Exercise for Diastasis Recti with Corrective Exercise Specialist Missy Sullivan
After I gave birth to my daughter, I realized that I had mild-to-bad Diastasis Recti (DR). A few months later, my doctor told me that I also have a hernia. What does this mean? Thankfully, my DR doesn’t affect my day-to-day life too much, other than a small bulge in my belly. It does, however, greatly affect my ab workouts. There are certain exercises that I can’t do or have to be very, very cautious with because of a risk of pain or of making my hernia worse.
I have been able to improve my DR quite a bit through thoughtful core work, but I was over the moon with excitement to be connected to diastasis recti and corrective exercise specialist Missy Sullivan to learn more about DR, how it can affect new moms and what else can be done to improve the condition.
How did you get into training moms in this way?
During my pregnancies I stayed very active participating in various styles of fitness. I thought I was doing all the right things until I learned I had severe diastasis recti (DR); separation of the rectus abdominus after my third pregnancy, which was coupled with incontinence. I went to my doctor to find out that surgery was my only option for DR and I sought out a women’s health physical therapist (PT) for my incontinence. After researching DR and looking for a local PT that could help me, it was then I realized that there is NOT enough support for postpartum moms! Why wasn’t I checked for DR during my check ups and why did it take all the way to a PT to find out that my DR was severe at 4+ fingers through my entire midline? That’s when I decided that there needs to be resources for all moms to feel empowered before, during and after pregnancy. I went on a mission to help provide women the necessary tools to connect and/or reconnect to their minds and bodies by providing exercises that are effective and safe to help every woman feel stronger and more confident. The knowledge portion is just as important as the exercises. Despite what you may hear, you are not stuck with pregnancy ailments including DR, incontinence, back aches, pains, etc.
How do you know if you have diastasis recti?
View this post on Instagram
Many of you have asked how to measure #diastasisrecti ... here is a simple method to test the finger width(s) in your abdomen region along your midline ... 1-2 fingers is “normal” BUT you still have to work on repairing the region to help reduce the gap. I have 4 fingers in each of my regions (with the lower region slowly repairing from when I first started my recovery process) It’s starts with strengthening and breathing - then you need to focus on repairing and pulling them back together. I feel strong, yet weak - but am optimistic with the new PT process! I’m now focusing in on drawing this area together - more to come on exercises within this journey 💕
Diastasis Recti Self-Check:
Lie on your back with your knees bent.
Place two fingers above your belly button (about 2”) and the other hand behind your head for support.
With fingers in place, slowly lift your shoulders blades off the ground.
You may feel a gap or you may feel you’re the connection of your muscles.
If there is a gap, you can measure the width by adding or taking away fingers, one should also note the integrity of your skin and depth of the separation.
You can then continue measure the same way at your belly button and two inches below it.
Typically, a small gap (1-2 fingers), may be considered “normal” but you could still exhibit all or many side effects of DR.
What are some complications that women who have diastasis recti experience? For exercise? For every day life?
DR can initially cause little or no pain with no other complications. Some women may never experience anything outside of this, but others could experience other consequences outside of the “mummy tummy,” including:
Incontinence, low back/pelvic/hip pain.
inability to wrap (activate, engage, contract) the core (weakened core).
Pelvic floor issues.
Intestinal issues (such as constipation).
Bad posture and slow to little progress in your fitness training.
Some may even suggest, to a degree, that DR could cause a hernia.
Not every woman will experience the same symptoms, as everyone’s body is different.
What exercises should you not do if you have diastasis?
I like to approach this with, not what exercises you shouldn’t do, but what exercises cause your body to be imbalanced or those that create a doming, coning or bulging in the core. If this cause and effect happens, this tells me the external force load of the exercise(s) is too much for your current situation. Typically, the exercises that place a load like this are: traditional crunches, sit ups, full frontal planks, bicycle crunches, hanging knee raises, back extensions, lifting heavy objects, oblique twists, and more.
These types of exercises can cause your abdominal wall to bulge out upon exertion if you lack core support and control. To help support your body with a load or force, you must learn how to properly breathe to recruit the right muscles during your movements to help control the added pressures being placed on the pelvic floor and transverse abdominal muscles (TA). Like anything, the goal is to not only strengthen your core, but to get your body to function optimally, so you can do what you always love to do, whether its certain exercises, fitness classes or simple daily activities.
Is it possible to completely “cure” diastasis recti with exercise?
