Diastasis Recti is Bad@$$: II - First Steps
Updated: Mar 6, 2021
The name “Diastasis Recti” is a bit of a misnomer which has led to a bit of the hysteria around it. The added media attention to DR, pelvic floor health, and the impact of hormonal fluctuations on our tissues has all been VERY valuable. However, we may have accidentally overshot the severity. (Not the importance - this stuff is important - but I’ll explain that more in the next article.) Whether it’s clickbait culture or a love for drama or the unconscious reiteration of female delicacy… I don’t know.
Diastasis means ‘separation’ which makes people think tears or holes which isn’t the case here. In DR, the two sides of the rectus abdominis (6-pack muscle) move farther away from each other and the fascia that connects them (linea alba) thins and stretches in order to make room for baby. This is a very good thing.
Most (if not all) women have some degree of DR by 9 months pregnant.
A lot of cases heal/firm up by 6 months.
…And even more cases by a year.
Hormones (postpartum and breastfeeding) and delivery method are variables to consider during DR recovery as well as personal genetics and movement habits.
Although width is/was the most commonly used assessment guide, the width of DR isn’t as significant a marker for function and recovery as the depth and “springiness” of your midline. The goal is to have the midline rebound like a trampoline when you press down on it with your fingers. What this springiness signals is that the fascia is able to effectively transfer load. That is just a fancy way to say that your linea alba is able to provide support down the front of your body in response to movement and regular old life.
NERDY NOTE - There are 2 classifications of Diastasis Recti:
a. Functional DR - this is the most common form of DR
It means muscles and connections are still firing and conversing with each other. We can heal with attention to breathing mechanics, physiotherapy, pressure management and movement.
b. Non-Functional DR - MUCH rarer
This one may require surgery.
Think about your core (abs, back, diaphragm, pelvic floor, fascia) as a team of basketball players playing zone defence. If one player gets picked or tripped, the other players need to step up and step in. In the core game, what if the player that gets tripped (i.e. becomes thinner and stretched out) is your linea alba? Sometimes, this is no big deal to our core and overall movement quality and life just merrily goes along. Sometimes this can lead to symptoms we’d rather not live with.
With DR, there are tons of little, everyday things we can do to support our healing *while* living our life, rolling out of bed, picking up our kids and strolling around town. In time, and in some cases, with ongoing postpartum physio and coaching, we can get back to the activities we love even in cases with significant DR. Our bodies are resilient.
❤️Tell your dear friend: 1. You just had a baby 💪. You’re a rockstar. Congratulations. 2. Good for you to be checking in on your own recovery. Wonderful initiative👏. 3. DR is completely normal (and helpful) and can heal up considerably with time. 4. If you’re like me and thinking, “That’s great but how can I begin my healing process now…?”:
A. Book an appointment with a pelvic floor physiotherapist. This is my #1 recommendation for ALL postpartum mamas. Check local mama groups for recommendations. You’ll want a PF physio that focuses on your whole core and body. Not your DR or pelvic floor in isolation. B. The only “avoid”s I’d say early in postpartum is repetitive, abs-focused exercises and impact exercise (jumping).
(And, yes, I'm cringing a bit even using the word 'avoid'.) Although no movement is inherently bad, I’d want to check on pelvic floor, breathing tendencies, postural habits, etc. first. These exercises (crunches, sit-ups, planks) may exacerbate DR and pelvic floor issues during healing because of the way they are often performed. The higher impact exercises (running, skipping rope) may exacerbate or create future concerns because ... The higher impact exercises (running, skipping rope) may exacerbate or create future concerns because, even if we feel up for running in our heads, our bodies have a lot of healing to do on the inside and our body has a lot to do - hormonally and structurally - after we give birth.
C. If you’re feeling up for it, take a stroller or stroller-free stroll.
Start with 5 - 10 minutes at a time. Your walk should be described as easy, chill and “Ahhhh….I Forgot How Good Fresh Air Feeeeeels On My Faaace”. Walking as a movement pattern (fancy phrase for “exercise”) is highly underrated in my books. However, if you feel significant downward pressure on your pelvic floor, experience incontinence, or anything that just doesn’t feel right to you, use that as a guide to stop for now.