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Let’s talk about Diastasis Recti (aka abdominal separation) and ways to safely heal your abdominal separation at home without an expensive gym or major surgery!
First off, you might be thinking "diastasis what?!" You aren't alone in that feeling - many people who are told they may have an abdominal separation think the same thing.
Diastasis Recti Abdominis (DRA) is the separation of the two rectus abdominal muscles (six pack ab muscles) along the middle of the abdominal wall. This occurs when the abdominal muscles are stretched in the middle at the linea alba (a connective structure for each layer of the abdominal muscles to attach to). The linea alba serves to provide structure and stability to the abdominal wall and trunk through its attachment of abdominal muscles.
It is common for pregnant folx to experience an abdominal separation - in fact, a recent cross-sectional study found the prevalence of DRA to be 57%. (1) However, abdominal separation can also occur without pregnancy, in men and even in infants.
As seen in the graphic below, this separation can happen anywhere along the abdominal muscles/linea alba. Typically it will decrease with time and safe, appropriate exercises but occasionally it will require surgery to put these muscles back together in the middle.
While the research behind defining a DRA is always evolving, in clinic it is still commonly defined by distance between the two rectus abdominis muscles and the depth of the gap between these two muscles. There is a variety of measurements for this gap found in literature, with the most common separation distance being greater than 2 cm. (2) It is best practice to have a clinician check you for a diastasis recti prior to beginning an exercise routine.
Once you have been cleared to return to exercise, it is time to start thinking about what kind of movements you will be doing. If you have a new baby this means a lot of lifting. Managing intra-abdominal pressure (pressure in your abdomen/belly) with movement is very important!
The graphic below helps to show that the diaphragm makes the top or ceiling, the abdominal muscles create the walls to the abdomen, and the pelvic muscles create the floor to contain all of our abdominal contents. As we breathe in, the diaphragm will lower down increasing the pressure in the belly.
We need to be able to safely manage this pressure without it pushing against our weak spot - our Diastasis Recti. Our recommendation: start with diaphragmatic breathing (Exercise #1 below). Each exercise after that will build on this diaphragmatic breathing to help increase abdominal muscle strength and decrease your abdominal separation.
1️⃣Lay on your back with knees bent. You can place one hand on your chest and the other on your belly.
2️⃣Take a nice breath in, filling your belly full of air. You can monitor that by feeling the hand on your belly lift up in the air while the hand on your chest should only rise a little bit.
3️⃣Breathe out like you are blowing out birthday candles and pull your abdominal muscles in. Do a few repetitions but allow for breaks in between so you do not get dizzy.
*️⃣ Make sure you aren’t using upper chest muscles from your neck and shoulders when you breathe.
1️⃣Sitting in a chair or laying on the ground with knees bent and feet flat on floor. Place a pillow, ball, or rolled towel between your knees.
2️⃣ Take a breath in. As you breathe out, flatten the arch of your low back into the ground (pelvic tilt) while tightening your belly muscles which will cause your pelvis/hip bones to rock towards your head.
3️⃣Squeeze your knees together into the object between your knees. Hold 3 seconds.
1️⃣ Lay on the ground with knees bent and feet flat on floor.
2️⃣Take a breath in. As you breathe out, flatten the arch of your low back into the ground (pelvic tilt) while tightening your belly muscles. This will cause your pelvis/hip bones to rock towards your head.
*️⃣ Take it a step further and add a kegel (pelvic floor contraction) while you tilt. Make even harder and try marching one knee up then the other knee.
1️⃣Lay on the floor with your knees bent and feet flat on the floor.
2️⃣ Engage your core/abdominal muscles and slowly slide your heel out until your leg is straight.
3️⃣Return this knee to the starting position and repeat on the other side.
*️⃣This should be a controlled motion - do not let your leg move too quickly. It should take around 5 seconds to lower the knee from the starting position towards the ground before you begin to slowly lift it up again.
1️⃣Lay on the floor with your knees bent and feet flat on the floor. Grab a sheet or towel to wrap around your abdomen - lay it under you before you lie down.
2️⃣Criss-cross the sheet or towel to help bring the two sides of your abdominals together (this can also be done with your hands if you do not have anything else available.
3️⃣Take a breath in. As you breathe out, perform a slight lift of your head and shoulders from the ground. *️⃣It is important that you DO NOT do a full crunch. This should be a very small movement during which you will feel your abdominals engage.
❇️Make it harder by doing this sitting without your back touching the chair and lean back until you abdominals can no longer control your movement.
1️⃣Lay on the floor with your knees bent and feet flat on the floor. Grab a yoga block, a ball, or even a book.
2️⃣Place the block (ball or book) between your hands and your knees. Press gently into the item with your hands and knees to engage your abdominal muscles (we are targeting Rectus Abdominus here - your six-pack abs).
3️⃣Take a breath in before you press. As you breathe out, press into the item and hold for 5 seconds.
❇️Make it harder by lifting your legs into the air at a 90/90 position (imagine your legs were up on a chair and someone took it away). Keep in mind this is much harder and takes good core control to perform. You should be able to keep your back flat against the floor with your legs lifted to determine if you are ready for this exercise.
1️⃣Lay on the floor with one knee bent, foot flat on the floor and the other leg is out straight. Press your knee into the ground and pull your toes back towards you to keep the muscles in the straight leg engaged.
2️⃣Take a breathe in. As you exhale lift your straight leg up in the air, lifting no further than the height of your bent knee. Slowly return the leg to the ground and repeat.
❇️Make it harder by not allowing the leg to touch the floor in between repetitions or holding the leg elevated at the top for 5 seconds.
Don't forget this is just the start. From here exercises will need to be progressed into sitting and standing as these are our most functional positions. We must be able to manage our intra-abdominal pressure and engage our abdominal muscles in standing and walking to return to full function and heal our abdominal separation.
For more information or to see videos of these exercises check out Pelvic Pride on Instagram.
Please keep in mind it is always best to seek clearance from your OBGYN that you can safely resume exercise. This information is not intended to diagnose or treat and is for educational purposes only. If you have questions about any of these exercises please consult your healthcare professional. If you
need help finding one in your area please reach out to us!
Where to find treatment in Maryland
At Pelvic Pride Physical Therapy & Wellness, we specialize in the treatment of ALL pelvic floor conditions, including diastasis recti, so you are in the right place! We are conveniently located in the Federal Hill neighborhood in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!
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