One of the most common topics I get asked about is abdominal separation. Is it preventable? Can you do things to minimise it? Can you fix it?
There is a serious lack of good quality research in this area and plenty of differing views. So I am going to debunk your questions according to the available evidence, my Masters-training, anatomical knowledge & clinical experience.
To cut to the chase, here are the answers to these common questions:
Can You Prevent Abdominal Separation During Pregnancy? NO
Can You Minimise Abdominal Separation During Pregnancy? YES
Can You Rehabilitate Abdominal Separation Post-Pregnancy? YES
Before we get into how to minimise & rehab abdominal separation, it’s really important that we dive into what’s going on in your body when abdominal separation occurs.
What is Abdominal Separation?
Abdominal separation is technically termed Rectus Abdominis Diastasis (RAD) or Diastasis Recti Abdominis (DRA).
It is the abnormal separation of the rectus abdominis muscles (the “6-pack” muscles) at the front of the abdomen. These muscles are divided right and left by a central connective tissue called linea alba. It is the stretching or weakening of the linea alba that causes an increase in separation between the rectus abdominis muscle bellies.
The degree of separation that is classified as abnormal is >2.7cm at rest. This is translated to approximately >2 finger width, and is best assessed by a Women’s Health Physiotherapist. If you are in Sydney, book to see me here!
What Causes Abdominal Separation?
Abdominal separation is very common in pregnancy, with majority of the pregnant women experiencing it in their third trimester. This is due to:
- Hormonal changes to the linea alba (connective tissue)
- Stretching of the abdominal wall to accommodate the growing baby
- Displacement of abdominal organs
How Do You Know If You Have Abdominal Separation?
During movements, such as sitting up from lying down, you will notice a bulging or doming along the vertical line of your belly button. This indicates you have abdominal separation.
This bulge may be evident during pregnancy and postpartum, and is something to be aware of and avoid! I will go into this more below.
Other times, your abdominal separation may not be as noticeable, which is why having an assessment by a Women’s Health Physiotherapist is a must. Please know that midwives are not trained to assess abdominal separation!
How to Minimise Abdominal Separation During Pregnancy?
- Learn how to activate your core muscles (deep abdominal and pelvic floor muscles) correctly by seeing a Women’s Health Physiotherapist in your second trimester of pregnancy. Perform these core activation exercises daily.
- Stand & sit with neutral posture. Commonly in pregnancy your arch in your lower back increases so stand up tall & gently tuck your tailbone under to reduce the arch in your lower back. Then draw your shoulder blades back & down.
- Avoid any movements or exercises that cause straining of the abdominal muscles or a bulge/doming i.e. sit ups/crunches, double leg lowers, planks or other advanced abdominal exercises.
- Roll onto your side to get out of bed and use your arm strength to sit you up rather than using your abdominals to pull you straight up.
- Use your arm & leg strength to pull yourself up from a low chair.
- Avoid lifting anything heavy that causes you to strain and hold your breath.
- Do Prenatal Pilates & other strength training 3 x week during your pregnancy.
- Do low impact exercise regularly during your pregnancy following my safe exercise guidelines here.
- Eat healthily during pregnancy to avoid excessive weight gain.
- Include collagen in your diet e.g. bone broth.
Can Abdominal Separation Resolve On Its Own?
Natural resolution of abdominal separation is possible, and has been shown to be most prolific in the first 8 weeks postpartum (Coldron et al 2008). However, in my experience as a Women’s Health Physiotherapist natural resolution without doing the right things during pregnancy & early postpartum is very unlikely.
One study reported that 32.6% of women still had abdominal separation at 12 months postpartum (Sperstad et al 2016). This is one of many reasons why postpartum recovery and core rehabilitation should be a priority from day 1 postpartum rather than waiting to see if dysfunction persists down the track.
Can You Rehabilitate Abdominal Separation Post-Pregnancy?
Yes, absolutely!
Your focus needs to be on restoring stability and function, so you can eventually get back to doing the activities and exercise you want without dysfunction or pain. Remember, the aim of the game is not about achieving complete closure of the muscles, as this is anatomically impossible.
It’s important to know that every body is different and therefore no two cases of abdominal separation are exactly the same. Just because a new mum you follow on Instagram recovered quickly, doesn’t mean your recovery will be the same. There are multiple contributing factors to the development & restoration of abdominal separation, and therefore it is not as simple as doing 1 exercise and it being “fixed”. Rehab takes time, consistency & guidance from a Women’s Health Physio.
How Do You Rehabilitate Abdominal Separation Post-Pregnancy?
1. Start core exercises day 1 post-birth
Hopefully you have seen a Women’s Health Physio during your pregnancy so you know how to activate your core muscles correctly day 1 after having your baby.
Learning how to correctly activate & isolate your transversus abdominis (deep abdominal muscle) and pelvic floor muscle is fundamental to restoring the function of your abdominal muscles. This is due to the fascial links between the deep abdominal muscles, and the rectus abdominis and linea alba. It has been shown that activating transversus abdominis, brings the rectus abdominis muscle bellies together and increases fascial tension of the linea alba (Lee et al 2008).
To optimise your core recovery, use my Early Postpartum E-book here!
2. Wear SRC recovery shorts post-birth
I recommend every woman wearing SRC Recovery shorts postpartum to provide medical grade compression to the abdominal muscles. They are designed to support the abdominal, pelvic floor and back muscles, whilst facilitating recovery by giving the muscles biofeedback to assist with their activation. You can wear this straight after you give birth if you have a vaginal birth or 5-7 days post c-section & up until 12 weeks postpartum.
