3 Exercises for Diastasis Recti
Many brand new moms look at their postpartum bellies with both wonder and horror. How did a baby (or babies) set up house in there for so long, and when will it stop looking so swollen and mushy?
Luckily, postpartum bellies gradually reform themselves, usually with substantial help from exercise and nutrition, but even the most diligent mom might find her belly looking alien after months of waiting for her muscles to snap back into shape.
This new mom might be the unfortunate recipient of diastasis recti, a larger than normal gap between the rectus abdominis muscles.
I was one of those new moms. In fact, I became so obsessed with closing the gap that I received my personal training certification with a specialty in postpartum fitness because I was looking for a cure.
I didn’t find a cure, but through trial and error I learned what might help.
What is Diastasis Recti?
Diastasis Recti is a separation of the rectus abdominis (RA), also known as the “six pack” muscle. The insertions of the other abdominal muscles surround the rectus abdominis and merge to form the linea alba, which is a connective collagen sheath. The linea alba stretches to accommodate a growing belly, but doesn't always return to its original size afterwards.
A small gap between the two sides of the rectus abdominis is completely normal. Everyone has some sort of gap because the RA is a paired muscle. However, a gap larger than two finger-widths, or approximately 2-3 cm, is usually considered a diastasis recti.
All pregnant women have diastasis recti because the abdomen must expand somehow, but lingering DR affects 39% of mothers 6 months postpartum, according to a 2015 study.
How to Close a Diastasis Recti
The evidence on how to close a diastasis recti is slim and low-quality. Despite the proliferation of many courses and workout programs billing themselves as “evidence-based,” most of the suggestions are anecdotal or plain wrong. This is because diastasis recti experts themselves often disagree about when the gap becomes a problem and about the best way to close one.
In the absence of good evidence, postpartum mothers and personal trainers are left with educated guesses. In some cases, any sort of abdominal routine will help reduce a gap, especially in the first few months. In other cases, no amount of abdominal work will budge the gap, which means these women should consult surgeons. And, in other cases, “inner core” abdominal work might reduce the gap.
Personally, inner core work that progressed to more generalized abdominal and upper body exercises helped me reduce my diastasis recti from the size of my fist to about two finger-widths.
As often happens, the more I learned, the more I realized no one really knew what to do because of the slim evidence-base. I tried many programs, but I only saw real results after I added in resistance training. Nonetheless, I needed that inner core work to help prepare me to resistance train safely.
Therefore, if you suspect you have diastasis recti, please modify all abdominal exercises that over-stress your belly. You will know your belly is overstressed if it pooches out, rather than pulls in, during exercise, or if you feel too much pressure anywhere in your abdominal canister, including your pelvic floor.
I’ll outline three good beginning exercises for any mom looking to rebuild her core after giving birth. None of these exercises are traditionally known as abdominal exercises, but each of them will gently work the abdomen from the inside out.
The Back Lying Kegel
New moms are often surprised that the very first exercise I recommend is the Kegel. The Kegel, when done correctly, involves a co-contraction of the transverse abdominis muscle. Some personal trainers insist that the transverse abdominis is the most important muscle for closing a DR. This isn’t true. All abdominal muscles are key. Nonetheless, the transverse abdominis is an important muscle to coordinate with the pelvic floor.
- Lie on your back with knees bent. Put your hands on your ribs.
- Breathe in. Try to feel the air gently push your ribs outward. If you can’t feel anything, put one hand on your chest and the other on your belly. Breathe in again. Where do you feel the most movement? Try for a movement in your lower ribs. You’ll still feel air in your chest and abdomen, but you also want to feel your rib cage move. You should feel your pelvic floor gently lower as you breathe in.
- Now breathe out. Feel your ribs compress a little. At the same time, lift your pelvic floor in and up. You want your transverse abdominis to co-contract. Do this by pretending the two sides of your hips are trying to meet along your bikini line. This is an isometric and subtle contraction, so you won’t see your abdomen move.
Accurately contracting your pelvic floor and transverse abdominis takes some practice. I highly recommend seeing a pelvic floor physical therapist if you have difficulty.
I love the pushup because it works the abdomen in a dynamic plank position. It’s also a simple bodyweight upper body exercise many women will encounter in workout classes or videos. Therefore, learning how to regress this exercise is important.
The pushup can be wonderful for building abdominal strength, but only if the appropriate level is chosen. A mom with DR should NOT start with a floor pushup on hands and feet. Instead, I suggest doing pushups on an incline. This way a mom can work her abdomen without overloading it.
- Place hands slightly wider than shoulder-width apart on an inclined surface.
- Keep your body in a straight line from head to toes.
- Make sure the lower back doesn’t arch too much. This is very important for DR. You might need to tuck the pelvis under slightly to achieve more stability.
- Bend your elbows and lower yourself only as far as you can go while maintaining form and a moderate contraction in the abdomen.
- Push up on an exhale.
Below is a good short video demonstration of an incline pushup.
Once you master an incline, move to the floor on knees, again making sure to not overarch your lower back.
The Single Leg Heel Drop
The best way to test abdominal strength is by using your arms or legs as levers that try to destabilize your abdomen. Your abdominal muscles then work to keep your torso from moving. The Single Leg Heel Drop is a simple take on this type of exercise.
- Lie on your back with your knees bent. Keep your arms at your sides. Bring your legs into a table top position above your hips. If you have a weak abdomen, this might cause your lower back to arch off the floor. Ideally you should have enough space to slide one hand beneath the lower back. However, if maintaining neutral is too hard, try imprinting your spine by pushing your lower back flush to the floor. This is sometimes called the Pilates imprint.
- While in tabletop, slowly lower one leg to the floor, touch your heel to the floor, and bring it back up. Repeat with the other leg.
Personal trainer and yoga teacher Cassie White wonderfully shows a variation of the heel drop combined with a heel slide and a knee drop.
Diastasis Recti can be incredibly discouraging. Remember, exercise helps, but time is also your best friend. If your baby is quite young, don’t stress yourself out by also obsessing about your changed body. Do simple and gentle exercises to gain back strength, then progress to more challenging workouts only when you are physically and mentally ready. In the meantime, talk with your doctor and physical therapist about your concerns.
I didn’t see measurable improvement in my diastasis recti for many months, and it took some trial and error to figure out what worked best for my body. Stay incredulous of experts who insist they have all the answers, but allow for experimentation. What works for one mom’s belly will not always work for another’s. Try not to worry about what you think your body should look like and instead focus on gaining strength and abdominal control, regardless of whether your diastasis recti ever fully closes.
PG Fernandes da Mota, AG Pascoal, K Bo, "Prevalence and Risk Factors of Diastasis Rectus Abdominis from Late Pregnancy to 6 Months Post-Partum, and Relationship to Lumbo-Pelvic Pain," A Manual Therapy, February 2015, Vol. 20, No. 1
D.R. Benjamin, A.T.M. Van de Water, and C.L. Peiris, “Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review,” Physiotherapy, March 2014, Volume 100, Issue