The changes our body endures during pregnancy are incredible. To be honest, I found it absolutely amazing to watch my body transform to host Enzo, and then twins, and then transform back! If you really think about it the female body is so powerful! I know first hand it can be hard mentally to see our bodies change. In some ways my body returned to the old me, and in other ways it will never be the same again. My tummy skin is looser and my abs are separated but, I am 100% ok with it. My 3 babies were worth it 😉 With that being said, I did and do try to exercise and stay healthy for me and for my babies. I want to look and feel my best! My mantra is that Mom has to feel great so she can take care of everyone else.
So what can we do postpartum to work on gaining our abs back?
It’s hard to believe, but over the course of your pregnancy your abdominal muscles will stretch by more than 50 percent. As your baby grows, your muscles will lengthen and your six-pack muscle (Rectus) divide and separate into two halves. This is called Diastasis Recti and it is 100% normal.
Almost every woman will have some degree of abdominal separation postpartum, but it will vary greatly in severity. For example, if you have had a C-section, it may be quite significant due to the medical procedure. Focusing on repairing and reconnecting your abdominals slow and steady is a crucial first step when returning to fitness. If you don’t first close your diastasis, you will never have a flat belly, you can experience worsening back pain, and will have lasting postural issues.
For this blog I have collaborated with both my dear friend and expert body plastic surgeon Dr. Christian Prada (right image) (Dr. Prada is known for his incredible “mommy makeover” transformations), and Doctor of Physical Therapy Taylor Wakeland (left image). Both are here to teach us more about Diastasis Recti and exercises to help heal postpartum!
Hernia vs. Diastasis Recti
Dr. Christian Prada of STL Cosmetic Surgery explains, “Diastasis Recti is a separation of the abdominal muscles caused by a weakness in the connective tissue, Linea Alba, that runs from the breast bone to the pubic bone. It is very common after pregnancies because the abdomen is stretched to make room for the fetus. With multiple pregnancies this stretch effect is often worse causing an even greater separation of the muscles. It is often misdiagnosed as a hernia, but differs from a hernia in that there is no opening allowing intra-abdominal contents (intestines or omentum) to exit the abdominal cavity. Hernias can cause a strangulation of the bowel and, therefore, if it is a hernia it is essential to repair.
Diastasis Recti, on the other hand, is simply a cosmetic issue and repair is not covered by insurance companies. Some patients have found core exercises can improve the separation, but this is typically the case only when the separation is under 1.5-2.0 cm. A normal separation is about 1cm! When patients are unable to improve their appearance with exercise or their separation is just too great, they are often referred to a Plastic Surgeon. They typically describe themselves as having an abdominal “pooch” or “pregnant look” that they do not like. An abdominoplasty procedure can be done to correct the muscle separation, remove stretch marks, remove excess skin and remove any excess fat on the abdomen. Some patient have also described gastrointestinal benefits as well after the procedure, with less bloating after meals, reflux and general discomfort.
If you have a Diastasis Recti that you are not happy with, see your local Board Certified Plastic Surgeon who can work with you to get back the pre-pregnancy body you want.
How can a Physical Therapist help?
Physical therapy can be an effective way to manage symptoms of DRA as well as improve functional capacity when DRA is diagnosed. Your physical therapist or a Pelvic Health Physical Therapist can help via postural training, stretching/exercises, bracing, and education.
After being diagnosed with DRA, there are many factors that you may not have considered regarding your pain or everyday movements that your physical therapist can help you with. Below are some tips to help teach you safe and effective ways to regain your full function:
1. Don’t hold your breath especially when lifting anything, including your children! When you hold your breath, your diaphragm fills with air and your abdominal muscles turn off. The pressure from the air inside of the diaphragm may contribute to abdominal muscle stretching which a woman has already experienced throughout their pregnancy. It also compromises the linea alba which is the connective tissue that holds the recti abdominal muscles (also known as the “6-pack” muscles) together.
2.Avoid traditional crunches or sit ups because it may worsen the abdominal separation. Everyone wants to get rid of their mommy tummy after pregnancy, but more advanced abdominal exercises like oblique twists or sit ups may cause more harm than good. It’s important to get your respiratory, pelvic floor, and stabilization abdominal muscles in sync to allow for greater tensioning of your abdomen! You want to avoid “doming” if you attempt an ab exercise that is too advanced. This is where your belly will bulge or pop up!
