Diastasis Recti is an increased abdominal separation in the midline of the abdominal muscles. This separation is completely normal and necessary when the belly expands by the third trimester of pregnancy. In more than half the women studied by Diane Lee, PT, BSR and Paul W. Hodges, PT, PhD the distance of the linea alba “remains abnormally wide 8 weeks after delivery, and, although some recover by 6 months (60.7%), many have not at 1 year.” https://www.jospt.org/doi/full/10.2519/jospt.2016.6536 If you are among the 39% of women who have had difficulty recovering, returning to exercise, or strengthening your abdomen after pregnancy, I want to offer you hope and instill confidence that it’s not too late to connect with your core.
The core is like a canister with a top, bottom and sides that wrap around. It isn’t just a group of muscles in the front that help you do a crunch. It’s a pressure system and the pressure has more to do with the stability of your core than we typically have given it credit for. Whether you are holding your child or a kettlebell you are loading your core. Having a core that functions well under load because the entire pressure system is integrated and efficient is the main goal. Keeping this goal in mind should guide your exercise program more than the single goal of closing the gap.
Many women with DRA avoid exercise for fear of making things worse. However, there is evidence from multiple studies that show the incredible benefit of exercise specifically for the deep core – which includes the pelvic floor and transversus abdominis muscles. https://academic.oup.com/ptj/article/98/4/260/4813620 The best way to connect to the deep core is through your breath. The diaphragm and the pelvic floor work in combination with each other. Inhaling through your lower rib cage allows for the pelvic floor muscles to open and relax. Exhaling fires the core automatically due to the change in abdominal pressure and allows for the pelvic floor muscles to contract. When you connect with your breath you can turn isolated exercises into dynamic movements. Whether you have Diastasis Recti, pelvic floor dysfunction, or a weak core the following home exercises are safe to begin.
As a physical therapist I believe that all women with a DRA deserve an individual assessment. Abdominal separation and core weakness is the reason one may seek treatment, but it is common to find other areas of the body that require just as much focus. For example, weakness in the pelvic floor, restrictions in the thoracic spine and pelvic girdle, and poor breathing mechanics will continue to affect the core weakness if not integrated into your program. Check out specific ways that Physical Therapy can help you on my website, with a free guide on Diastasis Recti.
Your home exercises:
1) Connect with your breath: Lie down on the floor with the knees bent in a hook lying position. Purse your lips and exhale like you are blowing out a birthday candle. Notice what you feel in your abdomen. Exhaling naturally fires the core to improve the intra -abdominal pressure to expel the air. Capitalize on this!
2) Kegels: Exhale through pursed lips again. This time, along with the exhale, perform a gentle kegel as if you are stopping your urine flow. Your pelvic floor muscles are part of your deep core muscles. When activated, they will help contract your transverse abdominus muscles. This combination pelvic floor and TRA contraction will feel like the drawing of a corset on your lower abdomen. Almost like there is a line that is drawing your two pelvic bones together.
3) Inhale: The inhale is just as important as the exhale. Your inhale should be focused on opening up the lower rib cage while relaxing the pelvic floor. Picture your pelvic floor muscles opening. Their opening is just as important as the contraction. Dynamic Crunch As you begin to practice this breathing pattern, check in with your body.Inhale – what area of your body expands? Chest, ribs, belly? Exhale- what area of your abdomen contracts? Upper rib cage? Middle of the belly? Lower abdomen? Can you engage your core and still breathe? This is important !!!!
4) Crunches: Attempt a crunch but before you lift off the ground, exhale, kegel, and draw in the lower abdominal muscles. Now you know how to activate the deep core. This makes the crunch more of a dynamic focused exercise than one that solely relies on momentum. Exhale, contract pelvic floor (gently as though you are lifting a blueberry) and lower abdominals, crunch to lift the shoulders off the floor then inhale and release back down.
5) Beware of: Do not hold your breath! Do not squeeze your buttocks! Do not use your adductor muscles to bring your legs together! These are all common compensation patterns. Don’t force the positions: breathe and move gently through each one. Learning how to connect and what to beware of will help you strengthen your core without injury or fear. When you try core exercises at home and aren’t sure how efficient you are or how balanced the abdominal pressure is, here are signs to watch out for:
- 1. Abdominal bulging
- 2. Pain in neck, back, hips
- 3. Widening or increased depth of the DR
- 4. Arching in your back
- 5. Breath holding
- 6. Pelvic floor pressure
Free Image from unsplash Image credit Remedy PT Image credit Continence foundation of Australia
Melanie Connell has been a licensed Physical Therapist for 20 years with certifications in manual therapy and health coaching. She is the owner of Remedy Physical Therapy & Wellness located in Southern California with a mission to help people find freedom from pain and gain freedom of movement. Remedy PT also includes an online program helping women connect with their core. Her practice is unique in that it offers a holistic approach toward your personalized treatment plan, combining physical therapy with the main pillars of health: breath, nutrition, movement, sleep, and mindset. The one thing she preaches to all her clients is the premise that “Everything Is Connected.”
Instagram – @remedyoc
Website – Remedypt.com
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