HOW TO HEAL DIASTASIS RECTI ABDOMINIS - A PLAN THAT WORKS
Let me remind you of this before we jump in here: there is no recipe to heal any injury. You are unique! Your health and history are unique.
This is especially true when it comes to diastasis rectus abdominis. It’s a complex beast of unknown origin! There are no evidence-based risk factors beyond being pregnant and heavy lifting (according to the science). And when we can’t put our finger on the exact cause of your injury, we cannot follow a prescripted recipe. It just won’t get you where you want to be efficiently (re. safely and quickly).
When it comes to healing your diastasis, you need to take a multi-faceted approach. This is the framework that I encourage you to follow to get the results that you deserve.
1 WORK WITH A PRO
There is no substitute for working with someone one-on-one who will help you:
properly diagnose your diastasis
understand your pressure tendencies
understand your gripping and postural tendencies
address your digestive issues (ie constipation, bloating, gas)
address scar tissue & fascial adhesions (ie from C-section, abdominal, hip or lower back surgeries, and chronic tendencies)
meet your goals (for aesthetics and/or fitness)
rebuild muscle and connective tissue
2 LOAD IT
For tissue to remodel (which needs to happen to heal and rebuild the linea alba) appropriate load needs to be imposed on it.
As women, we typically don't load enough. The fact is, without enough load your body will not rebuild both the muscle and collagen you need or want.
“We are in a pandemic of underloading postnatal women.” - Gráinne Donnelly
Yes! I see this all the time when I am working with my clients. Women do not believe they are strong enough, and yet when encouraged, supported and/or given different cues they blow their beliefs out of the water.
I think there is a lot of fear factor around loading with diastasis. This is many thanks to social media and the fear factor around getting or worsening diastasis. Work with someone great and you'll progress safely and efficiently.
3 MIND THE GAP…AND KNOW THYSELF
It is important to get to know YOUR abdomen.
Get your hands and eyes involved in monitoring your abdomen with different exercises and strategies. Your physical therapist should help you here!
Know when your linea alba is nicely loaded and has good tone, and when it is slack. Know when certain muscles are dominant and when others are playing on the sideline.
Know what exercises or strategies widen your gap and which draw the two sides closer together.
Know what exercises or strategies cause your linea alba to dome or cave (more on that below).
4 LOOK BEYOND THE DOME
Consider that diastasis is more than just a stretched linea alba.
Understanding your PRESSURE SYSTEM is critical for rebuilding effectively.
Your pressure system is affected by:
your breathing:
Work on maximizing your deep inhalations so they expand your ribs (360 degrees), belly (yes, belly!), and chest. Work on long, full exhalations that tap into all of your abdominal muscles, creating a nice flat belly - no bulging/pooching or drawing in any one area (aim for evenness across the belly).
Address poor breathing patterns like: shallow breathing, belly-only breathing, or paradoxical breathing (when the belly draws in as you inhale).
your digestive health:
Work on eliminating chronic bloating, gas, constipation, and straining. The extra pressure in your gut will exert pressure on the abdominal wall - not what you want.
every structure of your trunk:
Ensure that you have good mobility and strength in all of the muscles of your trunk, from shoulder to shoulder, hip to hip. Work on stretching, foam/ball rolling or cupping areas that are tense.
Work on eliminating areas that you “grip” (tense) all day long - often the upper abs, pelvic floor, glutes, and jaw.
5 ALIGN YOURSELF
While there isn’t a “perfect posture”, there are optimal ways to move your body and it’s important to keep in mind that variety is important.
Let’s look at an exercise like a deadlift. There are certainly ways to deadlift (with poor alignment) that will wreck your knees or lower back, but there are multiple ways to deadlift with good alignment. And your well-aligned deadlift will vary slightly from my well-aligned deadlift because my anatomy is different than yours.
Ideal posture may vary from person to person, but the goal is always the same: good biomechanics. Which means our muscles, joints and ligaments are able to work optimally.
If we tend to live the majority of our day outside of our optimal posture, we risk injury to our joints, muscles, discs, and ligaments.
Optimal alignment (aka posture) of your torso is important for healing your diastasis.
Understanding that some postural tendencies will likely not help you heal your diastasis is the goal here. There are two biggies:
THE PELVIC DUMP (an anterior pelvic tilt)
This is a common posture during pregnancy and often continues into motherhood (common with babywearing and simply holding our babes and toddlers)
The pelvis dumps forward and the lower back over arches (hyperlordotic). While this isn't always an issue during pregnancy, it often does contribute to lower back pain, pelvic girdle pain, pelvic floor issues, and possibly DRA as it puts more stretch and tension on the abdominal wall.
If you have any of these symptoms, you might tap into your pelvic positioning during your day to see where you tend to be. Consider trying to stack your ribs over your pelvic and get that pelvis more neutral (level), not dumped forward.
If you have a strong tendency to live in an anterior tilt, try working on your:
lower ab strength
rectus (ab) strength
hamstring strength
glute strength
adductor (groin) strength
tight hip flexors, lower paraspinal muscles
THE TECH-NECK
Forward head posture is very often associated with upper ab gripping (dominance vs lower abs).
Very often there is more pressure down into the lower abdomen and even the pelvic floor. Women might have symptoms like stress urinary incontinence or pelvic organ prolapse. I see this often with my clients. They often complain of the "mom pooch" not going away and/or pelvic floor dysfunctions.
These postures may (or may not) contribute to diastasis because of poor pressure management.
Consider trying to:
stacked body alignment - ear in line with your shoulder, hip and lateral ankle bone
working on tight neck and jaw muscles
addressing poor breathing tendencies (work on better 360 degree expansion in those lower ribs)
glute eccentric strength (lengthening those glutes) - untucking the pelvis
lower abdominal strength
be mindful of where your head is in space when using devices like phones, computers and tablets
6 PATIENCE IS A VIRTUE
Persistent diastasis recti (beyond one year postpartum) will take time and work to regain tensile structure. There is no bouncing back, magic belly band, or as I said at the start, no recipe program that will expedite your progress.
Your body is unique and remodeling tissue is influenced by so many factors - many of which we simply don't understand or have control over. But tissue does remodel! Even women who had excess loose skin after having a baby say that it does diminish with time (with no work).
Put in the work and you will make a change.
Be strategic and smart - don’t waste your time with exercises that aren’t right for you or that don’t load your enough (see above)!
Work with someone great who will work you well!
You can do this!
