Facts and Tips for Healing Diastasis Recti, Part 2

Now that we’ve looked at the cause of diastasis recti (DR), let’s look at how we can begin to heal DR and improve the function of your abdomen. (Please read the previous blog post for a detailed understanding of DR).

Since the main cause of DR is sustained pressure on the abdominal wall, you will want to look at your daily movements and breathing patterns, and change the balance between movements and activities that put pressure on the abdominal wall and the pelvic floor, and those that don’t.

Posture

Your alignment or posture might be causing excessive intra-abdominal pressure. A common postpartum posture is jutting the pelvis forward and collapsing into the joints. See the graphic to the right. 

When you move your weight back to your heels and stand tall with minimal effort, you will fire the posture muscles of your pelvic floor and your core without the need to consciously contract anything.

Breath

What about your breath? When your spine is aligned, think of breathing 360 degrees all around your lower ribs. You can put a resistance band or a pair of stretchy tights around your lower ribs (at the level of your bra line) and cross it in front. Relax your abdomen, feel the band/tights expand all around, including in your back, with every in breath and then release with each out breath.

Many people walk around sucking in their abdomen, thinking it will strengthen their abdominal muscles. This is counterproductive and will direct the pressure downwards onto the pelvic floor as well as cause shallow breathing, which creates tension in the shoulders and neck muscles.

When you are aligned and breathing 360 degrees, your pelvic floor works in tandem with your diaphragm like a piston moving up and down. When your diaphragm descends as you breathe in, your pelvic floor releases and as you breathe out, your pelvic floor gently lifts. 

Nutrition

Nutrition also plays an important part in healing diastasis recti. If someone has chronic constipation, bearing down frequently will put a lot of pressure on the abdominal wall and the pelvic floor. Many people with DR suffer from bloating because the abdominal wall does not have the resistance to support inflamed intestines, and it’s important to identify food sensitivities or anything that is inflammatory for the gut.

Visceral fat puts pressure on the abdominal wall and this pressure will continue until the pressure is decreased by reducing the visceral fat.

Routine Movements

The literature shows that transitional movements, such as climbing stairs or getting up from a chair, generate a lot of pressure on the abdominal wall and pelvic floor. If you do those movements while holding your breath, this will cause you to bear down and increase this pressure. Many people aren’t even aware they are holding their breath. One solution is to talk when you perform these transitional moves, as you can’t hold your breath while you’re talking.

What about when you cough and sneeze? Are your abdomen and pelvic floor being pushed out? Your pelvic floor should be lifting up and your abdomen drawing in when you cough and sneeze. Check it out right now. Do a fake cough. What do you feel in your pelvic floor? Is it pushing out or lifting up? Only when you are aware of how your body responds are you able to change it.

Strength Training

According to current research, healing DR and strengthening the whole abdominal wall entails a combination of developing strategies for effective and efficient patterns in your daily movements, as well as progressive strength training for the whole core.

The first step of a progressive core strength training program is to learn how to activate the diaphragm, the transverse abdominis, and pelvic floor muscles in unison. It is important to activate the core from the bottom upward, starting with the pelvic floor. This will reduce pressure on the pelvic floor. Activating the pelvic floor is like lifting a cherry tomato with your vagina (learn more in this short video).

Very often the transverse abdominis (TA) muscle has “turned off” after having been excessively stretched during pregnancy, so the stronger, outer muscles take over. As mentioned in the first post, tension in the linea alba is essential to healing, which is accomplished by activating the TA.

To activate the TA, think of drawing the abdominal wall inwards towards the spine (remember to start by activating the pelvic floor first). You can place your flat hand on your lower belly and as you exhale, lift your pelvic floor and feel as though your lower abdomen is drawing away from your hand. As you inhale, release your pelvic floor and abdomen to the starting position. Move your hand up to your navel and repeat this move, by activating the pelvic floor and the lower and middle TA on an out breath, feel as though your lower belly and navel are drawing inwards, away from your hand. Inhale and release the pelvic floor and abdomen. Finally, move your hand to your upper abdomen, and, as you exhale, activate the pelvic floor and feel as though your lower, middle and upper belly are drawing inwards, away from your hand. Release everything on an inhale.

In this way, you are developing an effective strategy of activating your deep core. Doing this in a variety of positions will increase your awareness of how to activate these muscles. It’s very difficult to isolate a muscle and although other muscles are also firing, you want to make sure the whole TA is working well, in unison with the pelvic floor and the diaphragm. 

