Beyond The Gap: Updates for Diastasis Recti Management

100% of women have have some degree of diastsis recti (DR) in the 3rd trimester. This isn’t stated here to increase fear but instead to let you know this is physiologically normal! Understanding DR and where you are in your journey will be helpful in managing it and related symptoms.

Here is just a bit of functional anatomy.

The fascia (linea alba) holds the two halves of your superficial abdominals together. This fascia is actually very pliable, just like taffy. That taffy gets a bit stretchy in the middle when you slowly pull outward on both ends, like with belly expansion during pregnancy. Usually, this is not a giant tear or hole in the fascia or muscle, as many women believe!

The goal is to regain the tension in the taffy between the muscles and not necessarily to bring the muscles together. We don't need to close the gap in order to look better, feel better and improve function!

The old way of DR assessment consisted of measuring the width of the gap. We still do that, but also important is testing if you can generate TENSION in the fascia when you engage during the test. And what happens to the fascial tension when you contract your pelvic floor and deep abdominal layer. This gives us way more valuable information about prognosis and ability to address symptoms related to DR. 

Let’s talk about management strategies along your pregnancy and postpartum journey with tips for better management during each phase!

Pregnancy

While you can't prevent DR, you can use strategies to avoid stressing it further while pregnant. I don't want you to be fearful of DR!! But a few tips here may be helpful in postpartum healing, so it's worth exploring

🌺 Avoid repetitive increases in intrabdominal pressures. This means breath holding while lifting something, straining to poo, etc

🌺 Alignment matters! How you stack your pelvis and torso keeps the pressure optimal and reduces the pull on DR

🌺 You want to optimally connect and coordinate the work between your pelvic floor, abdominal, diaphragm and low back muscles. See a specialist to guide you in this

🌺 Avoid engagement of your abs in a "sit up" fashion. Both as an exercise or as a strategy to move from your back to sitting up (always log roll onto your side and then sit up!)

🌺 Make sure you are breathing well! Using lateral expansion of your ribs is so important. There are SO many benefits, but the big ones are torso mobility, full access to your diaphragm, positive impact on DR, your pelvic organs and of course the pelvic muscles!!

Labor and Delivery

Yes, there are even some considerations for how to better manage DR when  on your labor and delivery journey!

🌺 advocate for the ability to be mobile during labor

🌺 avoid pushing that increases intra-abdominal pressure for sustained periods with a closed glottis. This means no purple pushing or closing your throat

🌺 choose positions where your sacrum can be free. Even if laboring on your back, this is still possible to modify so that your sacrum isn't restricted by the bed

🌺 advocate for practices that reduce the likelihood of operative birth procedures

Postpartum

These recommendations can be broken up into early and late postpartum strategies for management of DR. Remember to please give yourself the time and space for healing!! You can't technically be diagnosed with DR before 13 weeks postpartum anyway.

Tips in early postpartum (up to 13 weeks): .

🌺 practice postures that reduce excessive intra-abdominal pressure

🌺 reduce activity where you have repeated high intra-abdominal pressures (breath holding, constipation)

🌺 avoid engaging abs in a "sit up" fashion

🌺 establish good diaphragmatic breath

🌺 start with exercises that focus on coordination of abs, diaphragm and pelvic muscles and the progress once inner control is achieved

🌺 avoid high impact exercise

🌺 avoid exercises which cause incontinenc

Tips in late postpartum (after 13 weeks):

🌺 neutral spine posture and alignment

🌺 ensure good diaphragmatic breath

🌺 optimize body mechanics for day to day tasks

🌺 reduce habitual activity that increases intra-abdominal pressures (constipation, breath holding when lifting, pushing etc)

🌺 correct any exercise that causes doming of abdominal wall

🌺 approach concentric contraction of superficial muscles with caution (sit ups etc)

🌺 address any thoracic or pelvic contributions to DR

🌺 approach exercises that cause incontinence with caution

Reference: Establishing Expert-Based Recommendations for the Conservative Management of Pregnancy-Related Diastasis Abdomins: A Delphi Consensus Study. Journal of Womens Health Physical Therapy 2019

All women’s bodies are unique. If you would like to know more about how the above relates to your specific condition, email me here. Please also follow us on Instagram or join our private Facebook Group for a ton of free support on common women’s health concerns.

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