If you live in Sydney I can measure & order these for you!
3. Posture and alignment
Correcting your posture & alignment is an important step in rehabilitating abdominal separation. This is because when you have upright, optimal posture core activation is much easier.
Your Women’s Health Physio will teach you this & give you strengthening exercises for your postural muscles. You can then incorporate postural awareness & strategies into your everyday life when you are breastfeeding, changing nappies, lifting & carrying your baby.
4. Movement Modification
The way you move, get out of bed, bend over, pick up your baby/toddler, put the pram in the boot and all the other many actions mums do, are essential to do in a way that supports your abdominal recovery.
You need to roll to get out bed rather than sitting straight up. You also need to activate your core before you lift your baby/pram etc. Your Women’s Health Physio will teach you this and how to move to prevent worsening your abdominal separation & causing back pain.
5. See a Women’s Health Physiotherapist at 6 weeks postpartum
This assessment is key to your rehab! A Women’s Health Physio assessment is different to your assessment with your GP & midwife. We will assess your abdominal separation, posture, how you move, and discuss your birth & any other symptoms you may have. We will then provide you with individualised exercises & advice.
Make sure you have this assessment as we teach you either using a real-time ultrasound machine or internal examination how to activate your core muscles correctly (which a lot of women do incorrectly).
We will also guide you back to general exercise safely.
6. Do Postnatal Pilates >6 weeks postpartum
At 6 weeks postpartum you can start Postnatal Pilates. Pilates is a great form of exercise to strengthen the muscles around your trunk, pelvis and hips in a controlled and safe way, whilst still working on postural alignment and core activation.
I recommend going to a Pilates class run by a Physio who has knowledge of abdominal separation. If the instructor is not a Physio then make sure they are trained in postnatal exercise & have a discussion with them about abdominal separation so they are aware of your Physio’s recommendations.
My advice is to do 3 x Pilates sessions per week. This can be classes or online exercises at home.
7. Avoid advanced abdominal exercises
While your abdominal separation is healing you MUST avoid advanced abdominal exercises. These include – sit ups, crunches, planks, table top, double leg lowers, boat pose (or V sitting) or anything else that causes strain in your abdominal muscles or gives you back pain.
8. Do low-impact cardio exercise
As well as Pilates, you need to do low-impact cardio exercise. Options are fast-pace walking, swimming & cycling. Pram walking is a good option with baby. Aim to do low-impact exercise 3 x week.
9. Muscle stretching & release work
When one part of our body changes structure or weakens, such as with abdominal separation, it can influence other areas, causing muscle/joint imbalances, tightness or tension. Releasing & stretching these areas will help to restore normal alignment and facilitate recovery. Your Women’s Health Physio will treat you based on their assessment findings.
10. Nutrition
Let’s not forget about the essential role nutrition plays in recovery and healing. Make sure you are eating an abundance of wholefoods (vegetables & fruit) and good quality proteins & fats during pregnancy and postpartum. Eating more protein increases the production of collagen, which is important for tissue repair. Good sources of this are bone broths and slow cooked stews, soups and curries that incorporate animal foods.
Supplementing your diet with a collagen powder such as vital proteins is a worthwhile addition to smoothies.
Is It Ever Too Late To Rehab Abdominal Separation?
Never!
You can learn how to strengthen your core muscles at any stage of life no matter how many years postpartum you are. However, the longer you leave it, the harder rehab is, so make the above steps a priority as soon as possible.
Woowa! That was a lot of info!
If you have any questions, please feel free to comment below. And if you would like to see me in Sydney – drop me a line at anna@thewholemother.com 🙂
Anna x
P.S My online pregnancy program The Pregnancy Academy has a whole module dedicated to Abdominal Separation & Online Pilates – check it out here!
References:
Benjamin et al (2014) Effect of exercise on the diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy 100: 1-8.
Boissonnault JS, Blaschak MJ (1988) Incidence of diastasis recti abdominis during the childbearing year. Physical Therapy 68: 1082-1086.
Coldron Y, Stokes MJ, Newham DJ, Cook K (2006) Postpartum characteristics of rectus abdominis on ultrasound imaging. Manual Therapy In Press, Corrected Proof.
Gilleard WL, Brown JM (1996) Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period. Physical Therapy 76: 750-762.
Lee et al (2008) Stability, continence and breathing: the role of fascia following pregnancy and delivery. Journal of Bodywork and Movement Therapies 12: 333.
Lee and Hodge (2016) Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study. J Orthop Sports Phys Ther 46: 580-9.
Lo T, Candido G, Janssen P (1999) Diastasis of the Recti abdominis in pregnancy: risk factors and treatment. Physiotherapy Canada 51: 32-37, 44.
Michalska et al (2018) Diastasis abdominis recti – a review of the treatment methods. Ginekologia Polska 89: 97-101.
Mota et al (2015) Diastasis Recti Abdominis in pregnancy and postpartum period. Risk factors, functional implications and resolution. Current Women’s Health Reviews 11: 59-67.
Sperstad et al (2016) Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine 50: 1092-1096.
Spitznagle et al (2007) Prevalence of diastasis recti abdominis in the Urogynecological population. International Urogynecological Journal 18: 321-328.