Diastasis Recti- AKA Abdominal Separation

We’ve all heard of it in some form or another. Diastasis recti, rectus diastasis, DRA (diastasis rectus abdominus), or just plain diastasis. It’s something most if not all of us wonder about while pregnant and after having a baby. I’m here to talk about all things diastasis, including commonality, how to test it and what to do about it.

Diastasis literally means “separation” and recti or rectus is referring to the rectus abdominis, the scientific term for your six pack muscles. So it means “separation of the abdominal muscles”. When it becomes too separated and appropriate force tension is lost, it can cause back pain, pelvic floor dysfunction (prolapse and/or urinary incontinence to name a few) and if not addressed appropriately, can potentially lead to things like abdominal hernias. These negative side effects are what physical therapists and other health care providers are concerned about.

Diastasis Recti is incredibly common among the pregnant and postpartum population. Studies show up to 90% of pregnant women had diastasis recti. It makes sense, there is now an entirely new human being (or multiple!) growing inside of your uterus and your body needs to make space somewhere! As the baby grows, our abdominal muscles can only stretch so far before they need to pull to the side. In short, having a separation during the last trimester of pregnancy is quite common, though there are things you can do while pregnant to maintain strength in your core and to have better support and less pain.

When it comes to the postpartum population, studies suggest that about 50% of postpartum women have a diastasis recti when checked one month following birth. So a little less than half of the women that have diastasis recti during pregnancy will have that separation come back together without any interventions. But for that other half, something should ideally be done to promote the closure (to a degree),return strength and facilitate good force tension to the abdominal wall in order to return to prior function without back or pelvic issues.

To test if you have a diastasis, lay on your back and put a hand on the midline of your abdomen, right in the center of your six pack muscles. Place your middle finger on your belly button, with your pointer finger 1-2 inches above and your ring finger 1-2 inches below. Now that your fingers are in the right place, you’re going to do a mini crunch where your head and shoulder blades lift off the floor. Keeping your head lifted you’re going to feel for a sinking in of your fingertips, or for a doming out into your fingertips. You can also look to see what’s happening. If you see either of these things, you can measure how far apart they are by finger widths and/or how far deep the separation is. Conveniently enough, fingers are about 1 cm wide so you can measure the diastasis recti just by using your finger widths.

It should be noted that technically anything less than 2 cm (or 2 finger widths) is no longer considered a diastasis. That’s sometimes one of our goals in physical therapy. We want to close the diastasis to 2 cm or smaller and generate good force tension throughout the abdominal fascia. With that being said, the bigger and more important goal is to retrain the core muscles to fire appropriately to bring strength, stability, and proper pressure management to the abdomen, back and pelvic floor. Included in this retraining is assessing the pelvic floor muscular coordination and strength, looking at the diaphragm and rib cage, and assessing the mobility of the back and hips. When all of these things work together, any remaining separation of the abdominal muscles is negligible and you can return to any activity without fear of injury or worrying about making the separation worse. Oftentimes diastasis is a symptom of the overall system dysfunction that is occuring. By addressing the system we fix the diastasis and have better function. It’s a win-win!

Let’s talk about some specific things that you can do while pregnant and after having the baby to decrease pressure in the abdomen and maintain your strength and therefore stability. To start, you can lay on your back and with your fingers find the bony part of your hips on either side of your abdomen. Now that you’ve found that, bring your fingers toward your midline about an inch. The next step is to do a forceful exhale – like you’re blowing out birthday candles. You should feel some tension underneath your fingertips (not sucking in and not pushing out). That’s the transverse abdominis (TA) muscle. This muscle is our body’s natural corset, and runs all the way from the spine to the front of our abdomen, underneath the other layers of the abdominal muscles. This is one of the key muscles that needs to be active when retraining your core. When this muscle is active, it creates tension along the tissues in between the six pack muscles and prevents either the caving in or the doming that happens when it’s not active.

The important part is activating this muscle so that even when you’re exercising, you don’t see or feel the diastasis. If you try a core exercise and can’t hold the tension underneath your fingertips (if you still have them an inch in from your bony hip area), or along the midline of your stomach then you know it’s too hard for now and you need to modify it. That muscle tension tells you your muscles are firing appropriately, stabilizing the abdomen and back, and managing the intra abdominal pressure that occurs when we exert ourselves. The same thing applies when you are pregnant. A good cue is to “hug the baby”. You’ll see your abdomen pull tight around the baby when you activate your TA.

Along with progressive strengthening of the TA muscle, you have to remember to recruit the pelvic floor muscles and have good mobility in your hips and back. Child’s pose, cat cow, thread the needle and other yoga or mobility exercises that encourage back and hip movement will help. Mobility is a huge component for sure!

There are so many things on the internet that will say “don’t ever do this exercise!” or on the flip side, “this exercise will fix your low back pain!”. The honest truth is that it’s very dependent on the individual. Everyone is going to start at a different place, and with the help of a physical therapist you will know where that starting point is for you. For more information on rehabbing a rectus diastasis and the other dysfunction that can occur with it, reach out to us, pelvic health physical therapists, to get all your questions answered and to get an individualized treatment plan.