The Who and Why Behind Diastasis Recti

What’s up with Diastasis Recti?

By: Dr. Lindsay Mumma, DC, and Dr. Lindsey Mathews, D.C.

 

What is Diastasis Recti?

Diastasis Recti (or DRA) is the separation of the linea alba, connective tissue, that connects each of your six-pack or rectus abdominis. This line extends from the bottom of the sternum to the top of the pubic symphysis; however, most separations you will see above or below the belly button.

Once this connective tissue widens there are a multitude of issues that can arise, ranging from the purely cosmetic to the functionally defective.  While the cosmetic aspect may be more important to some than others, the functional aspect can impact your ability to lift your children pain-free or maintain urinary continence.

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Who gets DRA?

As the abdominal wall expands with the growing fetus and uterus, most women’s bodies are able to accommodate for these changes.  If the body fails to accommodate changes appropriately, the linea alba can stretch, widen, or split.  This typically happens in the second or third trimester of pregnancy (2).  But this does not only affect pregnant women.  DRA can be present in infants who have not fully developed their abdominal wall, and also in men or women who repeatedly practice poor abdominal loading techniques or exercises.

You may have heard that small, fit women are at a greater risk. Well, we’ve witnessed diastasis recti in small, large, medium, and women of all sizes.  We feel there are a lot of misconceptions in regards to why the fascia tears and what can be done about it.

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Anything I can do during pregnancy to avoid DRA?

There is no one size fits all model. Just as there is no one size fits all diet, each person is unique, and each person has their own underlying issues that will contribute to the possible separation of the fascia.

Diastasis Recti is not a disorder. It is more of a symptom or a clue that something else is going on. There is a bigger, underlying issue that needs to be addressed.

That said; if you are pregnant, planning on getting pregnant, or even just had a baby, I would highly advise you see a chiropractor and a skilled body worker. If your pelvis and diaphragm are not functioning dynamically, then you will have issues. It may present as sciatic type pain, lower back pain, a breech presentation baby, rib pain, abdominal fascia separation, or something else.

So, anyone, male or female, could potentially get abdominal fascia separation.

Anything I can do during pregnancy?

Thinking about the core and how it functions, we like to use the Chinese Finger Puppet analogy. If you have ever played with one of those toys, you know that they are cylindrical and when you pull in a certain direction the whole contraption tightens up. Well, our core is not just our 6-pack or 4 pack or whatever you got. It’s the entire axial skeleton. The core is the front, back, and sides of you. The core is everything from your diaphragm to your internal and external obliques to your lats and of course your glutes. Your core muscles protect your organs and spine.

Some fitness suggestions while pregnant…

  • Avoid “Crunch Type” motion.
  • Engage your entire core.
  • Incorporate your breath.
  • Overhead squats and front squats with PVC  or empty barbell.
  • Strict pull-ups with or without bands.
  • Strict presses with KBs, DBs, Barbell, or PVC.
  • Side Planks and Regular planks (depending on severity) with movements like push-ups. Please avoid holding the regular plank for extended periods.
  • Overhead walking lunges with plate.
  • The list is endless.

As you can see there are many safe options and things to think about during your pregnancy. There are a ton of other options that we did not even list here. Another thing to think about is your recovery. Your training may be amazing, but if you are not recovering smart then your body will start to break down. Your muscles need to be pliable and your joints need to be freely moving. If there is a limitation somewhere, then your body will start to exhibit some interesting compensatory patterns.

  • Visit a chiropractor regularly.
  • Get soft tissue done regularly.
  • Eat nutrient dense foods and take your fish oil.
  • Swimming is a great active recovery exercise.

If you don’t want to worry about it at all, BirthFIT does fitness and nutrition programming.

 

What about postpartum?

Start thinking about belly breathing. Yes, now. “Sucking in your gut” will do nothing for you. It will only inhibit your diaphragm, which is a huge core stabilizer, and needed for proper functioning of the entire core complex. Avoid the temptation to hide or suck in your postpartum belly. You will recover faster if you can master belly breathing.

During the 0-8 weeks postpartum phase, the body will start to return to its so-called normal state as the uterus shrinks. It is important to being to work towards improved abdominal loading and normalizing loading patterns after the baby is born. Think about all the times you will lift your baby. Establishing your “new normal” may be weird and frustrating. However, by addressing your biomechanical deficiencies now, you will be way better off in the long run.

Go to your chiropractic as soon as your feel comfortable. Get soft tissue work done when you feel ready. And, start to walk. Take a few walks a day with your baby.

When you feel ready start with something simple like Dr. Stu McGill’s modified curl up or other simple bodyweight movements. Video below:

Dr. Stu McGill Exercise

After the 8-week mark, women start to get a little anxious. Please remember to be patient. Healing and recovery is different for every person. One woman may be healed in 9 weeks while another may take 15 months before she feels completely healed.

You may also feel that your strength and endurance all return by 12-15 weeks, but you still have a “soft tummy”. This is NORMAL. Be patient with your body, train smart, and recover smarter.

Women that over train in the beginning are usually the ones that never get the ‘abs’ they had before. Those that train smart and recover smarter will usually regain all function and even the ‘abs’ they had before.

