What is Diastasis Recti?
Diastasis Recti is where the abdominal muscles (Rectus Abdominis) have separated to form a gap in the abdominal wall of around 2cm or more. For most people this happens during pregnancy as the abdominal wall becomes stretched as the baby grows, however it is not just pregnant mums that can be affected.
Highly trained individuals can develop diastasis as a result of tightness in the obliques which can pull either side of the Rectus Abdominis laterally, parting the middle, and leaving a gap. (So please stop hammering your obliques without any counteractive abdominal work!).
For most women after their pregnancy, the abdominals will reform and the gap will close, however for some this doesn’t happen, and they are left with a Diastasis Recti.
How do I know if I have a Diastasis?
Lie on your back with your knees bent and feet flat on the floor. Bring yourself into an ‘ab prep’ position by raising the shoulders and upper back off the floor slightly with your eyeline now directed to the gap between the knees. Now see how many fingers you can fit into the gap in your abdominal wall which will be either just above or just below the belly button. This is an objective measure that can be done at various points during your rehab journey to check on your progression.
I’ve had my diastasis for a long time now, is it too late to get any result from a rehab programme?
In short; no! It is proven that you can start rehab at any stage of a Diastasis. Just be aware that you can’t fast track the starting point of the rehab programme just because you’re 3 years post-partum. If you’ve not engaged in any correct rehab then your start point is the same as someone who is a few months post-partum.
Why should I not do sit ups and planks… that’s core work right?
These exercises put far too much stress on the abdominal wall which is now significantly weakened and should be avoided. They can actually make a Diastasis Recti worse as they encourage the pulling apart of the Abdominis Recti. Isolated oblique work should also be avoided.
So what should I do?
I have put together my level 1-5 rehab exercises for Diastasis Recti. As highlighted previously, no matter how long you have had your Diastasis, if you have not previously engaged in a prescribed rehab programme, start at level 1 and work up from there.
Level 1: Deep breathing transverse abdominis engagement and pelvic floor.
Deep breathing is a great way to get the deep core muscles engaged correctly and safely. Most peoples’ ‘go to’ is to brace the core hard without the correct engagement and result in a doming of the abdominals. See why we want to avoid abdominal doming on my previous blog post (click here).
Lie flat on your back with the feet flat on the floor and bent knees. This will just ensure the lower back stays in a comfortable position throughout the breathing exercise. Take a deep breath in for 5 seconds filling the ribs and diaphragm with the breath. You should see the stomach inflate and rise up towards the ceiling. Now as you breathe out for 5 seconds, pull the stomach in and belly button towards the spine, creating a nice flat abdomen. Lightly contract the deep abdominal muscles.
Once you have nailed the breathing with the abdomen inflating and then deflating into a nice flat position, we are going to layer on engaging the pelvic floor also. The Pelvic floor is a vital part of core strength and therefore providing the foundation to build upon your abdominal strength in your rehab. To do this, use the breathing exercise in exactly the same way only this time as you take that nice prolonged out breath not only are you going to engage the deep abdominal muscles but your pelvic floor muscles also. To do this simply imagine you’ve got to hold in a wee and passing wind. That’s the simplest way to think of it!
It is not until you can fully engage the deep core muscles – the transverse abdominis and the pelvic floor – that you should progress any kind of core strengthening. This is going to ensure the safest way of building up the superficial strength to start to close the separation of your abdominal wall. Repeat 10 times.
Level 2: Pelvic tilts.
Pelvic tilts are going to now be your progression to ensure correct lower back and Pelvis position during abdominal exercises.
Lie in the same position as your deep breathing. Just make sure the feet are roughly hip width apart on the floor and they are also nice and straight. Take a nice deep breath in, and as you breathe out, engage the Transverse Abdominis and Pelvic floor as you did in level 1, and at the same time rock the pelvis backwards so the lower back is ‘imprinted’ into the floor. Hold for a couple of seconds checking there is no doming in this position, and then allow to pelvis to gently rock back to the start position. Repeat 10 times.
Level 3: Single leg slides.
Our progression into level 3 is now all about ‘adding levers’ to challenge the core's stability with movement.
To start this exercise, you want to bring yourself into the pelvic tilt just as you did in level 2. When you are in a posterior pelvic tilt and you have engaged the deep core muscles (transverse abdominis and pelvic floor) you are going to slide one foot across the floor away from the body into an extended leg position. Bring the leg back to the start and then alternate sides. To perform this exercise correctly the pelvis should remain in a backwards tilt throughout the leg slides. If you are rocking the pelvis forward go back to the level 2 exercise and continue with some holds in the backward pelvic tilt position.
Aim to alternate sides up to 20 reps in total. Keep your extensions slow to keep the tension through the core for a sustained time. Work on just a small distance first and then build up to a fully extended leg.
Level 4: Single leg extensions from double table top.
This level 4 progression is the same movement as the level 3 leg slides only this time not using the floor as a support, therefore progressing the exercise. Instead we are going to start in a ‘double table top’ position. To do so simply bring one leg off the floor keeping the knee bent so the knee sits directly above the hip. Then bring the other leg off so that is also in the table top position. From here, keeping the pelvic tilt position and deep core engagement from level 1 and 2, start to extend one leg away from the body. Bring the leg back to the middle and then alternate sides. Just like in level 3 keep the extensions slow and controlled to maximise the time under tension. If in this exercise you start to lose the Pelvic control regress back to level 3 single leg slides. Aim for 20 reps in total.
Level 5: Single leg extensions in ab prep.
The final progression is doing our level 4 leg extensions but in an ab prep position. This position involves bringing yourself into the double table top position first and then raising the head, shoulders and upper back off the floor. Before then coming into the leg extensions check that you can keep the abdominals flat from the start. If you see a doming on the stomach the deep core muscles are not fully engaged. Remaining in the ab prep position, slowly extend one leg with a controlled motion, bring back to the middle, then alternate sides. Repeat for 20 repetitions.
By setting just a small amount of time aside each day to practice these exercises your Diastasis will start to improve