasis recti would be a protrusion out from the middle of the stomach. For women (or men who can get this as well), severe separations may require surgery and more of a conversation with your family doctor or obstetrician.
There is some research to support the use of exercise training and in particular core strengthening to fix a diastasis recti. The specific exercises that work the best? We don’t really know right now to be honest. But with exercises, I think there are many different ways to skin the cat and so we have quite a few in our tool box.
The abdominal crunch is probably one of the best exercises for bringing the two ab muscles together based on an ultrasound study of women with diastasis recti. With your hands cradling your head, you breathe in and then as you breathe out you gently bring your head and shoulders up off the floor. It doesn’t have to be a big movement, especially at first. Think about contracting your abs to bring them closer together, hold for a second, and then come down
Exercise: 2-3 sets of 8-12 reps (depends on your baseline levels).
Posture is going to be another important one. In your pregnancy, the weight of the baby creates a big arch in mom’s back to try to counteract the weight. Continuing with that big arch can put a stretch on the muscles in the front of the abdomen. Really thinking about your alignment with your rib cage down and your back less arched. It will take some practice because you’ve had your back arched for the last 9 months!
Gradually returning to exercise will be key and making sure you don’t do too much too soon.
With time, exercise and a little perseverance, that diastasis should shrink and you’ll be back to feeling like your old self again!