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Diastasis Recti: A Guide for Fit Pros

As a fit pro working with pregnant or postpartum women in any capacity — whether you coach them one-on-one or they attend your group fitness classes — Diastasis Recti (abdominal separation) will be one of the hottest topics you deal with. It’s hot because of the degree of interest (or more accurately panic) so many women have about this condition, but also because of the degree of influence you can have on the extent to which your clients experience it. As a fitness professional, the actions you take with your clients can either help mitigate, or exacerbate, Diastasis Recti. We want to make sure you are doing the former, so let’s discuss how to do that.

To Start, Three Letters You Need to Know: I.A.P

In short, Diastasis Recti (DR) is a “pressure problem” caused by a buildup of excess intra-abdominal pressure (IAP). IAP is the amount of pressure in the abdominal cavity at any given time. IAP alone is not a bad thing. On the contrary, a certain amount of pressure in the abdomen is needed so that the core can assist in accelerating, decelerating, or stabilizing any movement. Trunk stiffness is key to successfully achieving almost all activities — both during high-performance and everyday activities like carrying grocery bags, lifting a child, or pushing a stroller.

However, issues arise when there is a buildup of IAP over time. This is exactly what happens during pregnancy. IAP changes based on the volume of the abdominal cavity and the contents within it. Therefore, a growing belly during pregnancy leads to chronically elevated IAP. Let’s look at how this increase in IAP impacts the abdominal musculature.

As you can see in the image on the left above, all the abdominal muscle layers (transverse abdominis, internal and external obliques, and rectus abdominis) – are connected at the front of the body by a tissue called the linea alba.  The linea alba is fascia. It’s strong, but flexible. The increase in IAP during pregnancy leads to an extreme stretching of the linea alba tissue. When this happens, the outermost muscle layer – rectus abdominis – begins to drift apart, as in the image on the right.

You may have gathered this, but let’s make one thing clear. A certain amount of diastasis recti is a normal and natural part of pregnancy. Some abdominal separation is necessary to allow baby room to grow. In fact, some studies show that 100% of women will experience diastasis recti during their 3rd trimesters. This natural bit of DR can be healed in the postpartum period, especially with proper recovery work, so it is certainly no reason to panic (please reassure your clients of this).

HOWEVER…

If a woman engages in activities or behaviors that further elevate IAP — beyond that caused by the growing belly — that is when DR becomes more of an issue in the postpartum period.  If not corrected, DR can lead to a host of problems. Beyond the annoying “pooch-like” appearance it creates in the belly, it can lead to low back pain, pelvic or hip pain, incontinence, constipation, or prolapse. It can also increases the risk of developing a hernia (when internal contents actually protrudes through a weak point in the abdominal cavity).  This is why proper “IAP management” is such an important part of your role as a fitness professional in working with these women — either as a personal trainer or group instructor.

Keys to Mitigating DR: “IAP Management”

Utilize the following tips to help mitigate issues with DR and/or support healing:

  • Correct her alignment: Getting your client into neutral alignment is the first thing you should address because movement patterns throughout the day add up BIG TIME. As one example, look at the image of the woman below in extreme lumbar lordosis (a common pregnancy alignment shift). Note how much added pressure she is putting on her abdominal wall (not to mention her lower back and pelvic floor) by standing in poor alignment.

  • Teach her 360˚ Breathing: The importance of this cannot be emphasized enough. One more reason we refer to 360˚ Breathing as the #1 most effective core exercise is because this style of breathing gets the “Core Canister” to work together in harmony as a pump to regulate intra-abdominal pressure. The more she becomes a 360˚ Breather, the better she will be able to manage her IAP.
  • Stop bad “belly slimming” strategies: There are two behaviors women tend to do in attempt to make their bellies smaller (or at least look smaller): sucking in and chronically engaging their core. Ironically, these two behaviors actually increase IAP and can therefore have the opposite effect.Watch this video to understand and help your clients STOP these behaviors.
  • Avoid improper core work: While a focus on deep core training is incredibly important during and after pregnancy, traditional core moves that target more of the outer core muscles should be avoided once a woman develops a belly (and in the early postpartum period) because they elevate IAP and place too much stress on the linea alba tissue. This includes movements involving spinal flexion, spinal extension, lateral flexion, and rotation with disassociation of hips and shoulders. Planks and plank-like movements should also be regressed, and eventually avoided, as they also increase IAP too much. We discuss the movements to avoid in much more detail in our Pre/Postnatal Performance Training Specialist Course as well as our Group Instructor Mini Course — giving you specific guidance by trimester, rationale, and movement examples.
  • Avoid breath-holding upon exertion: Breath-holding during the exertion phase of a movement (or the “valsalva” technique) spikes intra-abdominal pressure, which DOES allow for greater force production and, therefore, the ability to lift heavier loads. This is the reason the valsalva technique is commonly used when individuals are trying to lift max loads. However, it has the side effect of increasing pressure on the abdominal wall and pelvic floor. Hence the reason DR and pelvic floor dysfunction are common among powerlifters, as shown in the image below (that’s right…DR is NOT a pre/postnatal issue exclusively. It is a “pressure problem” that can happen to men and women alike). Since your pre and postnatal clients are not trying to lift max loads, ensure they are exhaling on the effort in all of their movements, and avoiding any breath-holding (this includes avoiding “bearing down” on the toilet as well).

Spotting Diastasis Recti

Many times you can spot DR (even during pregnancy) by watching for a vertical “torpedo-like” protrusion down the center of the abdomen during any movement that engages the abdominal muscles, as shown in the images below.

In the images above, you are seeing the abdominal contents protrude through the separation. If you ever see this in any client (man, woman, young or old), it is a sign that the movement the individual is doing is not appropriate for his or her body. It is creating too much intra-abdominal pressure. Encourage the individual to stop the movement and find an appropriate regression where you no longer see the protrusion.

Assessing for Diastasis Recti

You can also check yourself, or a client for DR. While the technical definition of Diastasis Recti is a separation of 2.7 cm (approximately 2 finger-widths) or greater, there is actually much more to this to get a true sense of your client’s DR severity.  For more information, read this post on How to Check Your Client for DR. 

Want More Information?

For more in-depth information on DR, explore our Pre/Postnatal Performance Training Specialist Course. You’ll learn prenatal training principles and beneficial core exercises to mitigate issues with DR and set your clients up for a faster recovery. You’ll also learn a detailed Core Recovery Protocol to take all your postpartum clients through to heal DR and effectively rebuild the core after pregnancy. If you are a Group Fitness Instructor, our Group Instructor Mini Course contains valuable information on how you can help your pre and postnatal participants manage their IAP levels in a group fitness setting. Many of these tips will benefit your entire class, so it’s a win/win for everyone!