Diastasis recti is a condition that may develop during pregnancy for some people. As the pregnancy progresses and the baby grows and gets bigger, the rectus abdominous muscles are pushed apart to accommodate the baby's growth. These are the muscles that run vertically down the anterior side of a person, on either side of the body midline and serve a major function in core strength. These muscles are commonly referred to as the "six pack" and may be clearly defined as a result of exercise and strengthening efforts. They normally lay close to each other on either side of the umbilicus (belly button) without any separation.

One in three people who are pregnant may develop a separation in these muscles during pregnancy (Sperstad, J. B., Tennfjord, M. K., Hilde, G., Ellström-Engh, M., & Bø, K., 2016., 2016). This separation often persists after birth and through the postpartum period, causing a space for tissue and organs to bulge and even protrude through. In addition to continuing to look pregnant as a result of the separation, some people can develop a hernia that needs to be surgically corrected. Diastasis recti are typically diagnosed when the separation of the two vertically running rectus abdominous muscles is larger than 1 inch.

There is a further complication from diastasis recti in the postpartum period as well. Post-birth parents may experience lower back pain as a result of this muscle separation. Recovering from childbirth, adapting to carrying a newborn/infant on the outside and allowing the body to get back to the pre-pregnant condition are all difficult under normal circumstances. Dealing with the effects of a diastasis recti condition just makes everything harder beyond the typical postpartum conditions.

Entering pregnancy in a fit condition and continuing to exercise during pregnancy can help minimize any diastasis recti that might develop. There are many other benefits for pregnant people who exercise during pregnancy in addition to reducing the rate of diastasis recti:

• Reduction in gestational diabetes
• Reduces the risk of gestational hypertension
• Reduces the risk of preeclampsia
• Less chance of a macrosomic baby
• Active labor total length can be shorter
• Maternal weight gain is better controlled

Reseach published in 2014, Postnatal Exercise Can Reverse Diastasis Recti and presented at the annual ACOG Conference that year indicated that people who began exercises to repair this separation in the postpartum period had similar positive outcomes as those who did the exercises during the prenatal period. NPR.org shared information on this study and conducted interviews with the study authors. The piece "Flattening The 'Mummy Tummy' With 1 Exercise, 10 Minutes A Day" aired yesterday and can be found here. Many discussions are occurring all over the internet on the success of this program as a direct result of this NPR piece. This condition has both a physical and emotional impact on parents, and with some simple exercises, core strength can be returned, pain reduced and the separation corrected.

The study compared two groups of new parents and demonstrated that those parents who did isometric contractions of the transverse abdominis, resistance training, and cardiovascular exercise either prenatally or in the postpartum period both showed "significant improvement (P<.05) in the reduction of postnatal rectus abdominis muscle separation. There was no significant difference in the final absolute separation measurement of the two groups." People who began the conditioning and strengthening exercises after giving birth had similar successes in resolving the diastasis recti situation. The pilot study demonstrated that the condition can be improved with this simple set of exercises. Both prenatal and postnatal subjects experienced full resolution by the end of the exercise program.

Childbirth educators can instruct pregnant people in how to properly strengthen the transverse abdominis muscles during a childbirth class. This information located in a general Google search or by exploring the website of one of the study's authors ' Leah Keller. The Dia Method is the system founded by Leah and highlighted in the study. Please note, accessing the Dia Method has a fee associated with it.

While ACOG recognizes that exercise can improve a pregnancy under normal circumstances, they are not specific in what type of exercises work for preventing, reducing or resolving diastasis recti nor when, how frequently or for how long any specific exercises should be done.

With additional research, clarification on the specific exercises that can mitigate this situation will be identified and can be shared with pregnant and postpartum parents. In the meantime, you can share this information with the families that you work with, help them to locate further information and have them be prepared to discuss this condition with their care provider, physical therapist or prenatal/postpartum exercise specialist. Maybe this is simple solution and families should know that it is not too late to start after the birth if the problem persists.

Have you heard families express concern about their diastasis recti situation? What do you currently tell them? Do you cover these exercises already in your classes? Let us know in the comments section.

References

Sharma, G., Lobo, T., & Keller, L. (2014). Postnatal exercise can reverse diastasis recti. Obstetrics & Gynecology, 123, 171S

Sperstad, J. B., Tennfjord, M. K., Hilde, G., Ellström-Engh, M., & Bø, K. (2016). Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med, bjsports-2016.

image source: Vimeo - Pelvic Relief

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