Got “mummy tummy?” Then you may, or may not, have diastasis recti.
Diastasis recti, or DR, is the over-widening and thinning of the mid line tissue during pregnancy and postpartum. Here are the facts you need to know about this common, yet widely misunderstood condition.
Myth #1: Almost every pregnant women gets DR.
Reality: Estimates range from 30%-98% of pregnant women will develop diastasis recti, also known as abdominal separation. This wide range and the confusion that surrounds it are due to several factors. Hard to believe, but the basic definition of DR has not been defined, nor has testing protocols. In the US, most prenatal fitness pros define DR as a mid line that is wider than 2.5 finger widths or about one inch.
Testing protocols, such as when and how to test vary. For most women, as they do the crunch-test, the mid line will close as the intensity of the contraction increases. So if you only gently contract your abs by lifting just your head off the floor you might think you might think that you have DR. To get an accurate test, you must lift the shoulders slightly off the floor, not just the head.
Hand position counts. The fingertips must be held parallel to the waist when testing. You’ll see plenty of videos that get this wrong, with the fingertips held parallel with the mid line. You also need to test above and below the belly button as diastasis can occur at, above, or below the belly button.
Testing too soon. For most new moms, the mid line closes on its own, at least partially, in the first month or so after delivery. Testing before 6 weeks postpartum will likely give you an inaccurate reading. But if after the initial postpartum period your mid line remains more than 2.5 fingertips wide, then special rehab exercises are warranted. Not just to flatten the belly, these rehab moves restore proper core strength and functional stability, and prevent complications such as back pain and umbilical hernia.
Myth #2: Diastasis recti can’t be prevented.
Reality: Pregnant women can, and should, take basic steps to prevent the condition from occurring in the first place. DR results from too much strain on the mid line tissue. To prevent DR, it’s best to take a two-prong approach.
First, you need to avoid all activities that place added strain and/or shear forces on the mid-line. Once your bump pops out, don’t do any moves that flex your upper body against the force of gravity (think crunches, many Pilates mat/reformer exercises), moves that twist the spine (bicycles, wood chop, triangle pose), and moves that cause your bump to bulge away from your spine (yoga “belly breathing”), and heavy lifting.
All pregnant women should do the “log roll” technique when rising from the floor or getting out of bed.
Second, all pregnant women should strengthen their deepest core muscle, the transverse abdominis (TvA), to provide much needed bump support. The TvA is our body’s internal “corset,” and when contracted compresses the abdomen. Safe prenatal TvA exercises include “Baby Hugs,” and “Baby Lifts” from either the standing or seated position.
Women who had DR in a previous pregnancy or have mid-lines are more than 2 finger-widths wide after the 24th week of pregnancy should splint their mid lines closed with their hands as they work their TvAs.
During all types of exercises, and movements like lifting and carrying, it’s important to perform abdominal bracing (a light contraction of the TvA) to support the mid line.
Myth #3: One postpartum exercise will fix it.
Reality: While most postpartum rehab systems start by rebuilding strength in the TvA, this is only step one. The TvA is our primary core stabilizer, and this function must be redeveloped with specific postnatal core rehab exercises. Because of postnatal ligament laxity, even basic core stability exercises can present quite a challenge after baby. These types of exercises are key to closing the mid line and flattening the belly, as well as laying the foundation for the safe resumption of strenuous fitness activities, or just lugging around heavy baby equipment without pain or injury.
Myth #4: You need to wear a special splint for months.
Reality: Postpartum belly binding in various forms has been used across all human cultures for millennia. Directly after childbirth, belly binding helps to support internal organs, and reduce back pain, pelvic instability, and mid line strain. But after the initial postpartum period, continual wearing of any type of external support garment can do more harm than good. Splints and other postpartum compression garments inhibit TvA activation. When wearing a compression garment, the TvA doesn’t need to do its job of stabilization, so it doesn’t. Over time, reliance on such a garment erodes core strength and torso stability and prevents full postpartum recovery.
Myth #5: If you have a “mummy tummy,” you have DR.
Reality: Lots of women end up with an overly round, distended abdomen (“Help, I still look pregnant!”) that no amount of crunches can fix. While some women with “mummy tummy” have DR, plenty do not. If you do lots of traditional ab exercises like crunches, without adequate TvA strength, then your belly will bulge outward during exertion. This common mistake prevents mid line closure and the belly from flattening after pregnancy. Why? Because in fitness, what you practice is what you get. (Muscle specificity theory.)
Fortunately, even if you had your last baby years ago, you can do postnatal rehab moves to build proper abdominal functioning and banish your baby belly.
Pre-and-Post-Natal Fitness, by Lenita Anthony
Therapeutic Exercise, Foundations and Techniques, 2nd edition, Kisner and Colby
Exercise After Pregnancy: How to Look and Feel Your Best, 2nd edition, by Helene Byrne