Before Adding Resistance – A Checklist

It is essential to start healing your core with simple rehabilitative movements in a variety of positions before you increase the load (by adding resistance). In each exercise, as you gradually increase the challenge, you want to make sure that:

1. You are able to breathe while doing the exercise and not holding your breath from exertion.
2. You are able to use your pelvic floor, your lower, middle and upper TA, and your breath in a coordinated way as described above. This will help ensure that ALL the muscles, including those that have been stretched and weakened from pregnancy, will activate when they need to.
3. You are able to manage the intra-abdominal pressure without causing the linea alba to dome outwards. If you do notice doming, check your strategy of coordinating the pelvic floor, TA, and breath and see if you’re able to minimize the doming. If not, back off and do a simpler exercise or try the exercise in a different position. You might be able to return to the exercise as you get stronger. Please watch this short video for more information on how much doming is ok.
4. The exercise is not causing any pain or pressure, particularly in your abdominal wall and pelvic area, and is not causing any leaking of urine.
5. You are doing the exercise with good form and not collapsing into your joints.
6. Once you know that ALL your core muscles are activating in unison and you’re able to generate tension across your abdominal wall without doming, add resistance. This is known as ”loading”–increasing the resistance slowly, so that the muscles and connective tissue are constantly being challenged. You want to make sure that you are still doing the exercises according to the above guidelines.
7. Add resistance together with movement so that you are developing both strength and strategies for more complex movements.

When an exercise feels easy and after taking into account all of the above points, you should move on to a more challenging exercise. Continuing only with “DR-safe” exercises will not strengthen your muscles or regenerate the connective tissue.

A Note About Planks & Crunches

Even though the internet is full of warnings about people with DR avoiding planks, you can safely begin with modified plank positions as long as you are able to keep your core activated and drawn in, then progressively increase the challenge, slowly, as your core becomes stronger. You might start by leaning on the kitchen counter with your arms outstretched and see if you’re able to keep your pelvic floor lifted and your abdominal wall drawn in. Then see how you do on a lower incline, perhaps with your hands on the back of a couch, and then on the seat of a couch, before lowering to your knees on the floor with your hands beneath your shoulders on the floor. Planks can be an excellent way to load the abdominal wall, provided you’re doing them at a level where you are able to activate your deep core muscles and draw in your abdominal wall.

The same is true of crunches. Abdominal crunches are spinal flexion and, since we flex our spines many times during the day (when we get out of bed, when we tie our shoes, etc.), we should learn how to flex correctly. Spinal flexion can put a great deal of pressure on the abdominal wall and pelvic floor, but if you are using all the points mentioned above for effective core activation, see what happens when you simply lift your head up off the floor. You can progress to roll downs (starting in the sitting position, then rolling down slowly, with control, to end up lying down on the floor). Some people are able to regulate the intra-abdominal pressure going down in this direction with more control than with sit-ups/crunches. Maybe it will never be right for you to do a regular crunch, but at least you will learn how to do daily movements with minimal pressure on the abdominal wall and pelvic floor.

Some countries (mainly in Europe) fund screening for every woman in the first 12 weeks after giving birth to check the abdominal wall and pelvic floor. If possible, everyone after giving birth should see a physical therapist who specializes in abdominal and pelvic floor health. Many people return to the fitness program that they did pre-pregnancy, which could be too challenging (and possibly damaging), especially if they are not activating the whole abdominal wall and pelvic floor. If people can get their abdominal wall and pelvic floor functional in the first year after giving birth, it can be of great benefit in later life.

Many people turn to free videos on YouTube for exercises to heal their DR. Unfortunately, these videos don’t guide a person through all the steps necessary for progressive strength training, which is essential for healing. Daily movement patterns are as important as exercises for healing and function of the pelvic floor and abdominal wall. For more information on healing DR, check out this free guide.

It’s never too late to start healing a diastasis, whether you gave birth months, years or decades ago.

About Rachelle Oseran

Rachelle Oseran, BA, LCCE, FACCE, CD(DONA), ACE, has been actively teaching childbirth classes since she was certified in 1984 and is a Lamaze-accredited childbirth educator trainer. She also teaches Mindfulness Based Childbirth and Parenting. She is a fitness professional certified by ACE (the American Council on Exercise) and, for the past 36 years, has been teaching pre/postnatal fitness, helping women and men heal from diastasis recti and has lectured and given professional workshops on the subject in the US, Europe and Asia. She combined her extensive fitness experience with her certifications as a Yoga and Pilates instructor to create the online course, IMPROVING CORE FUNCTION, a systematic, effective and affordable program for healing diastasis recti. She is passionate about helping people heal their diastasis recti and gaining confidence in their bodies so they can return to the activities that they love. 

She lives in Jerusalem, Israel, with her husband. They have 3 sons, 3 daughters-in-law and 4 grandchildren (so far). 

Follow Rachelle on Facebook, Facebook group for healing DR, Instagram, and YouTube.

Author photo credit: Dani Sarusi Photography