How to fix Diastasis Recti 

The separation of abdominal muscles (Diastasis Recti) has become a better-known postnatal condition thanks to maternal health advocates, who have raised awareness about it in recent years. Information about it is now available, and women are becoming aware of this condition and seeking help.

The situation was different when I had two babies in a row a decade ago. It took me a year and a half to understand what caused my body's discomfort and functional problems. Finally, after researching my symptoms, I learnt that I was suffering from Diastasis Recti, a condition I had never heard of and no one had told me about.

At that time, I ran a small fitness studio, and many of my clients were new moms. When I learned more about postpartum rehabilitation and started talking about it, I noticed that many women were hungry to learn more. When my article about Diastasis recti was published in a local newspaper, I started to get more requests. 

Separated abdominal muscles - Diastasis Recti

After my second childbirth, I felt that something had happened in my abdominal muscles and the core. I had to re-learn many of the exercises I was used to doing before my pregnancies. I also had to re-establish my balance and coordination. I found lunges, in particular, very challenging at the beginning.

To my surprise, the doctor and the maternity nurse did not seem to know much about postpartum exercise. I was told I could keep working out as before, as everything was in order in the postpartum checkup. No one tested the recovery of my abdominal muscles, however. I later learned that returning to vigorous training too soon and doing the wrong exercises can do more harm than good and even prevent the healing of the Diastasis Recti.

One-third to two-thirds of new mums suffer from Diastasis Recti, but it is still a relatively under-researched condition, like many women's health issues. Risk factors include multiple pregnancies in a row, being pregnant with more than one baby, and being over 34. Obesity and lack of exercise also increase the risk, even among men. 

Training the deep abdominal muscles before and during pregnancy reduces the risk of muscle separation; however, rigorous exercise too soon after childbirth can worsen the condition. 

The physiology of Diastasis Recti 

During pregnancy, deep abdominal muscles, the entire peritoneum, and the white line (linea alba in Latin) stretch as the belly grows. At the same time, direct abdominal muscles are pushed apart to the sides of the belly, and the white line between them widens.

Commonly, the rectus abdominis (known as the "six-pack") muscles fail to restore after childbirth, i.e., space remains between the muscles, activation of deep abdominal muscles is reduced, and muscle tension is low. This condition is the separation of abdominal muscles, Diastasis Recti.

How to test the abdominal muscles for separation?

Here's how you can check the condition of your abdominal muscles:

Lie on your back. Bend your knees and relax your abdominal muscles.

Lift your head and shoulder blades from the floor. Feel your belly above and below the navel between the abdominal muscles with your fingers.

Test how deep you can insert your fingers and how wide this gap is. In a normal situation, no gap or gap of a maximum of two centimetres exists.

However, no exact centimetres are usually defined in the diagnosis of Diastasis Recti. What matters more than the gap between the muscles is the elasticity of the midline between the muscles (linea alba). If the midline between the rectus abdominis feels soft, rehabilitating exercises are needed.

Postnatal training of abdominal muscles

Many of my clients suffer from separated abdominal muscles. Personal trainers typically know very little about Diastasis Recti unless they are specialized in maternal health and postpartum rehabilitation or have a personal interest in it. Women who suspect they suffer from Diastasis Recti should find a well-informed trainer to supervise their training.

The condition of the abdominal muscles should be examined before restarting the workout regime and progressing to more challenging exercises. Do the test above to ensure the separation does not worsen when doing the exercises.

Using less than half of your full strength in exercises that increase muscle strength would be best. Crunches, forceful rotating exercises, and sit-ups should be avoided initially. 

Exercises to fix Diastasis Recti

The deep and outer abdominal muscles (i.e. "six-pack") should be trained differently. The aim is to focus and activate the muscles instead of straining them to extremes. The exercises below are a safe way to start if the postpartum checkup gives you the OK to start working out.

When your muscles have become used to exercising, and you feel they need to get challenged more, you can replace exercise 1 with its variation (2). Start by doing the exercises three times a week. After a month or two, you can increase the number to five times a week if you wish - however, remember to have a few days off every week.

 1. Deep abdominal muscles – Activation while sitting down

Breathe in. Start the activation from the pelvic floor muscles while breathing out and pull the navel slightly. You can also compress the sides somewhat towards the centre line of the belly. Hold for 4-6 seconds, breathe in, and relax. Rest for 2-3 seconds and repeat.

Do two rounds of 8 repetitions.

Exercise 1, variation 2: Sit on a chair with the soles of your feet on the floor, start activation from the pelvic floor muscles, and pull the navel in slightly. You can also compress the sides slightly inwards—keeping a neutral spine curve and good posture. Breathe in and tighten the contraction of the belly slightly when breathing out and lift one heel off the floor. Return the heel to the floor when breathing, in and relax the belly muscles slightly.

2. Deep abdominal muscles – Activation while lying on your belly

Start the activation from the pelvic floor muscles and lift your stomach from the floor.

Imagine a tunnel between your belly and the floor (it does not matter if you cannot lift your stomach from the floor). Hold you, you're back and gluteal muscles relaxed. Concentrate on the movement carefully and hold for 10-15 seconds. Rest and repeat three times.

3. Deep abdominal muscles – Balancing on one foot

Stand up and ensure you have a neutral spine curve and good posture.

Breathe in. Start the activation from the pelvic floor muscles when you breathe out and pull the navel slightly. Lift one foot and hold your balance for a few seconds. Relax as you breathe in, and repeat on the other side. Do the exercise slowly and keep control of your core all the time.

Repeat five times on both sides. 

Fixing the separation of abdominal muscles with exercise

The point of training the abdominal muscles is not to get back to the pre-pregnancy weight. Don´t worry about protruding belly unless this causes severe back problems. One common cause of lower back pain is the reduced activation of deep abdominal muscles.

The principal task of the abdominal muscles is to maintain the support provided by the core. If your core is weak, the risk of back problems, urinary and bowel incontinence, and uterine or vaginal prolapse increases. Abdominal muscles also keep internal organs in their correct places. Even if these matters do not seem topical, they may become topical in the future. For this reason, it is essential to maintain good muscular strength. However, it is always possible to enhance the condition of abdominal muscles and the entire body; therefore, it is never too late to start exercising.

Happy training!