I think it’s important to say that while some of my urgency to fix my DR stemmed from the desire to get out of pain and feel strong again, some of it was also fueled by the immense societal pressure to have a “flat” tummy after birth. Therefore, in this article, I’ll be answering the most common questions we get about effective solutions for DR, but I will also be answering questions about the association of a flat tummy with abdominal strength as well as the glorification of its appearance.
Here we go:
I just got diagnosed with diastasis recti, a 3-finger separation. Where do I start?
It can be alarming to get this kind of diagnosis and hearing that parts of your body are “separated”. The first thing to do is to dampen that alarm with facts. A 3-finger separation (reminder: The “finger” measurement is used loosely as being around a centimeter) is normal for most people after birth, in fact, even up to 4 or 5 fingers is common. Additionally, describing this as a separation only tells part of the story. Yes, your rectus abdominis muscles are separated, but they aren’t broken or torn. Instead, the tissue between them (the linea alba) has weakened and stretched, making the tension between the six pack muscles to be reduced, thus allowing them to have a wider gap between them. For more information on what a DR is and isn’t, check out this article.
Next, the question you ask is important, as the likely answer might be to go do a bunch of abdominal exercises. However, doing that first jumps over key aspects of your healing and may reduce or completely hinder your full recovery. The first thing to do after being diagnosed is to work on your breathing technique and your posture. Both of these tasks may seem passive, but the opposite is quite true. Correct breathing and functionally aligned posture are key for the resolution of DR because of how incorrect breathing can negatively affect intra-abdominal pressure and how misaligned posture can create a lot of tension down the front line of the body.
We want to focus on diaphragmatic breathing and neutral pelvis posture, with the shoulders and the ribs “stacked” on top. Diaphragmatic breathing allows for the ribs to expand and the diaphragm muscle to work effectively, which in turn regulates intra-abdominal pressure and also conditions the pelvic floor. A neutral pelvis with stacked shoulders and ribs provides a balance of “action muscles” and “stabilizing muscles” in your body, which gives your deep abdominals (transversus abdominis) a chance to engage.
Once your deep abs are engaging and the pressure in your abdomen is regulated, my next suggestion is to focus on glute and midback strength. These two parts of the body act like anchors, pulling you into extension and helping to stabilize your shoulder and pelvic girdle. It is after this work that it then becomes time to do more specific and direct work for your rectus abdominis, like supported crunches and other types of more traditional ab work.
I’ve seen a lot of programs claiming that I can cure diastasis recti. Is this true?
In my experience, no, curing DR is not an appropriate goal. The focus needs to be on creating more proficiency in the mechanics of the body as I described in the first answer. Once that occurs, you will see a reduction in the size of the separation. Many people heal to 1-2 finger width separation after a few months of this sort of work. A 1-2 finger width separation is normal (everyone has some amount of separation, even people who have never been pregnant!), and more importantly your abdominals will now be more functional for you in your daily life.
Also, one thing that I’ve seen a lot in my own body and in people with whom I work, it tends to be the case that our DR can worsen at certain times in our life. Things like PMS, digestive distress, holding/carrying children, travel, stress can all worsen DR temporarily. This is because of the adjustments we make in our posture, shifts in our structure, and the ways in which our body compensates during those times. So, I prefer to consider progress to be less linear and more fluid. This also means that once you discover the tools to help you heal, you can employ them when you go through a hard moment.
I’ve technically healed my DR, but I still have a pooch. What gives?
I feel you on this one! Let’s start with identifying the reality that most bodies, especially those with a uterus, will have a natural “pooch”. This is because our organs must fit somewhere. In fact, if we look at images and paintings of people throughout history, rarely do we see them represented with a flat tummy and a six pack. In general, people with uteruses will have a pooch, period.
We then also need to dig deeper into glorification of six pack abs, as this has been pumped into our brains since we were young as a sign of a very strong, fit person. The reality is that all humans have six pack abs, however those people who have visibly “cut” abs simply have significantly low body fat combined with overtraining for this muscle group. Having an overdeveloped rectus abdominis with very little adipose tissue in the midsection does not increase your functional strength, agility, and resilience.
Finally, though, to address the question more directly, when a pooch remains after healing diastasis recti this could be due to normal belly function and also could be a signal that there is some regression in the resolution that needs to be addressed. It could mean that you need to take a step back to the basics of healing (breathing and posture) and then refresh your body’s memory of anchor point strength. It might also be important at this point to check-in with compensations in the body, perhaps the hip flexors or the iliacus are very tight and are causing some of the distention in the belly.
I’ll conclude with stating that this might also then be a moment where reaching out for one-on-one help from a pelvic floor physical therapist would be warranted. Many times there are structural issues in the body that need hands-on attention from a clinician of this level. It can also be very helpful to have the physical therapist evaluate your deep ab recruitment and make sure everything is in working order. We, as a society, tend to stigmatize needing help like this, but it can often be the very best way to support your body.
How MommaStrong helps you address and treat diastasis recti:
The good news is that all programs in MommaStrong are DR friendly! However, if you want to do targeted work or you are starting as a new member, I would suggest checking out our Di-Recti programming in Longer Fixes (after watching the Welcome video first, of course!). It will help you tackle all the aspects of this and even go beyond what has been covered here in this article. PLUS, you can get a ton of extra personalized support in our community, and from our Physical Therapist Advisor. You are so not alone.