3.Use a functional approach to train your abdominal muscles in a more balanced manner instead. You don’t want to over train your external oblique or rectus abdominus musculature. If you aren’t sure what a balanced core program looks like, reach out to your local physical therapist or pelvic health specialist.
4.Posture matters too! Although we could all focus on improving our posture, rounded shoulders, slouching, and arching your back may contribute to widening your DRA.
5.Focus on activating your abdominal muscles that help to stabilize the spine and flatten your stomach with everyday activities! Think about brining your belly button towards your spine when performing activities like folding laundry, lifting grocery bags, vacuuming, carrying a child, and sitting. However, this shouldn’t be a forceful contraction!
Exercises to Help Support Healing
Exercises, including bracing, can be used to help possibly reduce your DRA. We do not recommend starting any exercises other than abdominal bracing or breathing until you’re cleared by your physician. Exercises can typically be started around 6 weeks postpartum. Below are some lower level exercises to start with followed by a few advanced exercises as well.
Bracing (using a blanket, long towel, or your own hands) can help work on strengthening your Rectus Abdominus in a shortened position. This “6-pack” muscle that everyone wants has been in a lengthened throughout a woman’s pregnancy. It’s similar to trying to recoil a stretched out rubber band or hair tie back to its original length.
Lay on your back with your knees bent. Think about exhaling and lightly drawing your belly button towards your spine. Then, bring your head and shoulders slightly off the ground while moving your ribs down and in. Try to maintain pressure down and in with your hands as you slowly roll up. DO NOT hold your breath and be on the lookout for that “dome” we are trying to avoid. A progression to this would be performing a seated crunch with the bracing!
This can be used as a great warm-up, a relaxation technique, and to assist with stretching your pelvic floor muscles. It’s also important to work on the abdominal muscles that play more of a role in stabilization. These muscles include your Transversus Abdominus and Obliques instead of your Rectus Abdominus.
Cues: Start in hooklying position, as seen above, with one hand on your belly and one hand on your chest. When you take a deep breath in, think about allowing your belly to expand and your ribs to come up and out. Focus on your chest making very little movement. Slowly, exhale and let your stomach return to neutral.
Lower Abdominal Contraction
Lay on your back with your legs bent. Lightly exhale and imagine you’re slowly blowing out a candle. As you blow out, focus on pulling your belly button toward your spine or the ground. This is commonly confused with a pelvic tilt and should not be forceful in nature. If done correctly, you should feel the small of your low back slightly flatten against the ground! We like to tell our clients to use a belt around their waist. As you exhale, the belt should become looser. As you inhale, the belt should become tighter.
Lower Abdominal Marching
Start on your back with your legs bent. Think about exhaling and engaging lower abdominals as previously discussed. With your abdominal muscles engaged, lift/march one leg up into 90/90 position. As you lift, make sure to maintain your belly button toward your spine. Slowly lower to the ground, re-stabilize and lift the opposite leg to 90/90 while not allowing your low back to pop up. Avoid abdominal doming.
Lower Abdominal Level 1
Progression if you are able to perform the above exercise correctly: Start on your back with legs bent, think about exhaling and engaging lower abdominals as previously discussed as you lift one leg up into 90/90 position. Maintain your stabilization as you lift the second leg up without allowing your low back to arch or your belly pop up or dome. Gently lower each leg, one at a time, without any abdominal or low back movement. Make sure to keep breathing throughout the movement!
Disclaimer: If you have any questions, pain, or discomfort please seek out your local Doctor of Physical Therapy, OBGYN, or Pelvic Health Physical Therapist. Furthermore, this is not solicited medical advice and these exercises are not a cure, but rather generalized information to assist with your diagnosis. Feel free to email us with any questions!
Thanks so much to Taylor and Dr. Prada for their amazing info!!
Here’s how you can get in touch with them
Taylor Wakeland, PT, DPT – firstname.lastname@example.org @taylorwakelanddpt
Dr. Christian Prada – @dr.prada