Diastasis recti (DR) is a common condition where the two long, vertical bands of the rectus abdominis muscles separate due to the stretching and thinning of the linea alba, the connective tissue running down the midline of the abdomen. While often associated with the postpartum period, DR can also affect men and individuals with significant weight gain or improper weightlifting techniques. The primary concern for those with DR returning to physical activity is whether high-impact exercise, specifically running, is safe.
How Diastasis Recti Affects Core Stability
Running is a high-impact, repetitive activity that creates significant forces transmitted through the core. The abdominal wall acts as a stabilizing “canister” that manages intra-abdominal pressure (IAP). When the linea alba is stretched and weakened by DR, this central support structure becomes compromised, making the core less effective at containing IAP.
The weakened abdominal wall loses its ability to transfer load efficiently between the upper and lower body during running. The impact of each stride increases IAP, but the compromised linea alba struggles to withstand this pressure. This inability to manage pressure causes the abdominal contents to push outward against the midline, resulting in a visible bulge or “doming.”
This outward pressure can lead to dysfunction in connected structures, particularly the pelvic floor. If the abdominal wall fails to stabilize the trunk, the resulting strain can lead to symptoms like low back pain, pelvic instability, or urinary incontinence.
Determining Readiness for High-Impact Exercise
Before attempting to run, it is crucial to assess the functional status of the abdominal wall, which goes beyond simply measuring the width of the separation. Consulting a pelvic floor physical therapist is the most reliable step for a comprehensive evaluation.
A simple self-assessment involves lying on the back with knees bent and gently lifting the head and shoulders slightly off the floor. Place fingers across the midline of the abdomen, feeling for the edges of the rectus muscles as they contract. While DR is often diagnosed by width, the ability to generate tension across the linea alba is more important than the width alone. If the connective tissue feels soft or you can sink your fingers deep into the gap, this indicates a lack of functional tension.
Running should only be considered if you can manage IAP during basic movements without visible doming or coning of the abdomen. A functional test involves checking if the midline remains taut and firm when coughing, lifting, or performing light core exercises. The presence of symptoms like pelvic pressure, heaviness, or urinary leaking during these activities signals that the core is not ready for high-impact running.
Strategies for a Safe Return to Running
For individuals who have established sufficient core tension and control, a safe return to running must be gradual and monitored. It is recommended to wait at least 12 weeks postpartum before starting a running program to allow for tissue healing. The initial phase should involve a progressive run/walk interval program, starting with short bursts of running mixed with longer periods of walking.
Focusing on proper running form is important for avoiding excessive IAP. This includes maintaining a posture where the rib cage is stacked directly over the pelvis, avoiding a forward lean at the waist that increases abdominal pressure. Diaphragmatic breathing, where the pelvic floor and deep core muscles are gently engaged on exhalation, can help stabilize the trunk with each foot strike.
The consistent use of deep core stability exercises, specifically targeting the transverse abdominis, should be integrated with running to rebuild foundational strength. Some runners benefit from external support, such as a compression garment or specialized binder. If you observe doming, pelvic pain, or urinary incontinence while running, stop immediately and return to core strengthening exercises.
Low-Impact Cardiovascular Alternatives
For individuals whose core is not yet ready for the jarring forces of running, low-impact activities offer a safe way to maintain cardiovascular fitness. These alternatives allow you to elevate your heart rate without the high IAP spikes or repetitive impact that can aggravate a healing linea alba.
Brisk walking is the most accessible low-impact exercise and allows you to focus on proper posture and deep core engagement. Swimming is another excellent option because the buoyancy of the water minimizes stress on joints and the core, while still providing a full-body workout.
When swimming, focus on strokes like freestyle or backstroke, and avoid intense movements like the butterfly, which can put excessive strain on the core. Using an elliptical machine or stationary cycling are also safe choices, as they mimic the movement of running but remove the ground impact.