Remember, everyone is different. Healing takes time. The average time is somewhere between 5 months and 18 months. That is a huge window of variability. Find a chiropractor and body worker you trust, so that they can help guide you in your recovery path. Use the support around you and show your body gratitude. You will be just fine.

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Dr. Lindsay Mumma, D.C. and Dr. Lindsey Mathews, D.C. wrote this article. Dr. Mumma is out of North Carolina.

Triangle Chiropractic and Rehabilitation Center, North Carolina. 

 

 

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29 comments to " The Who and Why Behind Diastasis Recti "
  • Jenny Chabolla

    Bri Battles said you referred her to a chiropractor who uses rock tape to help with diastasis recti. Do you know someone in the inland empire?

    • Lindsey Mathews

      Hi Jenny,
      Thanks for following BirthFIT. I have not met Dr. Amanda Peterson but I hear she is the go-to in the Riverside area. I hope to get out there sooner than later to meet her:) Email us with any questions. Info@birthfit.com. Thanks. -Lindsey

  • Stephanie

    My abs are still separated after 2 years postpartum (26 months). My kids were really close together. I have done planks, running, no-situps(since I have read that), and suck in a lot! Any advice would be appreciated.

    • Stephanie,I just saw your comment and want to point out that sucking in won’t actually help to strengthen your stomach. Sucking in inhibits your diaphragm, which decreases stability throughout your torso. I wrote another article on that here if you’d like to read it: http://www.tabatatimes.com/sucking-in-doesnt-make-you-skinny-strong/
      Diastasis affects many people – not just pregnant or postpartum women – and doesn’t have an expiration date. Just because it’s been two years does not mean you are a lost cause! With some specific manual therapy and education, your loading patterns can improve and you can begin to heal the separation. You can contact BirthFIT to find a provider in your area that might be able to help you hands-on. Best of luck! – Lindsay Mumma

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  • Nikki

    What does PVC mean in your exercises? When I search for the definition I get plastic pipes or a cardiac condition – what are you referring to – a body action/part or piece of exercise equipment?

    • Lindsey Mathews

      Yes. PVC is referring to plastic pipe. Basically it’s a super light stick/rod. You can even use a broomstick.

  • Janice

    Under fitness suggestions while pregnant it says to do overhead squats and front squats with a PVC or barbell. I’ve been doing Crossfit for a year and a half and am pregnant now. So I have been lifting heavier. Is it not recommend to do more weight with those two movements? Will it make the separation worse?Also, my doctor told me if I continue to work my abs too much I will get a “pooch” after pregnancy that I can’t get rid of. What do you think about that?
    Thanks

    • Lindsay Mumma, DC

      Hi Janice,The recommendations are conservative, and the best advice we can give is to work with your coach and your doctor (even better if your doc is familiar with the work we’re doing here at BIRTHFIT – check to see if one of our affiliates is near you!). It’s completely individual. Some women are able to stabilize well and can lift heavy, but others struggle to maintain a neutral position when pregnant, and increasing weights can be problematic. There’s really no good answer without seeing your movements. BIRTHFIT also does remote coaching and individual consults if you’re not able to find someone close by who can help you navigate these movements safely.
      As far as your doctor’s rec, there’s no legit science behind that claim that we’ve ever found, but it is unfortunately spread around regularly. The pooch he’s referring to is a result of DRA, so if you’re smart about movements and even smarter about recovery postpartum, you can prevent or heal this.
      Hope this is at least somewhat helpful for you! We have some new DRA info coming to the BIRTHFIT blog soon, so stay tuned. Enjoy this time and congrats!

  • Tracy Horn

    Found you via Julie Foucher’s podcast with Lindsey Valenzuela. Couldn’t agree more that better SEO would serve you well as I have very actively been searching online for two months for Diastasis Recti recovery information to little avail. This post is the first thing I’ve found to be at all helpful–so thank you!! But know that even those looking for you may not be finding you. :( I coincidentally just found a great chiropractor who I started with this week who had many similar recommendations. If you program workouts specifically to help heal DR while also getting in good metcon work in, I’m all ears. I’m 18m postpartum with twins and wasn’t diagnosed with DR til 15m. Luckily I haven’t had as much time to workout as I would’ve liked so I didn’t do even more damage but pre diagnosis I was definitely doing all sorts of poor flexion exercises bc I had no idea I had DR. Knowledge is everything.

    • Lindsey Mathews

      Hi Tracy. THANK YOU so much for the good information. I’ve passed this along to my super awesome team here in Los Angeles. Where are you located? We have some free videos on YouTube- Functional Progression 2 would be really great for you. We are also working on a DIASTASIS RECTI three part video series that will be free and show the basics of what the heck is going on. You’re are so right- KNOWLEDGE is EVERYTHING! :)

  • Corrine Dimitruk

    Any recommendations for a chiropractor in the East Bay area/ just outside of San Francisco. I’m pregnant with no 3 and have done crossfit since 2008. Looking for someone for preventive care. thanks.

