What is Diastasis Recti or DR? Simply put, it is stretching (not a separation) of the linea alba between the rectus abdominus muscles, 2-3 finger widths or more apart.
|Illustration of Diastasis Recti|
What is a normal width? The linea alba in a normal adult is about 1/2 to 1 finger width, although this can vary a little. The linea alba is also normally tight instead of lax.
So can my diastasis close all the way?
Possibly and….it probably will get close enough to not need surgery.
While I specifically help women strengthen their core after pregnancy and work with many that have diastasis recti, this really shouldn't be the ultimate goal. Why? Because there are many other factors and variables to healing and measuring diastasis recti. While some can "close it," some will not and do not need to. Yes, it is true.
DIASTASIS RECTI does not have to close all the way to restore core strength, stability and function.
So this means I don't need to address my DR, I can just do any core exercise? No, it means we need to stop obsessing over getting it closed ALL the way and focus on restoring core function, strength and stability. Waiting for it to heal naturally, meaning do nothing, is very slow, risky and unproductive. Research has shown that being proactive makes a difference in tissue response.
Research by Diane Lee has demonstrated that core function can be restored without a separation closing all the way. I have also seen this with some of my clients over the last 5 years and I have experienced it myself. DR may not close completely, but with progressive core exercise it can improve and "close" when the core engages. I along with many of my clients can perform any core exercise safely without risk of the linea alba stretching out further. From my experience, most women can get it to a 2 or less with proper exercise progression and splinting. No one knows how your connective tissue will respond. Give your tissue the best chance possible to heal. Muscle, tissue, breathing, alignment, genetics and hormones are all involved in the process. Muscles coordination can improve, strengthen and engage properly to help protect or improve any laxity in the linea alba.
IDEAL HEALING ENVIRONMENT
1-Gradual progressive inner/outer core exercises
2-Splinting (recommended if within 3 months post-partum or have a separation 2 fingerwidths or more)
4-Avoiding contraindicated exercise (temporarily)
Gradual progressive core exercise is key. Building inner and outer core coordination and strength progressively is important in order to help increase blood flow, strengthen fibers and load the tissue. Too many moms are just doing basic transverse abdominal (TVA) exercises over and over and while it is helpful, it isn't enough to stimulate change in muscle or tissue length and strength. So while they see some improvement, they don't restrengthen the core enough to engage well during exercise, putting them at risk for DR to return. Many also jump from basic TVA exercises to difficult core exercises such as plank variations or full push-ups before the core is strong enough to handle that exercise resulting in poor form or risk of further separation. Gradual strength progression is key.
Timing - Connective tissue has a remodeling phase and while this can last from one month or many months, it begins within a few weeks post pregnancy. While pregnancy is different than a quick onset injury, it is still somewhat similar. Tissue is trying to remodel whether the separation is minimal or large. Regardless of a degree of separation, the linea alba is vulnerable and weak postpartum. Yes, hormones from pregnancy and breastfeeding are present postpartum, but it doesn't mean strengthening can't happen. This is the time to restore core coordination and strength before returning to more vigorous exercise.
Splinting - While I do not require my clients to splint, splinting does help speed the healing process. I do recommend it for my post-natal clients (within 3 months) regardless of separation. It can help align, protect, support and load the tissue. *Splinting for up to 4-6 weeks is recommended while doing progressive core exercises. Most can get it their separation to a 2 or below in that time, stop splinting, and continue strengthen their core and move on to more challenging core exercises.
*Not all splints or binders are created equal and yes, some are harmful (corsets)
Sometimes the tissue doesn't actually tighten, but the muscles learn to engage well, making a separation appear"smaller". This isn't a bad thing! Core activation, coordination and strength can improve and minimize a separation temporarily the when core is engaged. This protects the core when more difficult exercises are performed.
So I don't have to have exercise restrictions the rest of my life? Right! As long as you can first:
1) minimize abdominal separation
2) re-establish core coordination
3) engage core well
4) improve core strength gradually
4) maintain proper form
YES! The majority of moms that recondition their core properly even with some abdominal separation can move on to other core exercises safely. I know there are some cases that need surgery, but I have yet to work with a client that could not move on to more challenging exercises or that needed surgery to restore function.
Is it too late? No, it really isn't ever too late to reconditioning the core. While there are ideal times for proper healing, strengthening can still take place with the connective tissue when given the right environment. Muscle will respond the fastest and help engage and protect the tissue. Tissue may respond slower, but it just may respond.
It's not all about DR postpartum. While DR seems to be the big weakness issue, it really is only one of several postpartum. These other weakness issues are just as important.
Instead of making your goal to close it ALL the way, give it your best shot, but realize that the finger width isn't the most important data. Make the goal to restore core activation, coordination, strength, stability and function so you can regain your life and move on to your favorite sports or exercise. While a diagnosis of DR is scary at first, it doesn't have to be once it is understood.
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Celeste Goodson is an ACE Advanced Health and Fitness Specialist, Pre/ Post Natal Trainer, certified to train those with musculoskeletal, neuromuscular and metabolic conditions. Celeste has a B.S. in Fitness and Wellness and has worked in physical therapy, cardiac rehab, and numerous fitness settings for over 15 years, exclusively training post natal women for the last 5 years. Celeste has designed the ReCORE Program™ and the Maternity and Post-Natal FITsplint™ to help moms strengthen, support and splint the core during and after pregnancy for a more effective recovery. Celeste enjoys running, being outdoors with the family.
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