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Bridging the Gap -- Diastasis Recti Postpartum


Diastasis Recti (DR) is a separation or thinning of the connective tissue known as the linea alba that separates the rectus abdominis muscle (6-pack ab muscles). Many people will also refer to this as "Mommy pooch or Mommy tummy." Whether it is for aesthetic reasons or function, it can be frustrating healing a diastasis recti and may even be a little scary if you're not sure what to do about it. But, with help from a physical therapist with experience in postpartum diastasis recti treatment, there really is no reason to be scared! There is a lot that can be done to help you rehab and strengthen your core and improve your diastasis.


Another common question I get is "How can I prevent diastasis recti while I'm pregnant?" And the truth is, you really can't prevent it 100%. The research shows that all women have some form of a diastasis at the end of their 3rd trimester. It's completely normal! Think about it, your belly is growing as your baby is growing. Your abdominal muscles must naturally lengthen and stretch to allow room for this growing baby! But, I am here to tell you that there are things you can do during pregnancy that may help prevent your diastasis from being more severe. Also, diastasis recti physical therapy can help you improve your function and quality of life postpartum. Seek out the help of a local physical therapist both during pregnancy and postpartum!


Maybe you're reading this blog because you've been told that you need to restrict certain movements & you've become fearful of moving at all. I'm here to tell you that this is not true. Our bodies NEED movement and I firmly believe no exercise is a bad exercise, but there may be some exercises that aren't appropriate for you AT THIS TIME. That does not mean forever. A big piece of diastasis rehab is to first learn how to use ALL of your abdominal muscles. This typically starts with learning how to coordinate and activate your deep core (the diaphragm, pelvic floor, and transverse abdominis) but then we need to make sure we include the obliques, rectus abdominis, and the entire body really!


Exercise progression & challenging the abdominal muscles and body with the right amount of load is KEY to healing your core postpartum. We must challenge you enough, but not too much!


Let's talk about a few things that can guide you when performing core exercises with a diastasis:

- Doming of the abdomen at the linea alba (midline) -- doming does not mean you have to stop the exercise or it doesn't mean you're making your diastasis worse, but it is a great tool to use as feedback! If you see doming -- check in & make sure you are breathing. Try to exhale on the hard part of an exercise to see if that improves the tension in your core. If you are having a hard time managing the pressure for that particular exercise, you may try a modification and work on that for awhile before progressing to a more challenging exercise.

- When to progress exercises -- no pain during or after the exercise, no leaking, no increased or new symptoms of pelvic heaviness, you feel like you have control over your core when performing the exercise, you are not bearing down during the exercise, you are able to perform the exercise without significant doming, and you are able to maintain proper form while the exercise feels easy


Dr. Munira Hudani, PT developed an acronym to help you think about all of these to know when to progress your DR exercises:

PLP - CC - DEF

-Pain

-Leaking

-Pelvic pressure

-Core control

-Core strategy

-Doming

-Easy

-Form control

*This is a great tool she developed to help guide you in readiness to progress an exercise!


Here is just one example of an exercise progression using the Straight Leg Raise exercise:




This is just one example of how we may progress an exercise to challenge your abdominal muscles gradually to improve your core strength. Diastasis is a total body issue, so when assessing a patient I am always looking at the whole body! We are addressing breathing mechanics, posture/alignment, body mechanics when lifting, total body strength, mobility limitations, core and pelvic floor strength and function, etc.


If you are struggling with healing your core postpartum, need help starting or returning to a fitness program, want to stop peeing your pants when sneezing/laughing/working out, or want to pick up your baby/toddler without pain...please know that there is help. Physical therapy can help :)


I'd love to help you! Please email me with any questions at restore.physicaltherapy614@gmail.com


Kaitlin Hartley, PT, DPT, PPCES

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