Diastasis Recti: The Pelvic Floor Therapist Perspective

Diastasis Recti: The Pelvic Floor Therapist Perspective


As a pelvic floor therapist working with pregnant and postpartum patients, I’ve witnessed the concerns, questions, and even fears that many women have about diastasis recti. This common condition affects many during and after pregnancy, and it’s essential to dispel myths, provide accurate information, and share evidence-based advice. In this blog post, we’ll explore diastasis recti from a pelvic floor therapy perspective, offering a clearer understanding, exercise ideas, and the latest research insights.

What Is Diastasis Recti?

Diastasis recti, often referred to as “abdominal separation,” is a condition where the left and right sides of the rectus abdominis muscles (commonly known as the “six-pack” muscles) move apart due to the stretching of the connective tissue (linea alba) that holds them together. This separation can occur during pregnancy when the uterus expands and places pressure on the abdominal muscles, and it often continues postpartum.  Some people have a closure of that separation without much thought or effort, and some have a really hard time closing that gap even months or years later. There are some variables that we can address to help create a stronger core, but there are other factors that we can’t always predict or control on how well the separation is going to heal on its own.  The truth is that the research is still not definitive in the prevalence and causes of DR, so a personalized approach is best and seeking the advice of a specialist in pregnancy and postpartum exercise.  Let’s go through and clear up some things about diastasis recti….

Myth 1: Diastasis Recti Is Uncommon

Diastasis Recti Is Uncommon
The Truth: Diastasis recti is prevalent, affecting up to two-thirds of pregnant women and many postpartum individuals. It’s a natural response to the body’s adaptation to pregnancy.  There is a lot of misinformation out there, including statements like “don’t do planks during pregnancy to avoid diastasis recti”. But avoiding movements like planks or push-ups does not guarantee that you will prevent diastasis, because it is a naturally occurring process anyway. And you can learn how to do planks and pushups in an efficient way that does not cause too much extra stress on that tissue, and they can be completely “safe”.

Myth 2: Diastasis Recti Always Requires Surgery

The Truth: While surgery is an option in severe cases, most diastasis recti can be addressed through conservative methods like pelvic floor therapy, specific exercises, and lifestyle changes. Surgery does not strengthen your core either, and a lot of times it is mostly for cosmetic reasons. You still should seek out PT after surgery to build your core muscles back up and make it functional.

The Impact on Pelvic Floor Health

Understanding the connection between diastasis recti and pelvic floor health is crucial. The pelvic floor muscles provide essential support to the abdominal region, and when the abdominal muscles separate, it can affect the pelvic floor.

Diastasis recti can contribute to:

– Pelvic floor dysfunction, including urinary incontinence.- Lower back pain and poor posture.- Reduced core strength and stability.- Decreased abdominal and pelvic organ support.

Myth 3: Diastasis Recti Always Leads to Pelvic Floor Problems

The Truth: While diastasis recti can influence pelvic floor health, it doesn’t guarantee dysfunction. Many factors, including genetics and overall muscle tone, play a role. Having a diastasis does not mean you are doomed for all kinds of problems – especially if you have a great PT on your team to help you strengthen that separation and teach you good breathing mechanics and pressure management techniques to avoid further problems.

Evidence-Based Approaches to Diastasis Recti Management

Evidence-Based Approaches to Diastasis Recti Management
Here are some evidence-based strategies to address diastasis recti and promote pelvic floor health:

1. Pelvic Floor Physical Therapy:

– Working with a pelvic floor therapist can be immensely beneficial. They can assess the severity of diastasis recti, develop a personalized treatment plan, and guide you through exercises that promote healing.

2. Gradual Progression of Exercises:

– Gradual, controlled exercise is key. Focus on core and pelvic floor strengthening, and slowly progress to more advanced core exercises while maintaining good control.

3. Breath and Alignment:

– Incorporate diaphragmatic breathing into your daily routine, especially tuning into getting your ribs down and in when you exhale – which can make it difficult to reduce separation if your ribs are always flaring. These practices support core and pelvic floor engagement.

4. Specific Exercises:

– It’s important to progress beyond things like pelvic tilts and deadbugs, because your daily demands are much higher and your programming should eventually reflect that.

5. Lifestyle and Nutrition:

– Pay attention to your nutrition and hydration, as these factors can influence tissue healing. Adequate protein intake is essential for tissue repair.

Myth 4: Crunches Are the Best Way to Fix Diastasis Recti

The Truth: Traditional crunches can sometimes exacerbate diastasis recti, mostly due to poor muscle recruitment when doing them. If you’re noticing a bulging out through that separation when doing crunches, it’s a sign that you’re not managing intra-abdominal pressure well and we either need to re-teach how to contract your abdominals during a crunch – or modify the movement for now until you can build back into it.

Myth 5: Results Are Immediate

The Truth: Diastasis recti recovery takes time, and results vary from person to person. Consistency and patience are key.  But what we often find is that people are told to just wait and be patient, with no actual plan to create results. And just waiting around doing nothing, or not learning the most optimal movements to be doing for healing, is not going to help speed things along – and you may be dealing with it for much longer than if you had more education and a plan to follow.  So yes, have patience. BUT ALSO make sure you have a plan.

The Role of Prevention and Education

Preventing extreme cases of diastasis recti or managing it during pregnancy can be incredibly beneficial. Educating pregnant individuals about their changing bodies, the importance of proper posture, and the role of pelvic floor therapy is a proactive approach.

Myth 6: Nothing Can Be Done During Pregnancy

The Truth: There’s a lot that can be done during pregnancy to promote abdominal and pelvic floor health. The goal is not to PREVENT diastasis recti from happening at all, but rather to maintain good tissue integrity, mechanics, and strength as much as we can to set you up for a more optimal postpartum recovery. Pelvic floor therapy and specific exercises can help.

Empowering Through Knowledge

Diastasis recti is a natural part of many pregnancies, and it doesn’t have to be feared. With the right approach, it can be managed effectively. As pelvic floor therapists, we’re here to support your journey to a strong and healthy core.  You should not be afraid to work your core during pregnancy, as this is not the cause of diastasis recti. But there may be core exercises that are more optimal for YOU at certain stages during pregnancy. There is no one size fits all approach, and there are no specific timelines of when you need to stop doing a specific exercise. Having a pelvic floor therapist on your team who is trained well in high level fitness will be helpful for you to navigate these decisions confidently.  Remember, the road to recovery involves patience and a personalized plan tailored to your unique needs. Reach out to one of our pelvic floor therapists for guidance, and you’ll be on your way to a healthier, happier pelvic floor and a stronger core!

Logan Lynch
Owner & Head Clinician at Life In Motion Physical Therapy

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Life In Motion Physical Therapy

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