Diastasis recti, or abdominal separation, occurs when the rectus abdominis muscles, commonly known as the “six-pack” muscles, separate. This condition involves a widening of the linea alba, the connective tissue running down the midline of the abdomen. Common during and after pregnancy, addressing this separation is important for core function and overall well-being. This article explores diastasis recti and effective repair strategies.
Understanding Diastasis Recti
Diastasis recti develops when increased internal abdominal pressure stretches the linea alba, causing the rectus abdominis muscles to move apart. This is most frequently observed in pregnant women due to the expanding uterus and the influence of hormones like relaxin, which soften connective tissues. Other factors contributing to its development include multiple pregnancies, being over 35 during pregnancy, or improper exercise techniques that strain the abdominal wall. Men and even newborns can also experience this separation, though in infants it often resolves naturally.
Symptoms often include a visible bulge or “pooch” in the abdomen, especially noticeable when straining or contracting the abdominal muscles. This bulge may appear above or below the belly button. Individuals might also experience low back pain, poor posture, or a sensation of softness or a jelly-like texture around the belly button.
To perform a self-check, lie on your back with knees bent and feet flat. Place your fingertips horizontally just above or below your belly button and gently lift your head and shoulders as if doing a mini-crunch. Feel for a gap between the left and right abdominal muscles; a separation of two finger-widths or more may indicate diastasis recti.
Effective Exercises for Repair
Repairing diastasis recti focuses on engaging and strengthening deep core muscles, particularly the transverse abdominis (TVA) and pelvic floor, without straining the separated muscles. Breathing techniques are foundational, such as diaphragmatic breathing, where you inhale deeply into your ribs and exhale slowly while drawing your belly button towards your spine. This action helps activate the TVA, which acts like a natural corset for the abdomen.
Pelvic tilts are a beneficial exercise, performed by lying on your back with bent knees and feet flat. Gently flatten your lower back against the floor by tilting your pelvis upward, engaging your abdominal muscles, and then returning to a neutral position. This movement helps strengthen the lower abdomen and pelvic floor.
Heel slides are also effective; while lying on your back, brace your abdominals and slowly slide one heel along the floor to straighten the leg, then return. This exercise targets deep core muscles without straining the midline. Other useful exercises include glute bridges and bird dog, which strengthen the core and supporting muscles while maintaining proper form.
When Professional Intervention is Needed
While targeted exercises can improve diastasis recti, professional intervention may be beneficial or necessary. If self-managed exercises do not yield satisfactory results, or if the separation is substantial (e.g., 5 cm or wider), seeking professional guidance is advisable. Physical therapists, especially those specializing in pelvic floor health, provide personalized exercise programs. They can assess separation severity, teach proper techniques for engaging deep core muscles, and guide progression to more challenging movements. Physical therapy also addresses associated symptoms like lower back pain, poor posture, and pelvic floor dysfunction.
In more severe or persistent cases that do not respond to conservative management, surgical options may be considered. Diastasis recti repair surgery often involves stitching the separated rectus abdominis muscles back together. This procedure is frequently performed as part of an abdominoplasty, commonly known as a tummy tuck, which can also remove excess skin and fat. Surgical intervention can offer a more permanent solution, improve core strength, flatten the abdominal wall, and alleviate symptoms like back pain or umbilical hernias.
Movements and Activities to Avoid
Certain movements and activities can exacerbate diastasis recti by placing excessive pressure on the weakened linea alba, potentially worsening the separation or hindering healing. Traditional abdominal exercises like crunches, sit-ups, and full planks should generally be avoided, especially in early recovery, as they can cause the abdomen to bulge outward. This outward pressure can strain the connective tissue and prevent healing.
Activities involving heavy lifting or straining, such as lifting heavy objects or getting out of bed incorrectly, can also be detrimental. Movements that cause the abdominal wall to visibly “cone” or “dome” indicate too much pressure on the midline and should be modified or avoided. Some yoga poses involving deep backbends or significant spinal flexion can put undue stress on the abdominal muscles. Being mindful of these movements and opting for core-safe alternatives helps protect the healing abdominal wall and supports the repair process.