Core Strength and Diastasis Recti

Diastasis what-ti?  If that’s what you’re thinking, you’re not alone.  Even I hadn’t heard of it before my training in pre- and postnatal exercise.  Let’s start with an anatomy lesson, move onto a definition, then discuss what to do about it.

When we talk about the core, we often think of the rectus abdominis – i.e. the “six pack” –  or the outermost abdominal muscles.  The deepest of all the abdominal muscles is the transversus abdominis, or the TVA.  While the muscles of the rectus abdominis run vertically, the muscles of the TVA run horizontally, acting like a corset to pull all four side of the body together.  The linea alba is the fascia (tissue) that connects the left and right halves of the rectus abdominis.

A primary role of the TVA is to provide spinal stability.  When the TVA is weak, our bodies compensate and provide stability in other ways.  This has a variety of negative consequences, including lower back pain, muscular imbalances, and poor posture.

Diastasis Recti refers to the separation of the rectus abdominis into left and right halves. Although anyone can have a diastasis, it’s common in pregnant and postpartum women because the growing uterus leaves the TVA overstretched and undertoned.  The rise in the hormone, relaxin, during pregnancy also facilitates a diastasis because it softens and relaxes fascia all over the body, including the linea alba. The TVA is further traumatized in women who deliver via c-section, as the surgery cuts through the muscles.

Not sure if you have a diastasis?  Not to worry.  You can ask your OB or midwife to evaluate you at your next appointment, or you can do it yourself.  If you want to self-diagnose, here’s one video I recommend.  Oh, and if you have a “mummy tummy” (y’all know what I’m talking about, right ladies?), there’s a VERY good chance you have a diastasis.

Estimates of the prevalence of diastasis recti are high, ranging from two-thirds to 100 percent of women in their third trimester.*  While you may not be able to avoid the condition, research shows that diastasis is less prevalent and less severe among women who exercise regularly.  The best exercises are those that focus on strengthening – you guessed it – the TVA.

Recall that the muscle fibers of the TVA act like a corset, pulling the four sides of the body together.  To strengthen the TVA, you need to tighten and relax that corset, much like you tighten and relax your bicep muscles when doing bicep curls in order to strengthen them.

Below are pictures of me illustrating this contraction.  As it turns out, I’m not only the owner and founder of WellMom, I’m also a client.  🙂  I have a two year old daughter, and I’m expecting my second in July.  The pictures below were taken when I was 17 weeks and four days pregnant with number two.  I’m drawing in my abdominals (i.e. tightening the corset) in the picture on the left and relaxing my abdominal muscles in the picture on the right.

The pelvic tilt is an EXCELLENT exercise to strengthen the TVA. If you have an existing diastasis, it’s also a very useful for rehabilitation.  Here’s one way to perform the exercise:

Lie on your back with your knees bent and your feet flat on the floor.  Begin in a neutral spinal position (you should be able to slide your hand between the small of your back and the floor).  Take a deep breath in.  As you begin to exhale, tilt your pelvis back, shifting your tailbone up.  Press the small of your back firmly into the floor and imagine drawing your navel in towards your spine and drawing the two sides of your rib cage together. Take another deep breath in, releasing the tilt and returning to a neutral spinal position.

You can make this exercise more challenging with the addition of heel slides.  To do this, while your pelvis is tilted back, slowly slide one heel along the floor until the leg is fully extended, then slowly draw it back in.  Release the tilt, returning to a neutral spinal position, then repeat on the opposite side.  For an even greater challenge, slide both heels simultaneously.

If you’re pregnant and uncomfortable lying on your back, you can also perform this exercise standing.  Stand with your head, shoulders, and hips against the wall, but with your feet away from the wall and your knees bent.  Tilt the pelvis and draw your navel toward your spine, as for the supine version.

I prescribe pelvic tilts to my clients, and I’ve been doing them daily as a part of my TVA strengthening routine since learning of my current pregnancy.  In fact, this technique has helped me to close the small diastasis that I had at the start of this pregnancy.  So get your pelvic tilt on!

*Benjamin, D.R. et al.  2013.  Effects of Exercise on Diastasis of the Rectus Abdominis Muscle in the Antenatal and Postnatal Periods: A Systematic Review.  Physiotherapy 100(1): 1-8.