Understanding Diastasis Recti and How to Begin the Healing Process

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Diastasis Recti.
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Those are awfully scary words, aren't they? There are many aspects of pregnancy and motherhood that are physically scary and demanding, and diastasis rectus abdominis (DRA) is one of them. I have had many moms write to me or connect with me in person with the sole purpose of having some clarity shined on this topic.

“My doctor told me I have a three finger separation. What do I do? Will it ever go back?”

For many moms, DRA is a much more concerning issue than losing the baby weight. They realize that until these abdominals are figured out, their body is not going to feel normal again. It’s a barrier to being truly strong, pain free, and having a stomach they’re happy with.

A lot of moms have actually given up. Learning that they still have DRA was the nail in the coffin. It was the excuse to not really try anymore.

“Sure I could try and workout and lose some weight, but I still have separated abs and that’s not going anywhere, so what’s the point?”

So they suffer from hip pain, back pain and a lack of strength to carry or lift anything.


Alright, these are big science-y words.

So what is diastasis rectus abdominis? What am I even talking about?

If you picture the rectus abdominis muscles (the six pack), there is a vertical line between the left and right sides that starts at the chest and descends to the pubic bone. This is a band of connective tissue called the linea alba. (Shown as the white vertical line in the picture below.)
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​This band of tissue is designed to expand and separate as your belly grows during pregnancy. However, what often happens is that this tissue can greatly lose its natural elasticity and tension, especially when put under the stresses of a giant belly. (Do you remember that extremely tight balloon feeling? Yep, that’s tough on the linea alba.)

Gaining excessive weight and carrying multiples certainly places more stress on the linea alba.


Can you prevent this?

​During pregnancy, there is not much you can do about it. In fact, probably 99-100% of pregnancies experience DRA to some degree. The linea alba is supposed to stretch apart like this. It’s just a matter of whether it finds tension again and rebounds quickly afterward.

Entering pregnancy with a very strong core structure certainly helps. The connective tissues will have more tension and return to normal very quickly afterword.

But what if you didn’t do that necessarily, and you’re here on the other side of pregnancy (maybe even a long time after) and you have separated abs still. What should you do?


Should you try to reduce your DRA at all cost?

First, you need to know that still having a gap between your abs is OK! The tension and density of those connective tissues is far more important than the finger width. If you still have a 2 finger gap, but it feels dense and sturdy, and the rest of your core is functioning well, then you’re totally fine. Your goal does not need to be reducing the gap at all cost!

(And you will be able to feel this tension. This spot will either feel really squishy or firm and dense.)

Still not sure what we're talking about? Lie on your back and perform a self-assessment as demonstrated below. Watch the whole video! Jessie shows how simply coordinating your breathing and engaging your pelvic floor makes a big difference! 

How do you start the healing process?

So how can we heal your diastasis rectus abdominis and get your core functioning at its best again?

There is a proper healing process with a few components, and each one is important. I’ll warn you…you will read through this and immediately think “yadda-yadda, just give me the exercises to do”.  Slow down and do everything. I'll say it again...

   ...Slow down and do everything!


1. Understand good posture. If your core is not well-aligned, you will never heal properly. It helps to picture your core like a soup can. There is a top (your diaphragm), a bottom (your pelvic floor), and the sides around (your back, glutes and abs). Your "can" needs to always be perfectly stacked, not tilted. “Don’t spill your soup!”

Think of your rib cage lining up directly above your pelvis, your diaphragm lining up directly above your pelvic floor.

A couple things to notice about your own posture: check to see if your ribs thrust up and out. This might be more easily noticed if your low to mid back usually arches. When the ribs flare out, this tends to make your back arch. Drop your rib cage.

Another thing to notice is if you tuck your bum. If you walk around constantly squeezing your glutes, you probably do this. It rocks your pelvis under and takes your core out of alignment. Relax your glutes and let your pelvis sit level.

Once you find good alignment, then you can properly “load” your core and correctly engage it during exercise.


2. Understand better breathing. Remember that the top of your can is your diaphragm and the bottom of your can is your pelvic floor. When you breathe, especially focused breathing, these should both engage.

