“Mommy tummy” isn’t a flattering term to describe the physique of new mothers and it hasn’t gained the positive mentality of the “Dad Bod.” It’s no secret that many mothers have difficulty regaining their pre-pregnancy figure. Although there are many barriers to performing mommy tummy postpartum exercises and eating right, there may be one major reason, that you’ve never heard of, and that no matter what you do your abs just won’t tighten up the way they were. This silent assassin is Diastasis Recti.
A diastasis of the rectus abdominis muscle (DRAM) occurs often during or immediately after pregnancy. It is a tearing of the abdominal muscles along the center tissue that holds the two sides together, the linea alba. It has been related to poor abdominal strength and muscle recruitment in addition to lumbopelvic instability and pelvic floor weakness. Aesthetically, it gives the appearance of what we call “Mommy Tummy.” Nearly all pregnant women experience DRAM during the third trimester of pregnancy, and almost half of women postpartum may have developed DRAM from the stresses of delivery.
The severity of DRAM is measured by the distance between the two sides of the abdominal (rectus) muscles, it is referred to as the inter-rectus distance (IRD). It is caused by the stretching and thinning of the linea alba and abdominal sheaths, which happens due to hormonal elastic changes of the connective tissue during pregnancy. This, in addition to the mechanical stresses put on the abdominal wall by the expanding uterus and displacement of the abdominal organs, causes mechanical failure, leading to the separation of the muscles of the abdominals along the linea alba.
The linea alba is a fibrous structure, composed of an extremely structured meshwork of collagen fibers which, in conjunction with the rectus sheaths are regarded as the most important structures for the stability of the anterior abdominal wall. These collagen fibers form the connections (aponeuroses) of the deeper abdominal muscles, which include the external and internal obliques and the transversus abdominus (TA) muscle. The TA muscle is the deepest layer of the abdominal musculature and has extensive aponeuroses that attach horizontally to the linea alba, originating from the thoracolumbar fascia and wrapping around the trunk. This muscle acts as a natural corset supporting the viscera of the abdomen. Research shows that activation of the TA muscle can stabilize the ribs, linea alba and thoracolumbar fascia. When engaged, it shortens the rectus abdominus muscles which converge on the linea alba. Tightening this muscle is typically an ideal core strengthening exercise, however, with the existence of DRAM, this and other typical abdominal exercises may cause the distance to widen due to tensile strain on weaker structures. Modifications, however, can be made as part of a comprehensive postpartum exercise plan to correct this fault, specifically, approximation.
Approximation is a simple technique used to facilitate bringing the two rectus muscles together during an exercise. It can be done by crossing the arms over the level of the diastasis and gently pulling each side of the abdomen together during the contraction portion of a movement. Another method that accomplishes the same feat, is to cross a sheet over the level of the diastasis and pull the two ends to tighten over the abdomen during the exercise. As a diastasis can occur at varied locations along the linea alba, it is important to apply the approximation accurately.
DRAM may occur at any of three areas: at, above, or below the level of the umbilicus (the belly button). There is a range of normal with this condition, but many agree that a measurement of the IRD greater than 1 inch of separation at one or more points along the linea alba is considered pathological. This occurs in 30-70% of all pregnant women and persists in 35-60% of women postpartum, often leading to low back and pelvic floor pain. As the abdominal wall plays an important role in the function and support of posture, respiration, trunk movement and lumbo-pelvic stability, it is not surprising that mechanical failures related to DRAM are largely due to the presence of abdominal weakness.
Postpartum Low Back Pain
Abdominal weakness causes an imbalance in the musculoskeletal structure of the trunk leading to compensatory muscular overuse and resulting postural faults. This leads to increased tension on the muscles, joints and ligaments of the spine, causing microtrauma and pain. Low back pain is a common complaint during pregnancy and the most common cause for sick leave after delivery. Research shows a correlation between the presence of DRAM and low back pain due to weakened abdominals and decreased trunk support. 10% of pregnant women report severe lumbo-pelvic pain that interferes with daily activities and about 4 in10 women claim persistent lumbo-pelvic pain 6 months after delivery. Studies have found that women who exercised before pregnancy have a decreased presence of DRAM and effective exercise recovery programs have been shown to decrease the IRD of an existing DRAM and consequent back pain postpartum. Therefore, even if it was difficult to stay active during pregnancy, it is not too late to make a difference and improve your quality of life and start a postpartum exercise plan.
