Act I. 

Scene I. 

“To core or not to core: that is the question”. 

Okay, those aren’t the exact words of William Shakespeare, but let’s be honest, conversation around diastasis recti abdominis (DRA) and exercise feel as ambiguous as Shakespeare. The information can feel overwhelming and unclear as to what strength and core exercises should and should not be done with confirmed DRA. A natural part of any pregnancy, DRA should not be feared or dramatized, we’ll leave that up to the Shakespearean actors and actresses! Instead, let’s dive into the literature and discuss what diastasis recti abdominis is, why it occurs, and the best diastasis recti abdominis exercises. 

 

What is Diastasis Recti Abdominis?

Beyond three intimidating words, diastasis recti abdominis refers to the separation of the two muscle bellies of the rectus abdominis, the often glamorized “six-pack muscle”(1). During pregnancy, a growing fetus causes expansion and separation of the abdominal wall. This occurs most frequently in the third trimester and into the postpartum period and is extremely common and natural(2)! While the separation of the abdominal wall is needed during pregnancy, there is concern that confirmed DRA can contribute to low back pain, pelvic girdle pain, and impaired abdominal muscle strength (3).

 

Looking for other ways to strengthen your core musculature besides just doing a plank? Check out this video HERE to learn a few of our favorite core strengthening exercises! 

 

It is important to recognize that there are MANY physiological changes that occur during both pregnancy and the postpartum period that could contribute to low back pain, pelvic girdle pain, and weakened abdominal muscles. But with the prevalence of DRA being high, we should not discredit its importance!

To determine diastasis recti abdominis, the distance between the two muscle bellies is measured. This can be done with ultrasounds, caliper, and palpation using two fingers. Clinicians often assess both distance and depth of the DRA (3). Measurement is taken 4.5 cm above and below the umbilicus, and then directly at the umbilicus as demonstrated in the picture above. DRA is classified as mild if the interrecti distance is greater than 2.5 cm, and is thought to be severe if >5 cm (3). Do not try this at home! Please seek out a skilled professional with training in the management of DRA to measure and manage this diagnosis.

 

LEARN MORE ABOUT OUR POSTPARTUM REHAB PROGRAM

Looking to level up your core, pelvic floor, and confidence with our 8-week Postpartum Rehab program through the [P]rehab App! Get started today! 

 

So, how prevalent is diastasis recti abdominis in our childbearing population? In a study that looked at first-time mamas, the prevalence of DRA was determined to be 33.1% at 21 weeks gestation, 60% at 6 weeks postpartum, 45.4% at 6 months postpartum, and 32.6% at 12 months postpartum(4).

It should be taken into consideration that the prevalence values of DRA will vary secondary to a lack of consistency with measurement techniques and a lack of a universal agreement around the definition of DRA. We also recognize that separation of the abdominal muscles is normal, needed, and common during pregnancy! 

So, how can we best support our mamas in the management of DRA? Keep scrolling to find out!

 

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Does Exercise Help Diastasis Recti Abdominis?

The short answer to this question is “yes”. The longer answer to this question is “there is lacking evidence to support THE BEST exercise intervention to treat DRA”. What we do know is that intervention surrounding proper lifting mechanics, intra-abdominal pressure regulation, posture education, and guided core strengthening can be instrumental in managing DRA. Several studies have looked at the influence of exercise on DRA, and the conclusion remains the same: appropriate and guided exercise does not harm!

 

LISTEN: LIFTING WEIGHTS POSTPARTUM

 

In a study that looked at a 12-week online program that prioritized diaphragmatic breathing, bridge variations, plank variations, and dead bug variations for the management of DRA, a meaningful change in DRA measurement was seen in two of the six locations along the linea alba for single pregnancy participants that were 6-24 months postpartum (2).

 

READ: BEST PLANK EXERCISES

 

Another study looked at women 3-6 months postpartum with confirmed DRA. One group underwent the use of abdominal bracing which included diaphragmatic breathing, pelvic floor contraction, plank, isometric abdominal contractions, and the use of a towel or sheet to secure the abdomen. In addition to this abdominal bracing regimen, this group also performed a traditional core program. The control group performed just the traditional core program. It was found that those who performed both the abdominal bracing program and the traditional core program had improved outcomes in DRA management compared to the traditional core program alone (5). 

Try a few diaphragmatic breathes as seen in the exercise below! This exercise can be performed in both sitting and on your back and can serve as the foundation for many core-based exercises postpartum or during pregnancy!

 

Seated Diaphragmatic Breathing:

 

Bridge – Adduction:

I like the bridge version with hip adduction as the adduction can serve as a great way to initiate core stability as well as lumbopelvic stability. Try a few repetitions without the adduction squeeze and a few without and see if you notice a difference!

