What is Diastasis Recti and How Do You Repair it?
Have you ever noticed a bulge or separation in your abs when doing certain movements – in and outside of the gym? Have you given birth or had abdominal surgery in the past?
If you answered yes to any of those questions, you may have a diastasis recti. But don't worry! It's can be repaired over time with these tips.
What is Diastasis Recti?
A diastasis recti is a thinning or separating of the linea alba. The linea alba is the tissue connecting your abs together and runs down the middle of your abdomen. When this becomes weak, it can eventually separate. It can look like doming, bulging, sinking, or herniating in the middle of your belly.
But diastasis recti is a symptom of a bigger issue. Excessive and unsupported intraabdominal pressure can also contribute to low back pain, pelvic floor dysfunction, and more.
There are certain movements which can exacerbate diastasis recti, or make it more noticeable. Most of these are either direct or indirect front loading positions such as:
- Yoga transitions
Additionally – daily functional movements may also make a diastasis recti more prominent:
- Sitting up to get out of bed or a chair
- Picking up a child
- Getting groceries or strollers in and out of a car
Just to name a few. Identifying and learning about what causes this pressure imbalance to occur is the first step in diastasis recti repair.
What Causes A Diastasis Recti?
Diastasis recti typically occur after trauma to the abdomen – with pregnancy and abdominal surgery being two of the biggest causes. Natural abdominal stretching during pregnancy is normal and expected. Every woman will have some level of diastasis recti by the third trimester. This expected abdominal stretching allows your baby to grow without shredding your abdominal muscles.
Your baby pushes up, out, and down on your respective diaphragm, core, and pelvic floor during pregnancy. All of these areas can be affected during the postpartum transition. It can cause core imbalances, as well as ineffective diaphragm and pelvic floor function. The natural stretching combined with subsequent dysfunction can set you up to improperly repair your diastasis recti after birth.
Other problems can arise from improper repair. Two out of three new mothers with diastasis recti also have some level of pelvic floor dysfunction. For many women the abdominal gap remains widened at 8 weeks – and if left untreated – can remain unchanged at one year postpartum.
Pregnancy isn’t the only way to develop diastasis recti – men can have them too! Abdominal surgery such as hernia repair where the abdominal muscles have literally been cut can lead to one forming. Additionally, poor heavy lifting and breathing mechanics, as well as the increased abdominal weight are all risk factors for a diastasis recti to develop.
Although developing a diastasis recti may not always be preventable – there are ways you can help repair it to prevent further damage.
How Do I Know if I Have A Diastasis Recti?
In order to check and find out if you have a diastasis recti, start by lying in bed and lifting your head. If you notice a tenting, doming, or bulge in the middle of your belly – you may have one. Another way to check is to feel the gap and depth between your two rectus muscles in the middle of your abdomen. It should feel like a trampoline or springy connective tissue. If your fingers sink in – this is a sign you may have a diastasis recti and your abdominal pressure is out of balance.
Measure The Gap
Diastasis recti are measured to determine severity as well as track improvement. To measure diastasis recti:
- Roll on your side and over to your back with bent knees – starting on your side helps put less pressure on your abdomen and pelvic floor.
- Relax your head and shoulders and place your fingers a couple of inches above your belly button.
- Lift your head and neck slightly (stopping before shoulder blades lift) and press down with your fingertips. If you feel a gap – you’ve found the diastasis. You will feel the muscles close in around your fingers as you lift your head and neck.
- Repeat the test in two other place – directly over the belly button, and a couple of inches below.
The gap created by a diastasis recti is measured in finger widths, you’re aiming for a 2 finger gap or less, but don’t panic if it’s bigger at first.
Even more important than the width of the gap – is the tension (or lack thereof) in the midline. When you apply gentle pressure with your fingers to the midline, this causes your abdominals to contract. This contraction of the muscles should create tension and resistance against your fingers. If you don’t feel tension or resistance when contracting, this is further confirmation of abdominal wall dysfunction.
Along with feeling for width and depth, look for any bulging or doming in your midline. It’s common to see and feel doming instead of a gap but both are signs of diastasis recti.