Here’s an exercise you can do right now while you’re reading this:

• Place your hands on the sides of your ribs, then inhale and exhale. What moved? Just your belly? Just your chest? Just your ribs?
• Now inhale and exhale again, allowing every part to move. Feel your chest, ribs and belly expand.
• Now when you exhale, push the air out a tiny bit harder but still slowly. Feel as many muscles engaging as possible.
• Now do it again: inhale getting everything to expand, exhale and gently engage while you slowly release the air. While everything is engaging, feel your pelvic floor engaging too. You know those kegel muscles? It should feel like the bottom of the can, the part your vagina and anus is sitting on, engages and rises into your core.
• You can even think about “grabbing beans” with your vagina and anus. Sounds weird, I know, but it works.

So here’s the “better breathing pattern” again:

Inhale and feel everything expand > slowly exhale and gently engage all the muscles while simultaneously “grabbing the beans” > then relax everything to inhale and repeat.

It will feel very bizarre at first, but keep practicing it. When you begin to “load” your core for squats, deadlifts, carries, pulls, etc., you should tie this all together. Exhale and engage a split second before the movement begins to provide your core with the tension it needs to do it properly. Keep practicing.

(Personal side note: Since I've been practicing this better breathing pattern, I'm noticing far less "leaking" during my workouts, coughing or sneezing. No joke.)


3. Understand good exercises for a strong core. Do the right stuff. Don’t wreck yourself by doing all the wrong core exercises.

Because I know you like lists and straightforward answers, here are exercises you should avoid if you're trying to heal your DRA:

1. Crunches
2. Sit-ups
3. V-ups
4. Pikes
5. Front planks (for a while…)
6. Roll-outs and any other exercise that places direct and intense tension through the abs.

Here is what you can and should be doing instead: work your body how it naturally works. Don’t think “spot training”, doing exercises for certain spots. Think “functional” movements instead. Work on pushing, pulling, carrying, rotating and resisting rotation. All of these motions require your core to engage and stabilize the spine. They are not directly training your core, but are indirectly training it.

I like to call these types of movements “sneaky core”.

So a “core circuit” might look more like a total body circuit, with squats, lunges and rows, with the emphasis being placed on good core alignment, breathing and engagement.

Here is a list of exercises that fit the bill for DRA healing:

1. Farmer’s carries (holding a weight on one side of your body and going for a walk)
2. Birddogs, biped thoracic rotation
3. Kneeling, half kneeling or staggered anti-rotation presses
4. Squats, banded squats, goblet squats, offloaded squats, squat to chopping lift
5. Bridges, banded bridges, physioball bridges, physioball hamstring curls
6. Bent-over rows, single arm rows, inverted rows
7. Physioball single arm chest press, physioball chest press, elevated push-ups

(Not sure how to do these? Go here and search my database for that particular exercise.)

If you look at the torso for each of these exercises, the core must perform some gentle bracing to maintain good posture and alignment. This is ideal for healing DRA. It’s indirect core work, but just enough to create tension through the area to encouragement your abs to come together.

When you feel like the density and tension of your linea alba is much stronger and you’re noticing improvement, you may begin to slowly incorporate these exercises:

1. Planks, tall planks, tall planks w/ hip movements
   
2. Side planks, tall side planks, side planks w/ hip movements
   
3. Floor push-ups and all the push-up variations
   
4. Pikes, roll-outs and more intense direct ab work

(Please note: I don’t believe there is ever a good place in a routine for crunches and sit-ups. These encourage poor posture and just don’t make sense for what a good, strong core should be.)

With every move, it’s important that you follow that inhale > exhale > engage > exert pattern. This will ensure that you don’t damage your core in any way while performing more challenging exercises.
 
(Plus it allows you to be able to eventually lift more! This is the exact breathing pattern that power-lifters employ when facing a heavy lift. DRA or not, I encourage incorporating this breathing pattern into your most challenging exercises, like push-ups. You’ll discover a stiffer spine that makes the movement much easier.)

Take it Slow

Healing DRA may take some time, so be gentle with your body. You'll have this body for the rest of your life, so don't rush into something that will wreck it. Whether you are immediately postpartum or your youngest baby is 10 years old, this will immensely help.

If you need more guided instruction for healing your body and getting stronger, consider joining the Strong Mommas Membership. All of the workouts for members, whether beginner or intermediate/advanced, implement correct core training. And over the next few months, I am designing a separate workout "add-on"...a core circuit designed specifically for healing diastasis rectus abdominis. Substitute this simple strengthening circuit for the regular core exercises and you'll be well on your way to having a stronger body, abs and all. 

Don't give up on your abs, momma.

They separated for a reason...your body was designed to do this. Now do the correct things to encourage them to strengthen and repair. 

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