Diastasis recti is not a disease so there is not “cure” for it, but with an appropriate exercise program that is designed specifically for you, you can greatly reduce or heal the gap. The key is to get your body to function properly again. By making improvements to your core strength, stability and function, you can help improve or reduce any other pregnancy related aches and pains as well. By learning how to manage force and loads placed on the abdominal wall, connective tissue and pelvic floor during activities and exercises, you can make improvements to your core strength, stability and the way your core looks.
Are there any circumstances where a woman should see a doctor?
Absolutely! I truly believe that the right fitness program with a certified fitness coach, trainer or specialist can help repair DR through breathing, strengthening and stability exercises that are proven to help connect or reconnect a woman to her body while pregnant and postpartum, but there are some abdominal separations that require surgery. If you know how to load correctly against the forces placed against the core, but are not progressing in a fitness program, you haven’t regained pain free function or continence, or your tissues have extensive damage, then you should talk to you doctor about surgery (I like to consider this as a last option).
Are there exercises that women can do pre-pregnancy / pregnancy to avoid diastasis?
There is no fail proof way to prevent DR from happening prior or during pregnancy, but there are exercises you can do to greatly reduce your chances. Understanding and getting to know your changing body is crucial. Breathing will play a very important role, not just in everyday life, during pregnancy, but in labor and postpartum recovery as well. Your breathing helps control your movements. You’ll also need to understand your core and the other muscles that are connected to it- your glutes, pelvic floor, back, etc. To help prevent DR or a widening of an existing gap, you need to learn how to work your inner core as a unit, making no room for doming, coning or bulging in that area. This is where you protect your connective tissue. If you continue with exercises or everyday moves that continually place force on your core, that continuing outward motion will continue to damage your tissue to the point that it can’t repair itself naturally after birth.
To decrease your chances of DR, you need to understand what fitness classes, exercises, movements, etc. place that extra pressure for you – and its then that you need to correctly engage, activate, contract, lift and wrap to secure your core integrity. You need to continue to strengthen your TA, which can prevent or lessen the severity of DR. Every woman should perform basic TA exercises throughout pregnancy to help prevent not only DR, but incontinence, prolapse and low back pain as well. Not only will strengthening your inner core help in prevention, it will help aid you during your labor phase of pushing.
Some basic TA exercises include: core activations through breathing, heel slides, glute bridges, modified side planks and squats.
What are some DR exercises that the readers can do at home?
Exercises and programs will vary as there is never a one-size-fits all approach. The key is having the right tools and strategies to adjust and adapt to demands. If you can fire up the right muscles and your body is correctly functioning through your movements, you can do a variety of different exercises, as long as you are not experiencing any pain or aches. I like to help moms mimic what they do or will be doing daily- bending to pick up toys, getting up and down from chairs, picking up the baby, etc. So, exercises like squats, lunges, bent over rows, deadlifts, chest presses, glute bridges, etc. are all great exercises to help strengthen your body. These exercises will help support you through pregnancy and postpartum, as well as the physical demands of motherhood.
View this post on Instagram
I’m sure you’ve heard numerous times in a fitness class, belly button to spine... many in the fitness industry understand the importance of TVA but how do you truly activate & engage it? It’s NOT as simple as pulling your core in... You need to understand your breath and how it helps you activate the correct working muscles! 🌬 Each of these videos will showcase the importance of breathes and wrapping your inner unit to create the movements! 💫 So grab yourself a band and follow along! Always engage & activate, then use your belly pump to create your movement! 1. Glute kick backs 🍑 great glute & core activation with core stability - remove the band if you are just starting a program - slowly kick back 8-10x on both legs) 2. Static Lunges with OH band pulls- add a core stability challenge as you focus on activating your glutes. Try 8-12 each leg 3. OH extension with marches - alternating legs for 10 reps each side. 4.❗️This shows belly doming/coning/bulging❗️if you see your tummy cone up 🍦 during movement - it’s a sign that you are placing too much pressure & load on your abdominals! You must regress this movement and continue to rehab your abs before adding a more challenging movement 🗻 Your breathe is so important in your rehab program!
How can people learn more about you / work with you?
I work one-on-one with all clients. Each program/session is especially designed for you, your strengths and your limitations. Every client starts with an initial assessment allowing me to create a program specifically designed for you and your body. The program will include daily exercises with progressions & regressions, and an online component of your weekly homework with exercise videos.
If you are in the Boston area, or if you are not local but are interested in a program, you can email firstname.lastname@example.org to set up an appointment. I offer virtual training via, Zoom or Facetime, for those outside of Boston.
You can also find Missy on social media, she posts great DR related videos on her Instagram!