How do you heal diastasis recti?

In this blog post I’m going to go through all the things you need to do to address your DR.

We are going to talk about exercises that focus on the abdominal muscles as they are absolutely an important part of rehabilitation.

HOWEVER, they are not the ONLY part of rehab.

So we’re going to start with a couple of things that you might not have thought of and THEN we will talk about ab exercises - (part 3, if you want to skip to it).

THE BREATH

The first thing you should address is your breathing mechanics - I know, I know, you think it’s mega boring and CBA* - just get to the core exercises! But breathing is the first function of the core (think, your baby can do this, but can’t yet hold itself up). I have met a lot of women with a stubborn DR, and when we improve their breathing mechanics, it suddenly gets a lot better.

* CBA = British slang for can’t be arsed

I won’t bore you with a full spiel on breathing, but here are a few things you should be looking for.

• Chest breathing - lots of women breath up into their chests, and not down into their belly and pelvic floor. This means those muscles aren’t going through a gentle stretch-contract cycle, which is important for their proper function

• Holding your tummy in all the time - if you are trying to suck your tummy in ALL the time, you can’t breath into it.

• Overactive diaphragm - some women bear down unnecessarily with their diaphragm in order to exhale or create stability - this creates a lot of pressure down on the lower belly (and pelvic floor) which can cause these muscles to bulge. These women need to learn to relax their diaphragms.

If you would like to know more about breathing, you can watch this video.

If you are a total geek (like me) and would STILL like to know MORE - please let me know and I will create more content on breathing (it just doesn’t seem to interest most people)

ALIGNMENT

You just need to stand up straight right?

Well, yeah, but most women, when they try to do this just thrust their chest up into the air, like this:

This is called a “military stance” and isn’t really ideal either. Sucking your tummy in hard and thrusting your rib cage up isn’t an ideal strategy.

The posture habit that I most see with mums is a tucked bum, and the rib cage translated backwards, like this:

Notice how the upper back lines up with the bum. This tends to jutt the hips forward - the bum goes flat and the belly sticks out.

I drew a picture of it, to help you visualize it better. Notice how in the drawing on the right, the plumb line from the upper back is behind the bum. On the left drawing, head, rib cage, pelvis and feet all line up.

There also tends to be a lot of internal rotation of the shoulders and the chest muscles get really tight, and the upper back muscles get weak (which we can stretch with mobility work and strengthen with strength training respectively).

And it’s not a surprise that women get stuck like this, because it’s really common in pregnancy to stand like this:

And then when you’ve got a newborn to stand like this:

While it's ok to hold your baby like this (it's very hard not to!) it is important that we get into better alignment when we can, which means that the diaphragm (bottom of the rib cage) lines up with the pelvic floor. It doesn’t have to be perfect all the time, but recognizing and getting into better alignment is the first step. Then we need to use strength training to strengthen the bits that are going to help you get and stay there.

CORE EXERCISES

Ok, so now we’re on to the bit that you really want to know… “what core exercises should I do?”

So I often get asked “can you give me a few exercises to get rid of my pouch”, and there are plenty of videos and articles on the internet that proclaim “3 exercises to get rid of your mummy tummy NOW!”.

It’s not quite as simple as this, if it were, no-one would be asking this question. There simply are not 3 exercises that help EVERYONE. A diastasis looks and functions differently from person to person. It might be higher up or lower down. The severity might be different - it might be deeper or wider. One woman may be able to engage her core better than another. One might bulge when she does a crunch, but not when she does a plank; another bulges when she leans back but can perform a crunch no problem - so we need to see how each woman performs in different exercises and movements.

Then we need to figure out how we can CHALLENGE those muscles (and connective tissue) in various movements, but not OVERWHELM them. If the movement or exercise is too difficult, the muscles will bulge.

If the exercises are too difficult and you are bulging, you could be doing more damage. On the other hand, if they are too easy, you will probably just be wasting your time. Your muscles won’t get stronger BEYOND the stimulus of the exercise/strength required to perform the exercise.

It's just like Goldilocks and the three bears... the stimulus has to be juuuuuuust right.

As your abdominal muscles get stronger and the fascia starts to respond better, you will need to make the exercises harder, or progress to more challenging exercises.

(think, if you always run 3K, you won’t be able to just get up and run 10… you have to work up towards that distance - this is called PROGRESSIVE OVERLOAD)

It’s also not just a random collection of core exercises. We need to start with gentle, easy exercises, again that CHALLENGE the muscles and connective tissues just enough and then gradually increase the difficulty of these exercises in accordance with the strength and responsiveness of these tissues. It shouldn’t just be a random mish-mash of exercises, some hard, some easy, some INCREDIBLY hard. There should be structure and clear progression.

This is why you should work with a professional - either a physio or trainer that specializes in this stuff, as it can be very hard to know what is too much and what is too little.

It’s also important HOW you do core exercises, not just WHAT you do. You can do a crunch WELL or you can do it badly. If you do it well, it may play an important part in your rehab. If you do it badly, it can make things worse.

I have a whole series of “core” exercises on my YouTube channel - try the different exercises for yourself. The right one for you will be a difficult - but if your tummy muscles are bulging it is too difficult right now (though you may be able to progress to it).

STRENGTH TRAINING

The core does not ONLY work when you are performing “core” exercises. It works in every movement - when you push, pull, row, squat, deadlift, lunge. These exercises focus on OTHER body parts, but your core is also working to stabilize you as you move. These exercises will not only help you move better and strengthen the rest of your body, but they will also help strengthen your core (although not enough - you will probably need some specific abdominal exercises which we talked about in the previous section).

The true function of the “core” - which remember, is made up of not only your abs, but all the muscles that wrap around your waist, your diaphragm and your pelvic floor. It is a closed pressure system that is cylindrical in shape - it looks a lot like a coke can.

These muscles work together to stabilize you while you create movement or force out to the extremities. This is why all these exercises that are not specifically core exercises can help you improve your diastasis and why EVEN THOUGH you have diastasis, you should still do a full-body strength training programme, which will increase overall muscle tone and strength all over your body.

Most women when they have DR think that they shouldn’t do any other type of exercise until they have healed the DR. This is a mistake as a full-body strength training programme, which will increase overall muscle tone and strength all over your body.

You do, however, have to me mindful of which exercises could be harmful - lots of impact, for example, might not be ideal given that your pelvic organs are not fully supported (since your abdominal muscles are weak). Exercises that are front loaded (the belly facing down) like pushups (or planks) aren’t a great idea - but with strength training you can lie on a bench and push dumbbels or a barbell away from you instead - it’s the same movement pattern (horizontal push) but without all the pressure on your abdomen.

Many strength exercises DOUBLE UP as core exercises.

You can also perform a standing cable press or a floor press - both of these will strengthen the chest, but because they are unilateral (one side) they also involve a lot of core strength. People don’t consider these to be core exercises, but they better replicate the TRUE function of the core - to stabilize you as you create force outwards.

TO SUM UP...

Ultimately, you need to assess your core as a whole, not just the diastasis - you need to look at breathing, alignment and various movements, paying attention to HOW you move. You need to firstly figure out why you have a DR in order to fix it.

How do you do that? That’s where experience comes in - I've been working with women for some time, and have helped lots of them heal a diastasis. It's hard to know what to do when you're seeing it for the first time on yourself, which is why many women benefit from an individual assessment and guidance to rectify the issue. If you'd like to know more about what happens in an individual assessment, you can check out this page.