Disclaimer: This is NOT intended to replace medical advice. Please refer to your preferred medical provider for any questions regarding this topic.
This is a hot topic when it comes to pregnancy and postpartum women but I feel like proper education and thorough research is lacking. My intent is to provide everything I know regarding diastasis recti as relates to available and current research, which is lacking in depth and availability currently. I want to preface this by stating I am not an expert in this field. If you are looking for someone who has specialized in this type of physical therapy I highly recommend checking out Julie Wiebe or the Pelvic Guru. I follow these instagrams, read their blogs, and have taken some of their professional classes which have all been extremely informative. I would call both of these individuals experts in the field.
Anatomy of the Rectus Abdominis
In order to dive into the topic of diastasis recti, it is important to first understand the anatomy and function of the rectus abdominis- the muscle of which diastasis recti occurs. The rectus abdominis is your 6 pack muscle. And while not everyone has a visible 6 pack, everyone has this muscle in their abdomen. What creates the 6 pack look of the rectus abdominis is fascia that separates the muscle into 6 parts. The linea alba (also called linea nigra during pregnancy when it turns dark and visible) is the line that vertically separates the rectus abdominis into two halves. The linea alba is made up of a tissue called fascia because it is a dense fibrous connective tissue. It’s primary function is to flex the truck, provide stability when lifting, assist with active hip flexion, and assist in forceful exhalation or coughing. This muscle must expand in order to accommodate breathing, weight changes, pregnancy, and for bloating. The linea alba allows for these abdominal changes to occur. However because of the flexibility of this tissue and its connective tissue properties, it is also a weak point in the abdominal wall. When the rectus abdominis contracts, it will pull on its attachment points including the linea alba.
So what is Diastasis Recti?
Believe it or not, everyone has a diastasis recti. Essentially this just means there is a gap between the two halves of the rectus abdominis. However, not all diastasis recti are created equal and not all are normal. In a study that looked at women who were never pregnant, there could be a separation in the rectus abdominis of up to 3 cm. Some people are just born with a separation and this does NOT mean that this would be something pathological. Most people have a 1-3 finger width gap along the linea alba. When someone gains weight or gets pregnant, this gap widens. It has been recorded that during pregnancy this gap can become as wide at 5 to 9 cm. THIS IS NORMAL. This is NOT pathological. No matter what the gap distance is, it can reverse after giving birth.
Postpartum Diastasis Recti
So after you give birth, what happens to the diastasis recti? Studies have shown consistently that most diastases will recover by 8 weeks postpartum regardless of the width during pregnancy. If the diastasis continues, herniation is present, or the postpartum woman is experiencing incontinence or prolapse, it is highly recommended she seek out a pelvic floor physical therapist to have a proper evaluation and treatment plan created.
There is not a proven strategy to prevent diastasis recti from occurring. However, there are steps you can take to promote good core health prior to pregnancy and in the pregnancy period. Pre-pregnancy is a great time to work on building your core strength with exercises like planks, side planks, hip thrusts, back extensions, and various other strength and stability drills. Once pregnant, your body releases hormones that relax the soft tissue structures in the body. This includes the linea alba. It is recommended that core specific exercises be avoided, modified, or performed with caution during this time because of the increased laxity of the linea alba. Because the rectus abdominis has direct connection to the linea alba, any activity that activates the rectus abdominis will cause it to pull on the linea alba. The greater the force it pulls, the more likely it is to widen the linea alba. Postpartum, a careful and strategic core progression should be performed to promote closing of the diastasis recti and safely return to your workout regimen or athletic participation. If you are interested in specific fitness plans related to pregnancy, pre-pregnancy, and postpartum Contact me and we can get a plan that’s perfect for YOUR athletic goals.