UNDERSTANDING DIASTASIS RECTI
by Alison Brunson, PT, DPT, CSCS, PCES
What is Diastasis Recti (DR)?
DR is a separation of the rectus abdominis muscle, think: “six pack abs” due to thinning of the linea alba. The linea alba is a band of connective tissue that runs between your “six pack” vertically; it functions to stabilize and control the abdominal muscles. It is flexible and is meant to stretch to accommodate pressure within your body. Some natural stretching and DR formation during pregnancy is normal!
However, it is important to avoid movements that increase intra-abdominal pressure. Exercises and movements that put too much pressure on the linea alba will create more stretching, thus making the DR worse. For example: you may see a “tenting”/”coning”/”bulging” when moving from a lying to seated position. This is why you’ve probably heard to first roll to your side and push up with your arms when getting out of bed. Continually putting too much pressure through the linea alba will cause more stretching and can make your DR worse.
I want to be clear: it is extremely normal to have separation of your abdominals, and the vast majority of women will have DR by the third trimester of pregnancy. Your body is designed to expand in order for your baby to have room to grow. There is also growing consensus between physical therapists that DR is not necessarily a condition we need to prevent and treat, since this is a natural way for our bodies to create space during pregnancy. DR often resolves in two to three months postpartum. That’s not to say that you shouldn’t perform abdominal exercises during pregnancy (& of course, seek a physical therapist’s advice about each individual case). A regular exercise routine is extremely beneficial. It is so important to strengthen your abdominals during pregnancy AND postpartum. The goal is to prevent severe diastasis from occurring.
There is a lot of negative talk surrounding DR online. Hopefully, this blog gives you a little more information to help reduce anxiety during your pregnancy and postpartum. Reading about DR can be a black hole of endless information, here is a summary of some basics. Keep in mind, everyone is different. Talk with a pelvic floor PT to learn what will work best for your own body.
How do I know if I have DR?
Signs that you have DR can include: a visible space between abdominal muscles or bulging/coning/doming of the abdomen. Ask your physical therapist to check for DR if you’re curious.
You can perform a “self-test” at home:
1) Lie on your back with knees bent
2) Barely lift your head off the ground
3) Feel for a gap between your abdominal muscles - gently press down with your fingers pointing towards your pelvis
a) Check in 3 places: (1) above, (2) at, and (3) below the belly button
b) Your fingers should get a “trampoline” or firm feel. If you have DR, your fingers may sink in
c) DR is considered >2 finger widths wide
RESOURCES
Ptaszkowski, paprocka-borowicz. Assessment of bioelectrical activity of synergistic muscles during pelvic floor muscles activation in postmenopausal women with and without stress urinary incontinuence: a preliminary observational study. Clinical Interventions in Aging. 2015;1521-1528.
Dufour S, Bernard S, Murray-Davis B, Graham N. Establishing expert-based recommendations for the conservative management of pregnancy-related diastasis rectus abdominis: A Delphi consensus study. Journal of Women’s Health Physical Therapy. 2019 Apr 1;43(2):73-81.
Thabet AA, Alshehri MA. Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial. Journal of musculoskeletal & neuronal interactions. 2019;19(1):62.
Resources from the APTA (American Physical Therapy Academy), Choose PT. https://www.choosept.com/guide/physical-therapy-guide-diastasis-rectus-abdominis
Hills NF, Graham RB, McLean L. Comparison of trunk muscle function between women with and without diastasis recti abdominis at 1 year postpartum. Phys Ther. 2018;98(10):891–901. Article Summary on PubMed
Keshwani N, Mathur S, McLean L. Relationship between interrectus distance and symptom severity in women with diastasis recti abdominis in the early postpartum period. Phys Ther. 2018;98(3):182–190. Article Summary on PubMed.
Kamel DM, Yousif AM. Neuromuscular electrical stimulation and strength recovery of postnatal diastasis recti abdominis muscles. Ann Rehabil Med. 2017;41(3):465. Article Summary on PubMed.
Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014;100(1):1–8. Article Summary on PubMed.
Sharma G, Lobo T, Keller L. Postnatal exercise can reverse diastasis recti. Obstet Gynecol. 2014;123 Suppl 1:171S.
Barbosa S, de Sa RA, Coca Velarde LG. Diastasis of rectus abdominis in the immediate puerperium: correlation between imaging diagnosis and clinical examination. Arch Gynecol Obstet. 2013;288(2):299–303. Article Summary on PubMed.
Disclaimer—
Alison Marks Brunson Physical Therapy PLLC owns and manages this Website. The information provided on this Website is not medical or professional healthcare advice. It is only for informational and educational purposes. Please contact your primary care provider to discuss your health concerns, diagnoses, or treatments. In a medical emergency, call 911. Your website-related activities and communications do not create a provider-patient relationship between you and us and do not create a duty for us to follow up with you. To learn about our services, please contact us directly.
