During pregnancy, as the belly grows, what many women don’t realize is that, to accommodate that growth, changes occur not only in the uterus and skin (hello, stretch marks!), but all the way down to the abdominal muscles.
That’s because, as your babe grows larger toward the later stages of pregnancy, your belly needs to expand out further than the abdominal muscles allow. This expansion is possible thanks to the linea alba—a line of connective tissue that runs from under your sternum to your pubic bone, and connects the two sides of your “six pack” muscles, or rectus abdominis muscles. The linea alba stretches and becomes lax, allowing your baby to have more room than it would otherwise.
It’s really quite phenomenal that your body is able to do this! However, this increased laxity in the linea alba can cause a separation between the abdominal muscles that can stick around long after pregnancy. This common separation is termed diastasis recti abdominis (DRA).
When your linea alba loses its ability to generate tension, it can’t support your belly very well. In fact, diastasis recti is often the cause of “stubborn” post-baby bellies. If you suffer from DRA, you might think that you look bloated all the time, or that you look four months pregnant when you’re really two years postpartum, and despite your best efforts, you haven’t been able to slim your midsection.
In “mom” talk, the connective tissue that runs down the midline of your belly, is now like a pair of yoga pants (aka everyday pants) you can see through when you bend over. That stretch, that thinning of the fabric… that’s what diastasis recti is like.
The connective tissue becomes more stretched, not as dense, not as “thick,” which leads to a very measurable separation between the two sides of your abdominal muscles. The gap can extend all of the way from your sternum bone to your pubic bone, or just somewhere along that line. Typically, the largest gap will be around the belly, giving you that “ever pregnant” appearance.
Or, even more serious to your health and workouts, maybe your feel that your lower back and pelvis aren’t as stable and secure as they once were. As the connective tissue of the linea alba becomes stretched, widened, and thinned, it can impair the ability of the abdominal muscles, and entire core system, to do their best work.
This means that you’ve lost some of the support network for the core, the spine, and potentially, your abdominal and pelvic organs. This loss of support can result in increased risk of injury to the low back and pelvic floor concerns such as incontinence. If you’re unsure if you have DRA, you might find this article on the signs of diastasis recti helpful.
Before you stress… DON’T! Diastasis recti is a very common occurrence with pregnancy and you can heal it. Here are three steps to do just that:
Step 1: Stack Your Body in Good Alignment
Think of alignment as how your body’s joints and bones stack up to create your posture. That posture can either be strong, supported, and encourage proper movement patterns, or it can be weak, and lead to losses in core strength. For example, if you are in a chronic “rib thrust” position (in which the bottom of the ribcage is positioned forward and upward, ahead of the torso), the linea alba could be constantly overstretched. With good alignment, the muscles and connective tissues have the right amount of length and tension.
Getting your body into good alignment is like the tale of “Goldilocks and the Three Bears.” You don’t want your spine too straight or too curved. You want it just right. That “just right” alignment is called the “neutral spine position.” This alignment gets the diaphragm stacked over the pelvic floor muscles to allow for the core stability system to work its best.
Here’s how to get into a neutral spine position and proper alignment:
- Stand with your feet facing straight ahead and directly under your hip bones (not as wide as your pelvis).
- Position your ribcage over the top of the hips.
- Allow a slight arch in your lower back so that your bum is “untucked.” Your tailbone should not be tucked under your torso.
- Focus on maintaining a tall thoracic spine,) thinking of growing up through the crown of the head. Allow a gentle forward rounding of the top section of the spine.
When healing your diastasis recti, use this alignment in all exercises and in daily life. The photo on the right shows what this alignment looks like when I am standing.
Step 2: Improve Your Core and Floor Connection
Understanding how to gain and release tension (engage and relax) in your core and pelvic floor muscles is extremely important for supporting your tummy in daily life and when exercising. When the ribs are over the hips, the diaphragm is stacked over top of the pelvic floor. This helps the pressure system in the core work well. When you inhale, the diaphragm moves downward slightly and the pelvic floor stretches to allow this change in pressure. When you exhale, the diaphragm moves back upwards and the pelvic floor contracts upwards, too. DRA occurs when the pressure system in the core isn’t managed well.
Here’s how to improve your Core and Floor Connection:
- Lie down on the floor on one side, making sure that your head, hips, and heels are in one straight line
- Drape your top arm over the front of your ribcage.
- Take a deep inhale breath, focusing on sending air into your ribs, belly, and pelvis.
- Then, perform a full exhale, feeling your top arm fall back toward your body, and a gentle “lifting up” sensation through your abs and pelvic floor. Focus on lifting your pelvic floor muscles up into your body and raising your belly button up toward your breastbone.
Note: The contraction is very gentle. Think of it as about only 30 percent of your maximum ability of contraction.
Step 3: Perform These Exercises to Heal Your Diastasis Recti
Now that you you’ve learned the core and floor connection, it’s important to use that connection to help heal your diastasis recti during “tummy safe” exercises, as my colleague Beth Learn from Fit2B would say. By “tummy safe,” I mean that they are going to challenge you to strengthen your core musculature, but will not cause any harm to your abdominals and pelvic floor. These exercises help to create tension, density, and strength in the linea alba.
For instance, I recommend that, while healing your diastasis, you avoid exercises that involve facing your belly to the floor (front-loaded positions) such as pushups, front planks, and bear crawls. The core may not be able to manage the pressure and intensity created by these exercises. Exercises like pushups or front planks require so much coordination of the core to be able to maintain proper form. Sometimes women feel that they can’t control the abdominals in that position. Their belly bulges outward, or they feel pressure downward into the pelvic floor.
In addition, exercises such as crunches, sit-ups, v-ups, and double-leg raises may also create a bulging belly. The bulging can occur when the core isn’t able to properly control the intra-abdominal pressure. The pressure from the ‘load’ has to go somewhere and usually goes outward. This can happen to anyone who doesn’t have proper intra-abdominal control, not just women with DRA.
Below are some of my favorite “tummy safe” core exercises for women completing diastasis recti rehab. Remember to use the core and floor connection in all of these exercises, exhaling through the toughest part of each exercise.
Heel Slides with Alternate Arms
- Exhale, extend one leg out straight, hovering the leg above the floor
- Simultaneously, extend the opposite arm towards the floor above the head
- Ensure the hips stay stable
- Inhale to return to the start position
- Exhale, squeeze the glutes, and lift the hips upwards until the body is in a straight line from shoulders to knees
- Inhale to return back down to the floor
Half-Kneeling Pallof Press
- Squeeze the back leg glutes tight
- Exhale to press the arms straight out in front of the chest
- Feel tension in your core to resist rotation as you press outwards
- Inhale to return back to the start position
One-Arm Farmer’s Carry
- Hold a dumbbell or kettlebell slightly away from the body
- Walk at a normal strolling pace
- Keep your body tall and centred (avoid slumping to one side)
Side-Lying Knee Abduction
- Get into a side lying position on the floor with your hips and knees bent to 90-degree angles. Make sure your head, shoulders, and hips are aligned (not rotated forward or backward)
- Keeping the 90-degree bend at the hip and knee, raise the top leg, opening up the hips, and then lower the leg back down to bring the knees together.
- Place a hand on the top hip so you can feel your hips staying stable.
Be patient with yourself, stay consistent! By prioritizing proper alignment as well as the core and floor connection in all of your exercises and in daily life, you’ll go a long way toward healing your diastasis recti and improving your core health.