I’ve read a lot about DR causing the dreaded “mommy belly” and am pregnant with my first. What is a good pregnancy exercise plan to prevent diastasis recti?
This is a great question, and gets right to the first myth that we need to dispel about DR. Diastasis recti will occur to everyone while they are pregnant by at least week 35! A 2018 study even found that the abdominal separation in pregnancy can range from 4.4cm to 8.6cm at weeks 35-41 of pregnancy, and the most-common definition of DR is anything greater than 2.0cm. And thank goodness that you do develop a DR while pregnant - otherwise your abdominal muscles might rip, or the baby wouldn’t be able to grow big enough to survive outside of the womb.
Oh no! So there’s really no exercises I can do to prevent diastasis recti while pregnant?
There is nothing you can do to completely STOP a DR from developing, but there is plenty that you can do to help improve your core strength and decrease the effects of a DR while pregnant! We have plenty of evidence to show that exercise during pregnancy can help reduce the size of a DR, prevent the development of urinary incontinence, decrease your risk of things like needing a C-section or having a preterm delivery, and improve the speed of your postpartum recovery. If you have questions about the safety of exercising in pregnancy, check out this link for FAQs on exercise in pregnancy, and this link for more specifics in a scholarly article (the Committee Opinion on “Physical Activity and Exercise During Pregnancy and the Postpartum Period” from the American College of Obstetricians and Gynecologists, aka ACOG).
Ok, so can you explain a little more about what a DR is exactly? I don’t think I understand it all.
Absolutely - this is a common source of confusion for most people! So, most of us know about the abdominal “six pack” muscle - aka the rectus abdominis. This is the highly-visible muscle in the center of the abdomen that creates a six pack in people who do a lot of sit-ups. As you’ll notice, to create the “six pack” effect there are two vertical lines of muscle, which are the right and left halves of the rectus abdominis. And in-between them is something called the linea alba. The linea alba is fascia, or connective tissue, that helps join the right and left halves of the abdominals together. It’s made up of fibers from ALL of your abdominal muscles, including the rectus abdominis, your external and internal obliques, and even your transverse abdominis! The linea alba is what lengthens, or stretches, during pregnancy to allow the baby to grow. So, it is also what creates the phenomenon of diastasis recti.
Oh wow, so then how do I know if/when I have a DR during pregnancy or postpartum?
This is another great question without a very clear answer. Clinically, the most-commonly accepted definition of DR is a separation between the two halves of the rectus abdominis (also known as the “inter-recti distance”) of greater than 2.0cm. Other signs are visible “coning” or “doming” of the middle of the belly with activities like coughing, sitting up from a reclined position, or when lifting anything heavy. At MommaStrong, we don’t recommend checking your own belly for a DR, as it’s difficult to know what you are feeling. Plus, there isn’t agreement on the best way to assess for DR anyway, and a self-check tells me nothing about how you are actually using your abdominals during daily activities!
When can I expect a DR to resolve postpartum?
Again - a wonderful question and one that we don’t have a ton of research on! Generally-speaking, if an abdominal separation hasn’t resolved by about 8 weeks postpartum, then we would say the abdominal wall likely needs extra help to recover. However, it is very common for a DR to persist for many months after pregnancy - this study found that a DR persists at 6 months postpartum in 45% of people, and even at 12 months postpartum in 33%. But good news - there’s a lot you can do to correct a persistent DR! You can see a pelvic/women’s health physical therapist, or do exercise programs designed for postpartum recovery like MommaStrong.
But I can expect my abdominal separation to return to zero, right?
No! This is another very common myth. No one ever has a zero-centimeter separation between their rectus abdominis muscles, even if they’ve never been pregnant! A 2022 systematic review and meta-analysis found the width of the linea alba ranges from 0.2cm-1.2cm in women who had never been pregnant. Since we don’t know what your particular separation was prior to pregnancy, it’s hard to say what width of the linea alba is “normal” for you. So, we like to rely more upon functional goals, like being able to care for your baby without increased lower back or pelvic pain, be able to cough and sneeze without leaking pee, and do core exercises without seeing any abdominal coning or doming. Plus, as you work to strengthen your core, the width of your gap may actually increase, and that’s ok! We care much more about the function of your abdominal wall that the gap in-between two sets of muscles.
