Diastasis Recti: Splitting of the Fascia of the Rectus Abdominis
A Little-Known Core Concern that Warrants Recognition
By Hope Zvara
Most people would love to have a killer core—that is, a waistline to die for—but at what cost? Diastasis recti is a splitting of the fascia of the rectus abdominis down the linia alba, or midline, that separates it into left and right halves. The condition occurs primarily in infants and pregnant women, but can also be the result of obesity, particularly when excessive fat surrounds the abdomen. Diastasis recti can also be cause by certain abdominal exercises and heavy weightlifting— which is a common cause of the problem among men.
In women, diastasis recti can occur during pregnancy, when the pressure of the uterus against the abdominal wall causes a widening and thinning of the midline tissue. However, women can live with diastasis recti for several years after pregnancy, especially if they do not perform the proper exercises to fix the issue or if they worsen the separation by exercising incorrectly. Having several consecutive pregnancies can prevent the uterus from returning to its normal size and interfere with the body’s healing.
A split that creates a gap wider than two-and-a-half fingers’ width may be considered a medical issue and should be dealt with immediately. Even at two fingers widths, sufferers may notice back pain, the sagging “mama belly” or a coning or V-shape at the line of the linia alba, where the abdominals should be connected. At any gap size, diastasis recti is a concern that can create issues if left unaddressed as the core muscles develop improperly. When something in our bodies is not working correctly, something else compensates, and that compensation eventually catches up with us.
What to Avoid
Exercise classes and boot camps that are focused on weight loss and strength training usually do not provide students with an understanding of transversus abdominis and pelvic support, so it is important for anyone that suffers from diastasis, especially new mothers, to understand the problem and how to properly heal from it. Because pregnancy stretches and thins the abdominal walls rapidly, the muscles afterward are vulnerable to injury. Like a balloon that is inflated and deflated several times consecutively, the abs can become distorted and saggy unless the proper care is taken to heal them from being stretched thin.
The abdominal exercises known as crunches or sit-ups can create a pressure down the midline of the belly that can cause the split. The source of problematic weightlifting is incorrect form; either sucking in or pushing out the belly prevents building true transversus abdominis strength.
Women should avoid wearing a support girdle or other tummy-trimming undergarments unless the split is two or more fingers width apart. The girdle’s support prevents sufferers from working the core muscles, leading to an issue that is much worse than a simple tummy bulge.
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How to Strengthen and Heal
Learning proper pelvic floor exercises will give the core the support it needs and build the base from which to mend the issue. The pelvic floor is the bottom of the body; with strengthening, this foundation can lighten the load on the rectus abdominis and help remedy urinary incontinence.
Due to pregnancy, excessive abdominal weight or improper core work, many women that have diastasis recti also have lordosis, an exaggerated forward curvature of the lumbar and cervical regions of the spinal column. Intentionally bringing the spine into a neutral position helps retrain the muscles into their proper position.
Choose exercises that facilitate using the transversus abdominis properly, working in three dimensions, or planes of motion, rather than simply along one plane (for example, with crunches, the movement is just rounding forward). Learn core exercises that require work in the transverse (horizontal) plane, rather than in the sagittal (or vertical) plan, as traditional sit-ups do.
Practice breathwork that will encourage a co-contraction effect on the entire pelvic core, from the pelvic floor to the entire torso. When exhaling, instead of sucking in our pushing out, make a small deflation of the belly, but more distinctly, a firm contraction of the entire core to feel a bracing effect.
Finally, become educated and ask questions. Not all workouts are equal and unfortunately, not all instructors are aware of the effects of their workouts on all parts of the body.
Three Moves to Rehabilitate Diastasis Recti
Forearm Plank Twist
Come onto the forearms in a forearm plank position, actively pressing forearms into the floor, keeping head in line with the body parallel to the ground. From the natural waistline, twist your lower body to the left, rotating your pelvis and feet to point in the same direction onto the side of the left foot, so that the left hip points toward the ground and right side faces the ceiling. Lift your hips actively away from the floor to feel the oblique and transversus abdominis turn on. Remain here for five to 10 breaths. Pause in plank and take a short break, and then repeat the opposite side, twisting the lower body to the right. After completing both sides, decide which side needs more work and repeat that side a second time.
Mini-ball Extension with a Twist
Sitting tall with a nine-inch, core-training mini-ball gently tucked behind your sacrum, sit tall on your sit bones and on an exhale using your transversus abdominis, press only your sacrum barely into the ball without rounding your spine. Inhale and extend your body back to make a 45-degree angle with the floor, watching not to arch the back and keeping a maintained focus on the linea alba. Keep the intention of exhaling and connecting both sides of the belly together. Place the fingers of one hand on one side of the rectus break and the thumb on the other. Upon exhaling, use the fingers and thumb to merge the split muscle. Do not extend too far back and remember to keep the pelvic floor active; a mini-ball or block can be placed between the inner thighs to assist. On the next inhale, take a gentle twist to the right and rotate only the torso, taking care to not move on the mini-ball, and with a strong exhale, focus on using your corset core, the area between the hips and the ribs, to rotate you back to center. Repeat each side five times and then work the weaker side again another five times.
Lying on the floor in a supine position, place a mini-ball underneath the sacrum with the pelvis in a neutral position. Exhale and actively contract the anal sphincter, vaginal passageway (for women) and urethra. Keeping this support, lift one leg up so that the shin is parallel to the ceiling, with the knee aligned over the hip. Keep steady and extend your opposite arm towards the lifted leg, palm to thigh. Now without moving the pelvis or spine, press leg and palm towards each other, creating resistance, for 10 to 20 seconds. Release the leg and arm and then repeat on the opposite side. Notice which side is weaker and repeat that side a second time. What you should notice is the entire core activating without you needing to do much of anything. This way to effectively use the core and support the spine is called bracing, or co-contracting.