Have you ever though you had diastasis recti after pregnancy? Do you notice coning or doming when you attempt core-specific exercise, lifting items overhead, or when sitting up in bed? Are you pregnant or have you recently delivered a baby in the past 6 months? This separation is referred to as diastasis recti, which is the formation of a gap between the two sides of the rectus abdominis muscle (your six pack muscles). It is a common dysfunction present after pregnancy and can be addressed successfully through physical therapy.
Key Points to Discuss:
- The causes of diastasis recti
- Symptoms and movements you should be aware of and monitor while pregnant and postpartum
- Normal healing timeline
- Safe exercises that you can perform to expedite healing
Diastasis recti is a 100% normal occurrence during pregnancy. As your belly grows, your abdominal muscles are stretched out to accommodate the growing fetus. Your linea alba is the tendon that connects your abdominals together in line with your belly button. This becomes thin and stretched near the end of your pregnancy and can show signs of stress via ‘coning/doming’. This indicates poor pressure management and reduced abdominal strength.
It is also normal for abdominal separation to remain present for a period of time postpartum. It is estimated that 50-55% of women have continued diastasis recti at 6 weeks postpartum. In order to rebuild your fitness after delivery, you need to understand what important symptoms to manage to facilitate healing.
When we return to any exercise postpartum there are a few things we want to look for to ensure we aren’t overdoing things.
Symptoms to be aware of include:
- Heaviness of the vagina
- Pain with sex
- Coning / Doming
Coning/doming is what is most related to the separation of the abdominal muscles with diastasis recti (see image above). This small protrusion is a sign of abdominal pressure being higher than the abdominal wall is ready for. When we see coning/doming, we will typically alter an exercise or slightly decrease the intensity of exercise to a level at which pressures can be better controlled.
This can vary very much person to person and is largely driven on size of separation. Diastasis is prevalent in 45% of females at 6 months and 33% at 12 months postpartum. Healing time can also be influenced by larger rib angle, postural impairments and impaired coordination of breathing as it relates to the diaphragm-pelvic floor relationship.
Safe Exercises to Perform:
For those with coning/doming issues during exercise, modifying our abdominal strength movements to where we are regaining control is a great start. Here are 3 drills to do that:
1. 90/90 Breathing with Abdominal Contraction
This is one of the most important foundational movements when recovering postpartum. As your belly grows, your ribs spread which lengthens your diaphragm and places it in a less efficient position. The diaphragm and pelvic floor work together like a piston; as you breathe in, the diaphragm contracts and pushes down while the pelvic floor eccentrically lengthens. As you exhale, the diaphragm returns to its natural position and the pelvic floor contracts upward. Being aware of this relationship and encouraging correct movement patterns is helpful in restoring appropriate pressure management.
2. Hollow Body Holds
Demonstrated below are the typical hollow body holds we would see an athlete in a CrossFit class do. For the postpartum athlete, we will work on developing control of all abdominal muscles. So in this case, I’ll have women hold one hand on their core to feel for their six-pack muscles. During hollow holds here we’ll find the hardest version we can handle without the six-pack muscles protruding above the other abdominal muscles. This may include keeping one or both knees bent or keeping arms tucked in towards your side to reduce difficulty.
3. Weighted Marches
Because many of the women we treat are getting back to running or functional fitness we also employ lots of weighted carries to challenge the body as an entire unit. Again, watching for coning/doming during these exercises.
If you are dealing with persistent diastasis recti issues, I would love to game plan a long term solution for you! Schedule an appointment at Onward Denver for an assessment and treatment plan.