Oh, the many joys of bearing children. Pregnant and birthing women put up with stretch marks, hemorrhoids, weight gain, boob issues, hair loss, sleeplessness, and hormonal insanity when we bring our little angels into the world. A lot of that stuff is temporary, or just an inconvenience. But one of the more serious and lasting results of pregnancy is a diastasis recti, or an abdominal muscle separation.
Not every pregnant woman develops a diastasis recti (DR), but it's a common side effect of a distended belly. You know how when someone has a six-pack they have a line that goes down the middle of their belly? That's called the linea alba and its made of connective tissue. Often, when a baby is growing behind the abdominal muscles, the linea alba will painlessly soften and widen to allow the left and right sides of the abdominal muscles to separate. This makes plenty of room for the baby to continue growing and stretching your muscles, organs, skin, and patience. Here's a really scary-lady pic to illustrate where the linea alba is located, directly in the middle of the rectus abdominis.
So if you have a DR, there's not actually a hole or tear in the middle of your belly. Even though the connective tissue of the linea alba is weakened and stretched, it's still there.
After birth, lots women have a DR that naturally heals. But for many of us mamas, it's a long uphill battle to get that top button of our jeans to ever snap again. Your abdominal muscles act as a corset around your middle, holding in all your organs and giving your torso its shape. When the abdominal muscles are separated, your stomach pooches out with the weight of your guts, and it's difficult to exercise your way back to a flat tummy.
Many women hit crunches hard hoping to expedite Operation Fitting into My Old Jeans So I Can Feel Human Again. Unfortunately, certain kinds of ab exercises can actually make a DR worse. When the your ab muscles are separated and you contract your rectus abdominis (the long flat muscles that run vertically along the length of your stomach; the cans in your six-pack) just gaps and the contraction can actually increase the separation. Imagine one of those old plastic coin purses. Yep, just like that.
And a DR can do more than just make you uncomfortable in any pants without elastic. When your ab muscles are separated, they can't help stabilize your torso as well as they used to when they were intact. Much of the work goes to the low back and you're at greater rick for back injury, discomfort, and/or a hernia. And if you've had a baby, I can promise you that you're gonna be doing a LOT of lifting and carrying for the next six years. So it's vital to get that core strong again. Here's a great article that addresses the physical aspects of a DR in more depth.
If you're not sure if you have a DR or how severe your separation is, try this test.
Yeah, It's Not Pretty. What Do I DO?
I spoke to Christine Anderson, DC, a pediatric and family chiropractor, pre and post-natal group exercise instructor, and mom of three. She filled me in on some safe and effective exercises moms can do that will help to strengthen the transverse abdominis (the deepest layer of abdominal muscle), the rectus abdominis (the most superficial layer of abdominal muscle), and the obliques (the muscles running along the sides of your belly). Additionally, the exercises, "help to strengthen the stabilizing muscles of the spine and the pelvis, reducing the pressure on the thinned and weakened connective tissue of the line alba," says Dr. Anderson. All of this will assist in closing the gap in your muscles and hopefully help to heal a DR.
Dr. Anderson highly recommends wearing an abdominal brace or splint anytime you're engaging your rectus abdominis and definitely during exercise. "Some women might find it helpful to wear while they are carrying the baby, cleaning house, etc., " she advises. I personally found this to be extremely effective in helping to heal my DR. The splints are usually very inexpensive and widely available. Order one up and get busy healing!
What If It's Hopeless?
I know some women who have such a large gap that they're scared to try any exercises or feel like there's no point in trying. But Dr. Anderson says, "Even with a large DR, these core exercises should be safe. But it may be wise to work with a physical therapist or chiropractor who specializes in DR repair so they can make sure you are doing the exercises properly and monitor your progress. As always, check with your health care practitioner first before beginning any exercise program."
Exercises to Help Heal a Diastasis Recti
Heel Slide: Lie on your back with your knees bent. Inhale. While exhaling, slowly slide one foot out, keeping your foot on the floor, as you engage your abs by squeezing your belly button towards your spine. Breathe in, and as you exhale, engage your abdominals and slide the foot back in. Switch sides.
Lower Ab Mini-Cruches: Lying down, extend your legs straight up until they are at 90 degrees. Arms are out at 45 degrees. Lift your legs up to the ceiling using your deep lower abdominals. It is a squeeze, not a popping up motion with the hips. Your feet should not go towards your nose but towards the ceiling. The lift is very small.
Opposite Arm and Leg: From an all-fours position, extend one leg straight out behind you. Imagine something is pulling your leg towards the back wall, but don't let your hip pop up. Extend your opposite arm out at ear level. Stretch your hand and foot away from each other. You can stay here for a hold or exhale and bring your elbow in to meet your knee and inhale as you stretch them out again. For added intensity, you can work up to using a resistance band. Wrap the band around your moving foot, and anchor it to the same-side hand that's resting on the floor.
- Back Work: Working on the back core is important in order to support the body and take the stress off the rectus.
Prone Superman Lifts: Lie on your belly. Bring your upper body up with your arms at your sides, hold, and release. In order to make the move more challenging, hold your arms straight out from your sides, like an airplane, as you move. Even more challenging, stretch your arms straight out in front of you, at ear level, as you lift and lower.
Prone Leg Raises: Lie on your belly. Lift your legs up from the hips and hold. You can also lower and lift.
Bridge: Lie on your back with your knees bent and feet flat on the ground. Lift lift up hips, squeezing your belly button to your spine. Lower down slightly and lift again. Don't lower all the way to the floor between reps. This can be done with your feet on an exercise ball to increase intensity.
Plank: (of course!) You can plank on your hands with your arms straight, or on your forearms with bent elbows, whichever is more comfortable to you. Make sure to really pull your belly button up and not let your belly sag. If you feel like you're unable to pull your belly up, try planking on your knees instead of your toes. Proper form is incredibly important for effectiveness as you do these exercises.
Plank with Moving Leg: Plank on your hands with straight arms. Slowly bring your knee up towards your nose, out to the same elbow, and across the body to the opposite elbow. Exhale each time your bring your knee up really squeeze your belly button in towards your spine.
Side Plank: You can side plank with on your hand with your arm straight, or on your forearm with your arm bent. If you have difficulty maintaining your balance, bring top foot to rest in front of your bottom foot. It help for a more stable base and makes it a bit easier to keep your hip raised. For added intensity, you can lower and lift your hips.
Although it's a frustrating, slow, and difficult process, it IS possible to heal a DR. That's me in the picture above. I had two really big babies and I had a terrible diastasis recti. Dr. Anderson is one of my instructors at the gym where I work out and she's been instrumental in helping me to achieve the above results. I put it off for a long time. And it took close to two years. But I wore my brace faithfully, did the hard work, and it all paid off.
If I can do it, anyone can. Thanks again, Dr. Chris!
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