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Diastasis Recti: A Guide for Fit Pros

As a fit pro working with pregnant or postpartum clients 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 people 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 mitigate, or exacerbate, Diastasis Recti. We want to make sure you are doing the former, so let’s discuss.

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.

In the left image below, you can see that 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 you can see in the right image. 

It is important to note that some degree of diastasis recti is a normal and natural part of pregnancy. It is necessary to allow adequate space for the baby to grow, especially during the third trimester. In fact, some studies show that 100% of pregnant people experience diastasis recti during the 3rd trimester (Sptiznagle et. al., 2007). If managed well, DR can heal within the weeks or months following delivery.

Additional Factors that Contribute to DR

As we discussed, DR is caused by chronically elevated IAP. One completely normal and necessary cause of chronically elevated IAP is a growing belly during pregnancy. The body is designed to do this.

However, there are other factors that can also elevate IAP. So, when combined with a growing belly, these factors could exacerbate DR. These factors also explain why DR is not just a pre & postnatal issue. 

  • Breath-Holding Upon Exertion: This technique, known as the Valsalva maneuver, is often used when lifting heavy loads. Holding your breath during the concentric phase of a movement spikes the pressure within the core. This results in greater force production. However, it has the side effect of placing excessive pressure onto the abdominal wall (and therefore potentially worsening DR). This is why DR is often experienced by powerlifters and athletes. Another example of breath-holding upon exertion is “bearing down” on the toilet during a difficult bowel movement. While this can be an effective strategy if constipated, if used consistently over time, it can lead to issues with DR.

  • Insufficient deep core strength: The deep core muscles of the “Core Canister” (diaphragm, transverse abdominis, and pelvic floor) are responsible for regulating IAP. If these muscles are weak, or overwhelmed from the stresses of pregnancy, they cannot regulate pressure as well. We don’t often focus on the Core Canister muscles in traditional fitness, but these muscles form the foundation of a strong and functional core. To learn the first step to activating these muscles properly, see our post on The First Move to Teach Your Clients.

  • Pregnancy Alignment Shifts: Being in Neutral Alignment is key to reducing stress on the soft tissues in the body — including the linea alba tissue that connects the left and right sides of the rectus abdominis muscle. Unfortunately, the physical changes of pregnancy tend to pull the body out of neutral alignment. One key change is that the growing belly tends to tip the pelvis forward into an anterior pelvic tilt — as you can see in the image below — resulting in some degree of lumbar lordosis. This alignment stretches and lengthens the linea alba tissue even more, thereby weakening it.

  • Traditional core work done with a larger belly, or too early postpartum: Pregnancy and early postpartum are periods in which the deep core is being taxed from the chronically-elevated IAP due to months of increasing weight gain and the stress from labor. During the later stages of pregnancy (when there is an obvious belly), and in the initial postpartum stages (in which the core needs a gentle recovery focus), engaging in many traditional core exercises – such as sit-ups, bicycles, side bending, leg lifts, v-sits, and full planks – could exacerbate DR because they
    further elevate IAP. For detailed guidance on movements to avoid, or regress, as pregnancy progresses see our guide on Movements to Avoid by Trimester. 

How to Spot DR & What to Do

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 you can see in the images below. This “coning” is the abdominal contents protruding through the weak point in the linea alba.

If you ever see this in any client (male, female, young or old), it is a sign that the movement is not appropriate for that individual’s body at this time. Encourage the individual to stop the movement and regress until you no longer see the coning. Seeing this protrusion is no need to panic. Nor is it an indicator that the movement is “banned for life.” It simply means that the current challenge exceeds the capacity of the core muscles at this time.

Diastasis Recti Assessment

You can also check yourself, or a client for DR. While the DR test is an imperfect one, you can learn how to perform the assessment in a manner that improves your testing accuracy in this post on How to Check Your Client for DR

Get the Complete Guide

For more details on DR — including tips for mitigating it during pregnancy, detailed assessment instructions, and how to kickstart healing in the most effective way, check out our Guide to Diastasis Recti

Source:

Spitznagle, T. M., Leong, F. C., & Van Dillen, L. R. (2007). Prevalence of diastasis recti abdominis in a urogynecological patient population. International urogynecology journal, 18(3), 321-328.