Diastasis Exercise Tips and Tricks From Your Pelvic Floor Physical Therapy Bestie
By Dr. Brook Orvis, PT, DPT, WCS, PRPC, CLT
Diastasis, which is also referred to as “diastasis rectus abdominis” or “diastasis recti,” is a separation of the rectus abdominis muscles which are the muscles on the belly that form what we think of as the “six pack” abdominal muscles. Hello Jason Momoa.
What Are the Rectus Abdominis Muscles and Diastasis?
The rectus abdominis muscles are a group of muscles on both the right and left sides of the abdomen that are joined together by a layer of connective tissue called the “linea alba.” Diastasis rectus abdominis (DRA) is basically a thinning and widening of the linea alba.
Prevalence of Diastasis Rectus Abdominis
DRA is incredibly common in people that are pregnant and postpartum, but can also occur in people of all gender identities and expressions, including those that have never been pregnant before. It can also been seen or experienced not only in folks that are pregnant or postpartum, but also in those that have an increase in adipose tissue or tissue in the abdomen causing increased tension and stress on the linea alba as well as folks that have a history of poor breathing mechanics and breath holding, chronic straining during bowel movements, chronic coughing and sneezing, and overexerting your abdominal muscles while using poor body mechanics.
For folks that are pregnant, diastasis is INCREDIBLY common and usually occurs in around 60% of people by the third trimester as the body continues to adapt to make room for a growing baby and uterus. We usually hope that this natural separation of the abdominal muscles will go away by 6 weeks postpartum, but for some parents diastasis can remain.
Your body is not fragile and I love reminding clients of this.
Common Symptoms of Diastasis
For some people having some slight amount of “diastasis” or separation between the rectus abdominis muscles is normal postpartum and the “gap” from diastasis itself isn’t necessarily an issue if there aren’t symptoms or dysfunction associated with it such as:
- Abdominal weakness
- Difficulty returning to exercise
- Abdominal pain or the feeling the sensation of “pulling or tearing” between the rectus abdominis muscles
- Leaking of urine (stress urinary incontinence, urge urinary incontinence, or both)
- Prolapse (where the pelvic organs sit lower in the pelvis than normal)
- Low back or hip pain
- Or other pelvic floor symptoms
As a Duke Women’s Health Residency Trained and Board-Certified Women’s Health (WCS) and Pelvic Floor (PRPC) Physical Therapist, I love working with clients with Diastasis Rectus Abdominis. It is something that is incredibly common throughout the lifespan and during pregnancy and postpartum and there is a lot of fear mongering associated with it including what exercises and activities are considered “safe” or not. It’s exciting to me being able to help clients reach their goals and return to doing activities they want to get back to like CrossFit, lifting weights, running, or even just being able to carry their kiddos without the fear that they are “making things worse.” Your body is not fragile and I love reminding clients of this.
Ways to Help Improve Your Diastasis From a Pelvic Floor Physical Therapist
If you’re struggling with diastasis or think you may have diastasis, here are a few recommendations from a pelvic floor physical therapist:
1. Pressure management is so important.
Breathing mechanics is something I usually go over early on with clients struggling with diastasis. You want to make sure that you are actually breathing with activities that increase the level of exertion placed on your system (like when lifting heavy objects or bending over) because these are the same activities where you may notice your diastasis or pelvic floor symptoms as a result of the diastasis are worse. Breathing out helps to manage the natural canister of the abdomen allowing the diaphragm to move up and naturally allows less stress to be placed on your pelvic floor which can inadvertently make your symptoms as a result of the diastasis better.
2. Engage the deeper layer of your abdominal muscles during core strengthening!
We have three different layers to our abdominal or core muscles (order is moving from the outermost to innermost layers):
- External abdominal obliques
- Internal abdominal obliques
- Transverse abdominis
When exercising, especially when pregnant, postpartum, or when we suspect that diastasis may be present, we want to make sure that we engage the innermost layer of the abdominal muscles, or the transversus abdominis. The transversus abdominis muscles serve as a corset to the abdomen and low back and when actively engaged can help to reduce diastasis and improve the tensile strength of the connective tissue running between the two sides of the abdominal or core muscles.
