Fortunately, there were two systematic reviews published on this very topic not too long ago, one in 2021 by Gluppe, Engh, and Bo, and then one in 2022 by Berg-Poppe et al. Both of these articles tried to obtain the answer to the VERY elusive question about which exercises are best for postpartum DR.
So, what did they find about exercise for DR?
Both reviews, not surprisingly, came to the same conclusion about the studies that are out there about DR. Most of those studies are not of great quality, and it’s also VERY difficult to generalize results due to the variety of methods used to both assess and treat DR. But the main finding across all studies? Core strengthening exercises DO help improve DR!
Are some core exercises better than others for DR?
The surprising answer seems to be—all core exercises help, regardless of the type! And there is never any one type of exercise that is proven to worsen DR. Let me say that again... there is not any one type of exercise that a person with DR should never do. It is not supported in research that exercise worsens DR!
Really?? I thought for sure that sit-ups and planks were bad for DR.
The answer to this really comes down to the fact that like most things in life, the answer lies in the gray of the “in-betweens,” versus a black-and-white “yes or no.” For DR especially, it really comes down to how you are doing the exercise instead of what you are doing. So absolutely, if you have a large DR and haven’t done any foundational deep abdominal work, then starting out with sit-ups would be terrible for you. Or if you focus on keeping your plank as low as possible and holding as long as you can without actually thinking about when your abdominals may be fatiguing, yes that could be harmful too. But as long as you start out with a good foundation of learning how to activate your deep abdominals properly, and how to BREATHE while doing abdominal work, then you can work up to crunches and planks safely again!
What about pelvic floor strength—does that have any impact on DR?
There is even disagreement across studies on the importance of including pelvic floor exercises in DR rehab... as of this writing, adding pelvic floor exercises to DR rehab doesn't seem to improve the outcome as compared to when pelvic floor exercises are NOT included.
So, what are the takeaways from this data?
It's generally agreed upon when pelvic health PTs are surveyed that activating the deeper layer of your core and pelvic floor FIRST is really important, essentially to get your “inner life vest” working again. Focusing on breathing is also important—please don’t EVER hold your breath while doing abdominal work! But then, layering any other exercises on top of that "inner life vest" of muscle activity is absolutely ok. Many of the studies included in these reviews had exercises like planks, Russian twists, sit-ups and reverse sit-ups. And guess what? The participants all still showed improvement in their DRs!
What does MommaStrong recommend about what you should and shouldn’t do while exercising with a DR?
First of all, in MommaStrong we really want you to make sure that your glutes and mid back are active before you start a lot of intensive abdominal work! Your abdominals attach onto both your ribcage and your pelvis, so if these areas of the body aren’t stable, then your abs don’t stand a chance. Check out this article for more information on our approach to healing deep abdominal dysfunction.
Once your glutes and mid back are awake, then you can do any abdominal exercises that feel good for your body, as long as you meet these criteria:
Perform a brace/blink/rocket first, and maintain at least the brace throughout the exercise
Don’t hold your breath
Don’t allow the middle part of your belly to “cone” or “dome” up towards the ceiling
If you find yourself doing any of these things with abdominal exercises, then the exercise is too hard for you. You either need to modify the exercise to an easier version where you can control those things, or just stop working out for the day and try again another time when your muscles aren’t fatigued.
And, we have a lot of great specific content for both DR and general core rehab. Check out our program here!
Berg-Poppe, Patti PhD; Hauer, Michaela BS; Jones, Cassandra BS; Munger, Mattison BS; Wethor, Cassidy BS Use of Exercise in the Management of Postpartum Diastasis Recti: A Systematic Review, Journal of Women's Health Physical Therapy: January/March 2022 - Volume 46 - Issue 1 - p 35-47. doi: 10.1097/JWH.0000000000000231
Gluppe, S., Engh, M. E., & Bø, K. (2021). What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis. Brazilian journal of physical therapy, 25(6), 664–675. https://doi.org/10.1016/j.bjpt.2021.06.006