 

Dead Bug:

One of the stated exercises in the study above was a dead bug. This is another good exercise as there are so many variations that can be done! Start with mastering the core engagement with the leg movement and then progress to different variations with the use of your arms!

 

Now I know what you’re thinking…the two studies above are looking at women who are not acutely postpartum. So, where are the studies looking at the benefit of exercise shortly into the postpartum period? Look no further. 

This study looked at the effectiveness of isolated transverse abdominis exercise on DRA in participants just 6-12 weeks postpartum. A small group of women performed transverse abdominis engagement exercises (aka guided core exercises) in four different positions, 4-5 times per week. Diaphragmatic breathing was incorporated in the engagement of the transverse abdominis, and a positive change was seen in DRA amongst the participants (6). Additionally, if we look into the timeframe of pregnancy alone, a large systematic review found three studies that supported the reduction of DRA prevalence by 35% with exercise DURING the pregnancy (7).

LEARN MORE ABOUT OUR POSTPARTUM REHAB PROGRAM

Looking to level up your core, pelvic floor, and confidence with our 8-week Postpartum Rehab program through the [P]rehab App! Get started today! 

 

So, does exercise help DRA? The evidence presented here all points in the direction of “heck, yes, sign me up!”. When in reality, we are still lacking quality studies and sufficient research to confirm that exercise alone can prevent or reduce DRA. And while we can’t yet state that exercise reduces DRA, we can support that safe exercise during pregnancy and in the postpartum period can assist in the management of DRA (7). 

 

READ: PELVIC FLOOR DYSFUNCTION IN ATHLETES 

 

 

Closing thoughts

“To core or not to core: that is the question”. Guess what, folks? We should core, strength train, stay active, and modify exercise when needed both during pregnancy and postpartum!

We can agree that exercise, including core-specific exercise, is not detrimental to DRA as long as it is performed safely and with guidance from a trained professional! Physical therapists who manage exercise in pregnant and postpartum individuals have undergone specialty training to best guide this population back to their preferred health and goals. Find a physical therapist that is trusted and updated on the most recent research regarding the management of DRA as they are best equipped to help guide you through a strength program specific to the needs of your body! 

Let’s leave the tragedy up to Shakespeare and support our mamas through diastasis recti abdominis. 

Exit.

End of Act I.

 

References

1. Venes D, Taber CW. Taber’s cyclopedic medical dictionary. 20 edn. Philadelphia: Davis, 2005.
2. Laframboise FC, Schlaff RA, Baruth M. Postpartum Exercise Intervention Targeting Diastasis Recti Abdominis. Int J Exerc Sci. 2021;14(3):400-409. Published 2021 Apr 1.
3. Gluppe S, Engh ME, Bø K. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis. Braz J Phys Ther. 2021;25(6):664-675. doi:10.1016/j.bjpt.2021.06.006
4. Sperstad JB, Tennfjord MK, Hilde G, Ellström-Engh M, Bø K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med. 2016;50(17):1092-1096. doi:10.1136/bjsports-2016-096065
5. Thabet AA, Alshehri MA. Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial. J Musculoskelet Neuronal Interact. 2019;19(1):62-68.
6. Tuttle LJ, Fasching J, Keller A, Patel M, Saville C, Schlaff R, Walker A, Mason M, Gombatto SP. Noninvasive treatment of postpartum diastasis recti abdominis. J Womens Health Phys Therap. 2018; 42: 65–75.
7. Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014;100(1):1-8. doi:10.1016/j.physio.2013.08.005

 

About The Author

Lyndsay Provencio, PT, DPT

[P]rehab Writer & Content Creator

Dr. Lyndsay Provencio graduated from Colorado State University with a BS in Health and Exercise Science and a concentration in Sports Medicine. After multiple personal sports-related injuries and discovering a passion for healing through movement, Lyndsay attended Creighton University to receive her Doctorate of Physical Therapy. An avid runner herself, she has a particular interest in working with high school, recreational and elite endurance athletes and has undergone specialty training in pelvic floor rehabilitation to better serve her clientele. Through this specialty training, she has acquired a Certificate of Achievement in Pelvic Health Physical Therapy through the American Physical Therapy Association. Additionally, Lyndsay is BSPTS C2 certified in scoliosis specific exercise and has found a niche working with adolescents with scoliosis to improve overall spinal health. No, you’re not seeing double! Lyndsay is an identical twin to Lauren Lynass, one of our [P]rehab rockstars. A native of Colorado, Lyndsay is an adventure seeker who loves to hike, camp, and race her twin sister on the mountain trails. When the Portland rain hits, you can find her curled up with a good book and a cup of tea.

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.