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