Diastasis rectus

What is diastasis rectus?

Abdominal muscles form an elaborate corset which supports your stomach contents
and your back. The central set of abdominal muscles are the rectus muscles. These are
divided into right and left halves, joined together by a thin, fibrous band of connective
tissue.
While you are pregnant, your abdominal (six-pack) muscles stretch to allow room for your
baby to grow. Diastasis rectus is when these tummy muscles over-stretch during pregnancy
and separate down the midline.

What causes diastasis rectus?

. Most commonly pregnancy – increased risk with twin or IVF pregnancy due
to increased bump size/tissue elasticity.
• Many years of abdominal loading/lifting with poor technique.
• Chronic straining
• During labor, especially while excessive breath holding during the second
stage.
• Obesity
• Hypermobility
• Multiple pregnancies

How can I tell if I have diastasis rectus?

Lie on your back with your knees bent and feet on the floor. Have your top rolled up so you
can see your tummy.
Tuck your chin in towards your chest and gently lift your head and shoulders up from the
floor. If you have Diastasis Rectus, you will see doming down the middle of your tummy. This
is your abdominal contents pushing through between your abdominal muscles.

How will your physiotherapist measure diastasis rectus?

Your physiotherapist will ask you to lie on your back and feel your tummy muscles while you
are relaxed and then while you are activating your abdominal muscles. They will measure
the gap between your tummy muscles at your belly button and 2 inches above and below.

Do’s and don’ts

. Avoid all strenuous exercises that cause your abdominal wall to bulge out.
• If you have to bend forward, engage your core muscles before you do this. (exercise 1)
• Avoid heavy lifting or bending. Learn the form & technique first.
• Avoid straining on the toilet.
• Avoid aggressive abdominal exercises that would put strain on the midline of the
abdominal such as sit ups or crunches or rising from a lying position by pulling up and
twisting at the same time.
• When getting out of bed, roll on to one side first before pushing up, avoiding the sit up
motion.
• Start exercises to strengthen your deep core muscles.
• Start with low level strengthening working on the deep tummy muscles first.
• Abdominal corset / supports can be useful to help activate your tummy muscles and
support your posture initially.
• Physiotherapy can also teach you more strengthening and stretching exercises that may
help.

Exercise 1 – Transverse Abdominus Activation (TAB)

• Lie on your back or your side with your knees bent up and your feet flat.
• Keep the normal inward curve in your lower back throughout.
• Place your fingers on your lower abdominal wall just inside your pelvic bones.
• Imagine you are wearing a low-slung belt across your hips.
• Gently draw in the area between your tummy button and pubic bone towards your spine
as if you were trying to do the belt up a few more notches.
• Start by holding this for as long as you can (5-10 secs) Relax. Repeat 10 times.
• Increase how long you hold for as you become stronger, up to 10 seconds.

• You can also try this exercise in sitting or standing when you feel confident.

Exercise 2 – Bent Knee Fall Outs

• Start on your back with your knees bent.
• Activate your deep tummy muscles and gently lower your right knee down towards the
floor – keep your left knee bent and pointing upwards towards the ceiling.
• Keep your pelvis stable throughout this exercise – try to avoid trunk rotation.
• Return your right leg to starting position as soon as you detect movement in your trunk.
• Relax your deep abdominal muscles.
• Repeat 2-3 exercises each side when starting out and build up.

Exercise 3 – Heel slides

• Lie on your back with your knees bent and feet flat.
• Place your fingers to feel your lower abdominal muscles just inside your pelvis and gently
activate your deep abdominal muscles.
• Straighten your right leg slowly, sliding your foot along the floor and then slowly return to
starting position when you feel your lower back begin to arch.
• Repeat 5-7 times each side when starting.

Exercise 4 – Pelvic tilt

Start lying on the floor. You can also do this sitting on a chair or gym ball. Round your lower
back and roll your pelvis backwards over your sitting bones. Feel the stretch in your lower
back. Return to the starting position. Repeat 10 times.

Exercise 5- Pelvic floor

  • Lie on your back with your knees bent and feet flat.
  • Imagine stopping urine in midstream.
  • Inhale while contracting their PFMs, ensuring to expand front, back and sides of their lower rib cage. During exhalation, relax your pelvic floor. The contraction should be held for 3-5 seconds, 3 sets of 10.
  •  While performing this exercise, you should not feel your buttocks tighten or movement in your spine.

Exercise 6- Diaphragmatic Breathing

  • Lie on your back with your knees bent and feet flat.
  • A pillow can be placed under the knees for support.
  • Place one hand on your chest and one hand over the apex (highest point) of the abdomen.
  • Take a deep breath in through your nose as if sniffing a perfume.
  • Hold the breath for 2-3 secs.
  • Exhale through your mouth as if blowing a candle.

About the Author: Ismat Khoja, Fitter Coach & a physiotherapist(MPT)

References:

Mesquita, Luciana & Machado, Antônio & Andrade, Angela. (1999). Physiotherapy for
reduction of diastasis of the recti abdominis muscles in the postpartum period. Revista
Brasileira de Ginecologia e Obstetrícia. 21. 267-272. 10.1590/S0100-72031999000500004.

Thabet AA, Alshehri MA. Efficacy of deep core stability exercise program in postpartum
women with diastasis recti abdominis: a randomised controlled trial. J Musculoskelet
Neuronal Interact. 2019;19(1):62-68.

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