What every mama should know about healing diastasis recti

Through the experiences of working with hundreds of pregnant and postpartum individuals (and being a postpartum mom myself), I’ve come to learn that the topic of healing the core after birth can be emotionally charged. Your core changes dramatically in pregnancy and what many people don’t know is that healing the postpartum core—especially if you’ve been diagnosed with abdominal separation, or diastasis recti—must be done with a gradual, methodical and safe approach.

What really happens to your core post-baby

I’m often asked about diastasis recti (the medical name for abdominal separation) and believe that education is key when it comes to minimizing and rehabilitating this condition.

It helps to better understand how and why the abdominals separate. The linea alba is a thin sheath of muscle tissue that stretches along the front midline of the abdomen. Under pressure, such as during pregnancy, this muscle sheath stretches and instead of holding the abdominal muscles in close proximity as they typically would, the muscles give to accommodate the growing belly.

What to know about diastasis recti

1. Most of us are affected by diastasis at some point in pregnancy
2. The body does “some amount” of healing on its own in the initial stages postpartum without any additional intervention
3. The body benefits from (and needs) our help (exercise training and physical therapy) as there is a limit to the healing that naturally occurs

I generally assume that all of my postpartum clients have some degree of separation. If you’ve had a baby, you should assume you do too.

How to test for diastasis recti

If you’re curious, it’s possible to check yourself for abdominal separation. The test involves placing your fingers above and then below your belly button while doing a small sit-up. If you can feel any bulging or separation between your fingers, then chances are, you have an abdominal separation.

If you try this at home and feel separation, please try not to worry! Find comfort knowing that this is very common and that there are strategies you can employ right away to facilitate the healing process.

Personally, I’d suggest asking a professional for a thorough assessment at the 6- to 10-week mark. You can ask your healthcare provider at your postpartum check-up, or can connect with a pre- and postnatal fitness specialist, or reach out to a women’s health physical therapist.

Independent of your timeline postpartum, the priority is focusing on strengthening your pelvic floor and the deep abdominal muscles which lie under the rectus abdominis, or your “six-pack muscles.” These deep muscles are known as the transversus abdominis (TVA).

Strengthening the abdominals after birth, and specifically the TVA and pelvic floor, is much like building a house. We begin by establishing a solid framework and foundation. By working on strengthening the deepest muscles first, then focusing on the more superficial layers when the body is ready, there’s a greater likelihood that your abdominals will realign to their original structure and function.

This foundation provides the integrity necessary to keep up with the busyness of being a mom and allows you to return to higher intensity activities such as running, skiing, climbing, or heavy lifting.

How to start healing diastasis recti

It’s important to work with a certified pelvic floor physical therapist to get individualized care, but here are my general recommendations to begin the healing process.

1. Reconnect to your core

Gently and regularly reconnect to your core in everyday life by working on your alignment. Your goal is to find “neutral” alignment as much as possible. In this position, you should notice your inner core muscles (TVA) as they gently flicker to life.

2. Utilize diaphragmatic breathing

Diaphragmatic breathing, or “belly breathing,” can help you further connect to the core. With practice, you can begin to strengthen the core with this simple breathing exercise. The practice is much more than simply bringing your belly button back toward your spine. This blog article does an excellent job explaining how to do this well utilizing a “wrapping motion.”

3. Practice active inhales

Practice inhaling through the nose and actively breathe into the rib cage laterally—allowing belly to gently expand. On the exhale, practice actively drawing the belly back toward your body with a wrapping motion utilizing your TVA. You can imagining the rib cage knitting together side-to-side.

4. Brace for support

In forward leaning positions in which your abdominals experience additional pressure, such as hands and knees, bending from hips, hinging to lift a car seat or stroller, placing baby in a crib etc, utilize “bracing” for support. Bracing is a combination of good alignment with an exhale breath to hug belly back toward spine.

5. Practice log rolling to sit up

Avoid “jack-knifing” to sit up. To practice log rolling as an alternative, move to the side with your legs narrowed and push yourself out of bed from the side with a log-rolling action. Utilize support from your upper body while bracing with your core and breath.

6. Avoid straining

Refrain from movements and actions that strain the abdominal wall or increase intra-abdominal pressure; i.e., straining, heavy lifting, intense torso rotations, full planking.

7. Skip traditional ab exercises

Avoid traditional abdominal exercises, like crunches, sit-ups and leg lifts. Instead, focus on corrective exercise that begin by strengthening the TVA first.

8. Be mindful of anything that makes the belly bulge.

You might notice this while attempting abdominal exercises, especially those that target the top layer of abdominal muscles, or those that are more challenging. Look for “doming” or “pooching” and back off if you see it as this is a sign that your core is not quite ready for the exercise you’re attempting. Remember that your core is healing. We want to work on strengthening the inner layer of muscles first so we avoid continuing to stretch an already vulnerable and healing core.

9. Try bodywork

Hands-on work in the form of massage and soft tissue strategies are proving to be effective and important. As the research continues to evolve, it’s becoming more and more clear that “healing” diastasis recti requires a multi-disciplinary approach. So, reach out to a qualified pelvic floor physical therapist to ask about their experience using these modalities to help with healing.

A note on healing diastasis recti

Practice patience and connect with specialized professionals who have the skills to help you progress with safety and efficiency. The path to healing postpartum will look a little different for every mama, but these techniques are helpful in ensuring your core strengthens in time.

A version of this story was originally published on June 20, 2018. It has been updated.