Can A Diastasis Recti Be Repaired?
There are many factors at play, including how much tissue damage is present, but it’s possible to improve and repair a diastasis recti. As with most things – diastasis recti is treated with an integrated program designed to align, connect, and strengthen your entire core.
When attempting to repair a diastasis recti, there are several things to be aware of – including your breath, posture, and how you engage your abdominal muscles.
Do you have a shallow breathing pattern or are you all belly? Both of these patterns prevent your diaphragm and ribs from moving properly. It also can increase tension or keep your abdominals stretched and out of balance.
Tips for Diastasis Repair
Start with the exhale and fully empty from the bottom. Exhale the air long and slow and hold for 5 seconds to help reset your system as well as increase your awareness. Follow with a deep inhale, allowing your back and lateral ribs to fully expand. Repeat 5-6 times. Incorporating this into a daily routine can help bring awareness to how your ribs and diaphragm move with your breath, as well as improve breathing habits.
Bringing awareness to your posture can also help repair or prevent diastasis recti. Do you grip and tuck – squeezing your glutes, tucking your bottom under and holding in your abdomen? This overuses and exhausts your glutes and abdominals causing them to fatigue and fail to absorb force. Inversely, do you hang forward from your hips with your knees fully or overextended? This pushes your abdominals out exerting more pressure and also prevents them from working well.
Rather than gripping tight, focus on stacking and elongating your midline to increase abdominal muscle activation. Stretch your pelvis down and away from your ribcage and try not to arch your back or tuck your butt under.
Improving how your abdominal muscles engage is the third way to help improve a diastasis recti. There can be too much of a good thing, especially when it comes to gripping or engaging muscles. Your belly and abdominals may look or feel differently depending on which muscle group is overactive:
- Middle transversus abdominus: your belly button is the only area moving or moves a lot more than the rest of your abdomen. This creates a cinch point which pushes abdominal pressure up and down affecting your diastasis and pelvic floor.
- External oblique: can lead to a narrowed ribcage and gripping of the upper abdomen and ribs.
- Internal oblique: can lead to a wider ribcage, making it harder for other abdominals to activate.
- Rectus abdominus: looks like doming or distended abs when activated. Some people view this as their abdomen is getting bigger when really they are overly strong or dominating with the one muscle group.
Taking a video of yourself actively engaging your abdominals can help identify if you have one group overpowering the others. This can still be tricky to figure out on your own so consider seeing a Pelvic PT or another practitioner with specific training in DRA.
Putting It All Together
After you’ve addressed breathing, posture, and muscle activation it’s all about perfect load.
Try incorporating some lower stress exercises. Laying on your back and marching, bird dog, and supported planks are all great exercises. Keep an eye out for your abdominals for bulging. If you notice the bulge again – pause and check alignment, breathing, and muscle activation. If it’s still there, simply reduce the load or weight and try again.
Focusing on your core and abdomen is only part of the picture when repairing a diastasis recti. Everything from your foot arch strength to head alignment plays a role in how your core works together. The missing piece may be something you don’t expect or recognize. Oftentimes, by simply identifying misalignments and learning the signs can help you move towards diastasis recti repair.
The MoveU program is designed to help you understand and recognize muscle weaknesses and imbalances throughout your body. From there, it will guide you to control those muscles and rebuild strength. If you’ve identified diastasis recti and are looking for tools to repair it – click here to join the program.
Still have questions? Click here to learn more about the program.
Written by Amanda Hayes Fugate MPT, owner of Pelvic Forward Physical Therapy in Asheville, NC
Amanda is the local pelvic health guru in Asheville, North Carolina. If you’re a marathon runner, Crossfit athlete, weekend warrior, or new mom – Amanda is your solution to all things related to pelvic health. Amanda works with patients who struggle with pelvic pain affecting their athletic performance or disrupting their sex life. She helps new moms manage the complex changes and restore pelvic floor function in a safe and comforting environment. Also, she collaborates with gyms and fitness-focused businesses in Asheville to provide educational workshops throughout the community. In addition to her private practice, Amanda is on faculty with the Herman and Wallace Pelvic Rehab Institute.