I have written about this in the past but it still seems to be a topic that so many people are unaware of or not sure about, so it seems fit to have another go at it. First off, diastasis recti is not limited to women who are pregnant or just delivered a baby, men and non pregnant women can suffer from this as well. The information below can be applied to anyone but most people with diastasis recti are new mothers and so this post reads more specifically for them.
After 10 years of experience helping my clients recover from Diastasis recti I can tell you two things for certain. One is that, in almost all cases it is fixable using specific corrective exercises along with changing daily habits. And the other thing is that there is no one-size-fits-all program.
In Part 1 (of 2) I am going to answer a few of the most frequently asked questions I get from my clients. Part 2 will cover some habit changing tips as well as a few progressions of the more universally effective exercises.
What exactly is diastasis recti?
It is the thinning of of the linea alba – connective tissue that runs down the mid-line of your abdomen, separating the left and right side of the rectus abdominus (major abdominal muscles in the front of your abdomen). The line alba runs from the pubic symphisis up to the xyphoid porcess. But the major point of separation tends to be from about an inch or so above the belly button to about an inch or so below it.
Will it go away on its own?
Sometimes, yes. It depends on a couple of things. The severity of the separation is a big factor. As is your ability to rest, eat well and avoid movements that pull on the tissue.
The wider the gap the harder it is for the body to heal itself. The unfortunate reality is that right after you have a baby things get kinda crazy and the things your body needs most to recover, like sleep and proper posture/movement patterns are not really on the table. The majority of the healing process should be done soon after and this is a time where we find ourselves overloaded with new responsibility. If you are a magician and have found ways to get good sleep, eat healthy and stay hydrated (very important) let me know and we can write a book about it and make millions!
When can I begin the exercises?
I usually tell my clients to wait about 4 weeks before coming into the studio or implementing a program I have given them. BUT, each situation is different and so some people can start almost immediately after delivery while others may need a couple more weeks of rest. This of course changes for those who had a C section. Some people will disagree with my occasional advice to begin almost immediately but the exercises I prescribe for the first stage are lower impact than simply getting out of bed or walking around holding the baby. They are safer and will do more good for your body than anything you will have to do just just go about your day. More on this a bit later…
Can I do sit-ups and planks?
God no! No sit-ups! Though being able to stand up from a laying down position is functionally necessary so it is part of the program at later stages. Until you are ready though, no crunches, no sit ups, no toe touch stretches, etc. As for planks…it depends. Planks can be a great tool as part of the healing process but there should be a progression to them. Rather than popping out into a full plank, we need to see how severe the separation is, and teach you how to form a proper brace and maintain it under tension. Once you learn the brace, we start against a wall with a slight angle and work our way down. It is more complex than this but this is the short answer.
What exercises do I need to stop performing?
Other than the crunches/sit-ups, I usually ask my clients to limit twisting movements, any exercises that require excess tension on the hip flexors and quads.
The twisting motion is sometimes okay if it is minor (under 45 degrees) and controlled with a brace but again this needs to be tested with each individual. Otherwise the twist, especially if done with any impact like with dancing, kicking, punching or ball tossing will likely undo any repairs done beforehand. Stretching your abdominal wall as with bridges, ball slams and certain yoga positions should also be avoided or minimized. Remember, if doing a regular plank is potentially harmful, then popping out into a burpee when your abdominal wall is in a weakened state is a terrible idea. I know, you’re probably super upset about not being able to do burpees anymore….wait they’re coming!
Can I do yoga?
Yoga in general is not a cure all. Exercise in any form is not a cure all. There are some movements and positions that are safe and some that are very much not so. If you take into consideration the above suggestions on what to avoid and learn how to do a proper core brace you should be able to self monitor in a group class setting. But definitely tell your instructor and hopefully they will know how to moderate things. I can’t emphasize enough how beneficial it will be to seek out a specialist, someone with a bunch of experience to help guide you through it. If you tore a ligament in your shoulder would you trust some rando with your recovery?
How long does recovery take?
