Physical Therapy Protocol for Diastasis Recti

Pregnant woman lying on a bed
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Diastasis recti, a condition that occurs when the connective tissue between the rectus abdominis is stretched too far, is prevalent in pregnant women due to their expanding bellies, reports Pub Med Health. There are ways to correct this, however, but if gone untreated, diastasis recti can lead to poor core stabilization, pelvic floor dysfunction and back or pelvic pain. Although diastasis recti may correct itself on its own, there are exercises that you can do to help repair your midsection.

Diagnosis & Precautions

You should wait three days after your labor to perform the check for diastasis recti. If you had a C-section, you should wait six weeks, or until your incision has healed. To check for the condition, lie on your back with your knees bent. Slowly lift your head and shoulders off the ground while you reach your fingertips to your knees. Maintain this position as you place one hand along the center of your rectus abdominis. You should feel a soft area between your abdominal muscles. Measure how many finger-widths can fit between your muscles. One finger-width is normal, but two or more confirms that you have diastasis recti. If you are unsure that you have diastasis recti, a doctor can perform a physical exam to confirm the condition. Do not begin any abdominal work if you have this condition. Exercises like situps, for example, can worsen and aggravate the separation, according to Airedale General Hospital's Women's Health Physiotherapy Team. Instead, you should begin to strengthen your transverse abdominis, the deepest layer of your abdominal muscles.

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Corrective Exercise

To correct diastasis recti, begin by lying on your back with your knees bent. Cross your hands at your waist, or use a towel to wrap around your midsection, and begin to guide your stomach muscles together. Take a deep breath in, and as you exhale, contract your pelvic floor while you raise only your head off of the ground. While you lift, continue to pull your muscles together to start lessening the gap. Perform 10 repetitions three times per day.

Next Steps

Once you have stabilized your midsection and closed the gap, it should then be safe to try post-natal exercise classes, such as a post-natal Pilates class to further strengthen your abdominal muscles. On your own, you should begin to strengthen your transverse abdominis, or TVA, and pelvic floor. An example exercise that can help strengthen both is called a heel slide with belly scoop. Begin by lying on your back with your knees bent. Squeeze your belly toward your spine to activate your TVA. Tilt your pelvis up away from the floor as you slide the heel of one foot forward until your leg is almost straight. Slide the heel back in and repeat on the other side. Continue drawing your belly in and tilting your pelvis up as you perform 10 repetitions on each side. Only once your TVA and pelvic floor have strengthened should you begin to strengthen your outer abdominal wall, including the obliques and rectus abdominis.

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Warnings

Exercising too aggressively while having diastasis recti can worsen the issue. If after four weeks the condition still persists, the function of your abdominal musculature can be altered. Take extra care as your abdominal muscles are returning to normal. Avoid twisting, lifting heavy items, doing heavy housework, and carrying things on one side. Speak to your doctor or physical therapist to determine next steps if the problem still persists as well as to determine when exercising will be appropriate.

Related Reading

The rectus abdominis muscle runs vertically down the middle of the abdomen. Diastasis recti is a condition where the muscles separate into a right and left side of the abdomen. The condition occurs frequently in pregnant women and newborn babies. The diastasis recti appears like a ridge that runs from the bottom of the breastbone to the naval area and protrudes when straining the muscle. Although the condition resolves itself over time, some treatment options exist.

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Time

Pregnant women who experience diastasis rectus do not usually need treatment to resolve the condition. Infants who are born with the condition do not need any treatments either. The majority of babies with diastasis recti have no difficulty with the muscular abnormality and as the child grows, the separated muscles rejoin, according to the University of Maryland Medical Center.

Hernia Repair

At times, a portion of intestinal tissue traps in the space between the muscles. This is referred to as a hernia. A hernia can be seen protruding under the skin, especially with pressure on it, such as coughing or straining. The hernia might strangulate, or become trapped, and cause redness on the skin, pain and nausea and vomiting. A strangulated hernia requires immediate surgery, according to Medline Plus.

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Surgery

Although the condition does not require surgery, some surgeons choose to close the separation while performing an abdominoplasty, also called a tummy tuck. The surgeon uses a suture to bring the left and right sides of the abdominal muscles together.

Exercise

Individuals with diastasis recti can perform exercises targeted to help narrow the separation between the muscles. A regular sit up may put increased pressure on the muscles and worsen the condition. To ease the muscles together, individuals lie on the back with feet flat on the floor and the knees bent. After placing the hands on the abdomen with the finger pointing toward the lower body, exhale and raise the head off the floor. The fingers press down in into the abdomen to help push the muscles together. Repeat the exercise daily until the separation decreases.

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