  • Chrissy

    I am 41 have a diastasis = had 3 kids… My concern is this, I did a lot of corrective work on my diastasis to the point of the fact that I cannot get a plastic surgeon to close it the remaining portion of the way….my concern is not looks…. It is function…..I have had issues with the inability to support my intestines, intestinal movement, fullness, and elimination of gases since I gave birth. None of the doctors I have seen seem to think that a diastasis could be the cause of my problems.. I believe that the connective tissue has been stretched / thinned to the point of the inability to compress the abdomen properly & apply proper support which compliments the function of digestion supporting and adding say a atmospheric pressure so gases do not expand out within the heated enclosed environment & are directed in the right direction down and out. I have had multiple tests = barium , X-rays , crohns, colitis, cat scans, nothing but the diastasis is there. Do you have any info about the complimenting functions of the abdominal wall creating homeostasis for the digestive system…please help…I believe the intra abdominal pressure is controlled by the abdominals keeping it in check as gases expand out from the chemical structures being broken down in a heated enclosed environment = gases expand = this expansion must be controlled….with a gap in the linea alba this leaves a weakness for the gases to gravitate to and try to escape out the front end = the closes weakness other wise it would go to the sphincters= the designed weakness for escape…do you have any thoughts on this matter…. My core is well trained could this be part of the problem = A trained body knowing the weakness is there & noticing the inability to function properly? Hence functional imbalances, digestive discomfort. I actually have to valsva (vomit ) out my gases, they try to come out the weakness right where the diastasis is = trapped = always pressure there . Any info ? no one has found anything wrong with me but diastasis & it has been 2 years that I have been to 5 plastic surgeons & 2 general surgeons & university care once = on my way for 2nd trip to the university for round 2 = exhaustion of tests = help please = info & any thoughts….thank you

    • Chrissy

      Sorry my email was wrong = foutchhouse@gmail.com

    • Lindsey Mathews

      Hi Chrissy. Thank you for taking the time to read the blog. I’d encourage you to Part 1, 2, and 3 of the blog series called Diastasis Rectus Abdominis- Filling the Gap. More useful information in there as well. Chrissy, I’d love to know where you are from or living right now. It sounds like you need to get in to see a DNS (Dynamic Neuromuscular Stabilization) practitioner ASAP. A well trained core is very vague statement to us. We usually like to examine the client for ourselves rather than take someone else’s suggestion. We offer phone consultations (under the EDUCATION tab) for those that cannot get in to see a DNS practitioner or living overseas or might just have limited resources. I’d encourage you to set up a consult with Dr. Erica (trained DNS practitioner, mother of 4, core and pelvic floor expert). Without hesitation, I know she could get you started in the right direction. Does that help?

  • Erin

    No PLANKS!!! This puts undue loading on the already fragile abdominal wall. NO PLANKS!

    • Lindsey Mathews

      Hi Erin. Thanks for your reply. Side planks, especially with a bottom knee down or modified in any way, are just fine. Regular planks, when done correctly with whole body engaged and glutes turned on are fine for a bit when doing things like a push up. Elevated push ups are a great option to still maintain the full shoulder range of motion as the belly grows. Now, if a woman feels pressure or discomfort or the DRA is aggravated/exaggerated then we stop the movement and go on to something else. Your comment is appreciated but it seems as if you assumed we don’t know what we are doing. We try to keep open communication and constant transparency with our clients both during pregnancy and the immediate postpartum, which we consider as the first 6-9 months. I’d encourage you to read Filling the Gap. This is a great insight as to how we work to rebuild the foundation in the postpartum period. Since your comment, I’ve edited the document for those like you that may not be familiar with our methodologies so they don’t go and do a thousand hours of planks:) Thank you again. Please let us know if you have any questions.

  • […] stretches trying to hold each pose for 30secs at a time, and also taking the abs I am doing, slowly. Here is a great article from BirthFit with a little more information on DRA. The stretches hurt so good but because of the […]

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  • Amanda

    I’m having a hard time finding much information on pubic symphysis. I’m not quite 2 weeks postpartum from my second vaginal delivery. I had absolutely no discomfort in pelvic girdle with first child. My second, I started to feel discomfort around 36 or 37 weeks. I was hoping it would go away after baby was born. What I’ve found was that it can take up to 8 months to heal. Is there anything i should be doing to make sure it’s healing properly, restrictions I should be taking, movements I can start too help with stabilization? Feeling lost

  • Taylor

    Thought you might be interested in this book by Katy Bowman. She’s a biomechanist and natural movement expert. In my opinion, she has a lot contribute to this conversation– mechanical causes, lifestyle, alignment…. https://www.amazon.com/gp/aw/d/098965396X/ref=mp_s_a_1_1?ie=UTF8&qid=1500822049&sr=8-1&pi=AC_SX236_SY340_QL65&keywords=diastasis&dpPl=1&dpID=51HYSZBxCXL&ref=plSrch

    • Lindsey Mathews

      Thank you Taylor. I’ve actually read that book. In full agreement about enhancing movement in your lifestyle.

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  • […] have to give them a break and time to heal. Ever heard of diastasis recti? It’s a nasty kick-you-when-you’re-down symptom of pregnancy that two out of three […]

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