So how do you engage the transversus abdominis muscles? Think about an invisible string attached to the back of your belly button and that you are gently pulling this string back towards your spine. Another cue I like to give to my clients is that you are zipping up a pair of pre-pregnancy pants engaging your abdominal muscles starting at the pubic bone and zipping up to the base of your rib cage. Make sure to continue breathing normally while you keep these deeper abdominal muscles engaged. If you have diastasis you should notice a significant improvement or even a resolution in your diastasis with this type of abdominal engagement while exercising.
3. Muscles respond to exercise.
There is still a pretty common misconception (and honestly a lot of fear mongering) that if you have diastasis that core strengthening and exercise is not safe for you and can make your diastasis worse. As a pelvic floor physical therapist, I actually recommend core strengthening exercises specifically to my clients with diastasis because the only way to help the system that is having dysfunction is to load it to help make it stronger.
BUT there are ways to do this safely. I usually recommend that core exercises that you decide to do with diastasis should not be painful, should not be causing excessive abdominal “doming” or “coning” at the site of your diastasis, and should not be causing pelvic floor symptoms (think bladder or bowel symptoms, any symptoms of prolapse, or pain in the pelvic region, low back, or hips). Your exercises that you decide to do should be challenging, but should also be appropriate for your level of fitness.
Are you doing core strengthening exercises or exercise in general where when you first start you don’t have any symptoms of diastasis and then as you continue exercising the diastasis symptoms begin? This is your body’s way of telling you to rest! As a pelvic floor physical therapist, I want you to challenge yourself and load your system doing the activities that provoke your symptoms. However, we essentially want to load your muscles up during exercise until you start having your diastasis or pelvic floor symptoms. Then once those symptoms begin (for instance with diastasis, you start to notice the abdominal coning or doming beginning to flare up with your exercise that you are performing), you stop and take a rest break.
When your symptoms start, this is your beginning repetition. Over time, you should start to notice that you are able to do the provocative exercise for longer or with more repetitions without flaring up your diastasis. This is how we address diastasis!
4. See a pelvic floor therapist if you’re struggling.
Struggling with diastasis or worried that you may have a diastasis? Or are you trying to decide what exercises are appropriate and safe for you to be doing with a diastasis but don’t know where to start or are worried that you are making your diastasis worse? I would 100% recommend working with a pelvic floor physical therapist to get specialized guidance and exercises specifically tailored for you and what you are struggling with.
I'd love to help and support YOU!
Have questions or feeling on the fence about whether or not pelvic floor physical therapy is for you? If you are looking for treatment for diastasis recti and you’re located in Durham, North Carolina I would love to work with you! Reach out to me at floraphysicaltherapy.com to tell me a little more about what is going on so we can chat more and get the process started.
Live outside of the state of North Carolina? I also offer virtual appointment options to provide more accessible care to those seeking out pelvic floor physical therapy treatment.
About Dr. Brook Orvis, PT, DPT, WCS, PRPC, CLT. Dr. Brook Orvis (she/her) is a Board-Certified Women’s Health and Pelvic Floor Physical Therapist, Duke Residency-Trained in Women’s Health, and the owner of Flora Physical Therapy. As a momma to a spirited toddler, she understands the difficulty of being a parent while prioritizing self-care, including caring for your body and pelvic floor. She believes that pelvic floor therapy is for everyone and is passionate about providing accessible treatment options for birthing people, men, women, kids, and the LGBTQIA+ community so that they can take better care of themselves and receive equitable care. She loves educating and empowering clients to take charge of their body and health and to not accept leaking of urine, prolapse, pelvic pain, pain during sex, and core weakness as a normal part of being a human.
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