March 10, 2020

By Carolyn Yates, PT, DPT

Are you seeing a gap in your abdominal muscles when you sit up? Do you feel like your abdominals are not coming back together after having your baby? Are you worried about your core strength and how to improve it without aggravating your back or worsening a separation you were told you have? If you answered yes to any of these questions, don’t panic! There are things you can do!

What is diastasis recti?

Diastasis recti is the separation of the rectus abdominis muscles (aka the six-pack ab muscles). Diastasis during pregnancy is a totally normal occurrence. Your body must make space for your growing babe and the separation of the abdominal muscles is a natural occurrence. Typically the diastasis resolves/comes back together within 8 weeks postpartum. However, sometimes you need to give your separation a little extra help to come back together and there is nothing wrong with that.

How do I know if I have diastasis recti?

Ways to know if you have diastasis postpartum:

• You notice a “doming” or “coning” of your belly. This looks like you have a little extra bump on top of your belly.
• Your abdominals look or feel like they are pulling apart when you do a sit-up type of motion.
• It looks like your stomach is pushing out slightly from between your abdominals when you perform a sit-up type of motion.
• You can push your fingers between your flexed six-pack abdominal muscles.

How is diastasis recti typically treated?

Although most women will have a diastasis during pregnancy (remember, it is a natural occurrence to make space for growing babe), there are varying degrees of separation. Treatment during pregnancy will be focused on education and activity modifications to not exacerbate the separation further, for example, avoiding sitting straight up from lying down position (like a sit-up) and instead, rolling to the side first and then pushing up with your arms. In addition, there may be exercise instruction to strengthen the deep abdominal muscles.

Related: How to prepare your pelvic floor for labor and delivery

Postpartum treatment will be similar, but will have more focus on re-engagement of the deep abdominals to encourage re-approximation of the muscles. You will also be assessed for tightness in your oblique and back muscles. If these muscles are tight then they will resist the re-approximation, or closure, of the rectus abdominis muscles because of their fascial connections to one another. If you have tightness, your PT will do manual release work in varying positions, as well as give you stretches to be doing on your own to improve the mobility.

Is it too late to fix it?

Focusing on proper engagement of the transverse abdominis muscle is the most important aspect of rehabilitation from diastasis recti. Many people think that they are doing a proper transverse abdominis activation when in fact, they are over-activating and engaging the rectus abdominis.

Practice engaging the transverse abdominis during an exhalation by making the “shhhhh” sound or imagine you are fogging a mirror and making the “haaaaa” sound as you pull your pubic bone slightly towards your belly button. Try this while lying on your back and place one hand on your belly above your belly button. You should feel very little movement under your hand. Once you feel like you can do this while lying down, practice in a seated position and then progress to standing and moving. You should be able to engage your transverse abdominis in all positions and exercises.

It is never too late to work on a separation. Reapproximation is easier to accomplish 5 months postpartum compared to 5 years but it is never too late to strengthen and work on re-engaging muscles to heal and improve the function of your core.

I’ve been doing the exercises, and it’s still there. Now what?

Some women’s diastasis will never fully reapproximate. However, there is a difference between having a diastasis with a strong, well-functioning transverse abdominis to support the inner core and one without. A “functional” diastasis is one in which you still have a separation in your rectus abdominis muscles but are able to strongly and efficiently engage your transverse abdominis to stabilize and protect your back and pelvis. If you have been working diligently to resolve your diastasis but you are not seeing much progress in the separation, go see a pelvic floor specialist. They make sure you are engaging correctly and give you a better idea of if your separation is functional or not.

Carolyn Yates, PT, DPT is a Colorado State licensed Physical Therapist with a pelvic floor rehabilitation specialty. She received a Doctorate of Physical Therapy (DPT) from Belmont University School of Physical Therapy and is the owner and head physical therapist of Verity Physical Therapy & Wellness in Boulder, CO.