Awesome, so I need to get started on core strengthening now then! What core exercises are safe for pregnancy, and how can MommaStrong help me?
This question has an easy answer - all of MommaStrong is safe for pregnancy unless noted otherwise! We have a whole program designed for pregnancy called Momma-to-Be that can take you from that positive pregnancy test up until the day you deliver. You will be working your core in every video whether or not you know it! And then of course, we have plenty of content to help you recover postpartum, starting day 1 with our 5-min Hazy Days videos. After 8 weeks postpartum, you will transition into our New Momma program, and then can also complete any of our other DR and core-specific extra content.
References (in order of appearance)
Fernandes da Mota, P. G., Pascoal, A. G., Carita, A. I., & Bø, K. (2015). Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual therapy, 20(1), 200–205. https://doi.org/10.1016/j.math.2014.09.002
Mota, P., Pascoal, A. G., Carita, A. I., & Bø, K. (2018). Normal width of the inter-recti distance in pregnant and postpartum primiparous women. Musculoskeletal science & practice, 35, 34–37. https://doi.org/10.1016/j.msksp.2018.02.004
Chiarello, Cynthia M. PT, PhD1; Falzone, Laura A. PT, MS2; McCaslin, Kristin E. PT, MS3; Patel, Mita N. PT, MS4; Ulery, Kristen R. PT, MS5 The Effects of an Exercise Program on Diastasis Recti Abdominis in Pregnant Women, Journal of Women's Health Physical Therapy: Spring 2005 - Volume 29 - Issue 1 - p 11-16
Davenport, M. H., Nagpal, T. S., Mottola, M. F., Skow, R. J., Riske, L., Poitras, V. J., Jaramillo Garcia, A., Gray, C. E., Barrowman, N., Meah, V. L., Sobierajski, F., James, M., Nuspl, M., Weeks, A., Marchand, A. A., Slater, L. G., Adamo, K. B., Davies, G. A., Barakat, R., & Ruchat, S. M. (2018). Prenatal exercise (including but not limited to pelvic floor muscle training) and urinary incontinence during and following pregnancy: a systematic review and meta-analysis. British journal of sports medicine, 52(21), 1397–1404. https://doi.org/10.1136/bjsports-2018-099780
Syed, H., Slayman, T., & DuChene Thoma, K. (2021). ACOG Committee Opinion No. 804: Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstetrics and gynecology, 137(2), 375–376. https://doi.org/10.1097/AOG.0000000000004266
Wadhwa, Y., Alghadir, A. H., & Iqbal, Z. A. (2020). Effect of Antenatal Exercises, Including Yoga, on the Course of Labor, Delivery and Pregnancy: A Retrospective Study. International journal of environmental research and public health, 17(15), 5274. https://doi.org/10.3390/ijerph17155274
Sperstad, J. B., Tennfjord, M. K., Hilde, G., Ellström-Engh, M., & Bø, K. (2016). Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British journal of sports medicine, 50(17), 1092–1096. https://doi.org/10.1136/bjsports-2016-096065
Wang, Y., & Wang, H. (2022). Systematic review and meta-analysis of the inter-recti distance on ultrasound measurement in nulliparas. Journal of plastic surgery and hand surgery, 1–7. Advance online publication. https://doi.org/10.1080/2000656X.2021.2024555
Lee, D., & Hodges, P. W. (2016). Behavior of the Linea Alba During a Curl-up Task in Diastasis Rectus Abdominis: An Observational Study. The Journal of orthopaedic and sports physical therapy, 46(7), 580–589. https://doi.org/10.2519/jospt.2016.6536