The importance of core strengthening in fitness is undisputed, but the presence of DRAM can compromise its function. Thankfully there are targeted diastasis recti exercises to help. Strong trunk musculature is the foundation of good posture, breathing and balance. Core stability is related to the balance of strength among the abdominal, back and pelvic muscle groups. This equilibrium is disrupted by the presence of DRAM, as the muscles aren’t able to translate force adequately through the tensile fibers, causing mechanical failure in the form of greater widening of the IRD and overworking of postural muscles in the spine. Generally it is advised to avoid exercises that could force a greater tensile strain on the linea alba, such as sit ups, abdominal twists or straight leg raises, which can widen the IRD, however, with the added support provided by approximation , as described above, these diastasis recti exercises are safe to perform and allow for gradual progression of strengthening exercises as the diastasis closes. A postpartum exercise plan that incorporates such methods throughout can be very effective.
Here are a couple of diastasis recti exercises from our postpartum exercise plan.
Pelvic Tilt with Head Lift
Start in hooklying position with approximation technique. Exhale as you lift your head off the floor and stop just before a bulge appears at which time you should gently approximate the rectus muscles toward midline, then slowly lower your head slowly to relax. 2x15reps
Approximation Technique: wrap a folded sheet around the abdomen and cross the sheet at the level of the diastasis. During exertion, pull the opposite ends of the sheet to cinch the abdominal muscles together.
Assume posterior tilt with TA brace in quadruped position. Extend one leg backward slowly to about the height of the pelvis, then return to starting position. 3x10reps, each side.
Click here for the complete Postpartum Exercise Plan!
Copyright © 2018 TherRex Innovations LLC. All Rights Reserved.
TherRex™ is your trusted source for the best researched and most accurate fitness and rehab information on the internet.
Acharry N, Kutty RK. Abdominal exercise with bracing, a therapeutic efficacy in reducing diastasis-recti among postpartal females. Int J Physiother Res. 2015; 3(2):999-05. doi: 10.16965/ijpr.2015.122
Benjamin DR, van de Water ATM, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014; 100(1): 1-8.
Brown AM, Robinson A, Jones F, Smith A, Williams P, Hanley J. The effectiveness of prescription exercises for women diagnosed with postnatal depression: a systematic review. MIDIRS Midwifery Digest.2017; 27(4): 488-495.
Huge, B.S. Women’s Health: Obstetrics and Pelvic Floor. In: Kisner, C., Colby, L.A. Therapeutic Exercise: Foundations and Techniques. 5th ed. Philadelphia, PA: F. A. Davis Company; 2007.
Katonis P, Kampouroglou A, Aggelopoulos A, Kakavelakis K, Lykoudis S, Makrigiannakis A, Alpantaki K. Pregnancy- related low back pain. Hippokratia. 2011; 15(3):205-210.
Litos K. Progressive Therapeutic Exercise Program for Successful Treatment of a Postpartum Woman With a Severe Diastasis Recti Abdominis. Journal Of Women’s Health Physical Therapy. 2014; 38(2): 58-73. doi:10.1097/JWH. 0000000000000013.
Mahalakshumi V, Sumathi G, Chitra TV, Ramamoorthy V. Effect of exercise on diastisi recti abdominis among the primiparous women: a quasi-experimental study. Int J Reprod Contracept Obstet Gynecol. 2016; 5(12):4441-4446.
Mota P, Pascoal AG, Bo K. Diastasis Recti Abdominis in Pregnancy and Postpartum Period. Risk Factors, Functional Implications and Resolution. Current Women’s Health Reviews. 2015; 11(1): 59-67.
Mota P, Pascoal AG, Caria AI, Bo K. The Immediate Effects on the Inter-Rectus Distance of Abdominal Crunch and Drawing in Exercises During Pregnancy and the Postpartum Period. JOSPT. 2015; 45(10):
Reilly ETC, Freeman RM, Waterfield MR, Waterfield AE, Steggles P, Pedlar F. Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomized controlled trial of antenatal pelvic floor exercises. BJOG. 2002; 109(1): 68-76.