It depends on the individual and the amount of trauma to the tissue. But it could take up to 2 years to fully close. Don’t freak out! The majority of the healing is done within the first year and for most women it will heal a lot faster than this. Again there are a few major factors – age, fitness level prior to pregnancy, degree of separation, nutrition and sleep. One of the main reasons it takes so long is that being a new mom is overwhelming enough as it is that sometimes (a lot) self care practices take a back seat. Don’t feel guilty about it, take the time you need to figure things out. But I’m not going to lie to you if you let things go long enough chances are it wont heal and if you have another child at a later date, it will more than likely get worse. Even if you do chose to do the surgery, if you want the surgery to stick you will need to do some exercises. So might as well get them going, just give yourself some time to get in the right head space so that you can commit to some consistency.
What is the best method to recover?
The best method is the one that keeps you consistent. I have found that implementing changes in frequent daily habits is what makes the most difference. A daily 15-25 minute routine will more than likely do the job but finding ways to monitor your posture and how you move in space, especially while holding objects (like…babies) will make the proper muscles work in tandem to quicken the pace. Give yourself some kind of reminder to correct yourself when you sit, stand, reach for things, pick up toys, hold your baby or car seat, lean on counters and walls rather than holding yourself up. All of this stuff adds up over the course of a day and then weeks and months. As far as rehab goes, getting some corrective practice in sprinkled throughout the day will do wonders for recovery.
What will happen if my abdominal wall doesn’t close?
Everything is connected so you can expect a slow but sure trickle down effect to different areas of the body. Sometimes diastasis recti can lead to pelvic floor dysfunction which can mean – incontinence, pelvic floor pain, low back pain, pain during intercourse, etc.. There is some evidence of digestive issues as well. In the long run, this may even lead to hip flexor issues, hip pain, knee pain and so forth.
The damage to your abdominal wall, will inherently lessen your core stability and strength so while your day to day functions will be fine any extra curricular activities may come with some discomfort and limited performance. I have had clients who have gone years with minor separation and have had very few problems other than that it is aesthetically displeasing. Your abdomen will tend to “tent” outwards, it may feel slightly uncomfortable but I know now that it often comes with some insecurities. This is enough in itself to warrant getting some help. Taking back control of how your body feels and looks, even without any of the more painful symptoms is good enough reason for me. It will only help you in the long run. If you feel less confident taking up a new sport because of the slight discomfort and worry, then this small issue might stop you from being the healthiest version of you for yourself and your kids.
From the conversations I have had with my clients over the years it doesn’t seem to have changed much, that many women feel ashamed by the incontinence and pelvic pain. Doctors don’t seem to ask enough if it is happening, we are not really told much about this anywhere else and so the conversation just never gets off the ground. There is nothing to be ashamed of, it is so so common and yet we never hear about it. I am here to tell you that if you seek out a specialist, you will have someone who needs and wants to know everything that is going on so that they can help you. If you are not comfortable talking to you doctor find a pelvic floor physiotherapist or a postnatal fitness coach who can guide you in the right direction.
Should I do my exercise routine daily?
First of all, the program you have needs to evolve. Most cases, the separation is minor and maybe one well structured program will suffice but more often than not, you will need to switch things up. This goes especially for someone who wants to get back to more high impact activity, like martial arts, Interval training, cross fit, tennis, hockey, etc..
You should be able to do your program every day. I never give a program longer than 30 minutes long. As we are focusing on the same muscles repeatedly for this time, this amount of time is sufficient to promote a training effect. If at the beginning you find that you experience soreness the day after training, then wait a day or two. Manage the cycle this way. Eventually you will be able to train every day without soreness.
There are plenty of other questions I get but these cover the most crucial information. If your program does not incorporate pelvic floor work, glute strengthening, nor does it assess hip flexor weakness vs tightness you may want to ask about these components. Make sure you aren’t just tightening your core. We want strength and elasticity and we also want your core to work in tandem with other major movers.
Stay tuned for Part 2 where I will get into more details about specific exercises that we use with our clients as well as more info on changing daily habits for healing.
If you would like to set up an evaluation (online or in person) to have a program designed specifically for you please contact us here.