Tips and exercises for postpartum recovery, focusing on diastasis recti healing, even years later.

Diastasis recti is a separation of the abdominal muscles at the midline tissue called the linea alba. This separation can be anywhere from the bottom of the ribs, all the way down to the pubic bone and can be varying sizes (measured in centimeters). Nearly 100% of women will have one at the end of pregnancy.

Diastasis recti isn’t usually painful, but can affect the function of the core. Many patients with diastasis recti feel core weakness and may struggle with symptoms such as lower back pain as a result.

Pelvic floor physical therapy is the best form of treatment for diastasis recti and diastasis recti physical therapy programs should be targeted at investigating where your diastasis is, how large it is, how long you have had it, and how to best improve the function of the core with various activities. 

Even though we would love for all patients to begin with diastasis recti physical therapy immediately postpartum, we understand that life gets busy. Even though physical therapy treatment is always more successful the closer to injury you are, physical therapy is still extremely effective even if you’ve had a diastasis recti for years. There is still a lot of improvement that can be made with the right training. Even if you had your baby years ago, you can improve your diastasis recti with the right physical therapy program. 

Just as if you can start an exercise routine to lose weight, or get stronger at any point in your life, the same holds true for fixing a diastasis recti, years later. The biggest challenge that you may face with starting a diastasis recti physical therapy program years after being postpartum is dealing with compensations that have developed over time. 

These compensations might make it take a little longer to notice changes with your diastasis recti the further postpartum that you are. 

A few compensations that might have developed over time include clenching/gripping and over dominance of the upper abdominal muscles, bearing down on the pelvic floor, mid and lower back stiffness, and hip weakness and immobility. It is important that any diastasis recti physical therapy plan involves a thorough assessment of all the things that might be playing a role in your diastasis recti.

In cases where the diastasis recti is located at the bottom part of the abdomen, patients will often only be able to generate force in their abdomen by overusing the upper abdominal muscles. This results in clenching and tension to the upper abdomen, with little activation of the lower abdomen, and may result in a “pooching” out of the lower belly. Overtime, this causes patients to further not be able to activate their lower abdominals and therefore can result in no improvement with their diastasis.

When you are activating your core, you want to think like you are zipping it up from the bottom (near the pelvis) and working your way up (to the ribs). We often say activate your core and zip it up like you are zipping up a tight pair of low rise jeans. This helps to recruit the lower abdominals first, which will help stabilize the rest of the core so that it can function better.

Bearing down on the pelvic floor often goes hand in hand with upper abdominal gripping. Due to upper abdominal gripping and therefore decreased lower abdominal activation, patients will often also bear down on the pelvic floor, further resulting in decreased ability to activate the lower abdominals.

Mid and lower back stiffness can develop due to a patient overusing their back muscles (known as the paraspinal muscles) in order to help them stabilize their core. Overtime, the back muscles will compensate for the core and therefore requires a lot of retraining in order to decrease the lower back activation and increase core activation.

Lastly, patients that have been dealing with a diastasis recti for a long period of time can result in increased hip stiffness. Since a patient with diastasis is often lacking core stabilization, the hips will often overwork and compensate overtime. This then results in stiffness and immobility throughout the hip joints.

These compensations need to be addressed during diastasis recti physical therapy in order to actually address all of the factors that are playing a role in your diastasis recti. Without addressing compensations, progress with diastasis recti physical therapy will be limited.

The key components to a diastasis recti physical therapy program includes core, shoulder and hip strengthening exercises. Since diastasis recti can affect the abdomen anywhere from the ribs down to the pelvis, it is important that physical therapy for diastasis recti incorporates strengthening and improving function of all the muscle groups that control the core. 

Since we are also likely dealing with compensations, your diastasis recti physical therapy treatment should also consist of manual therapy, including soft tissue and joint mobilizations to help relax the tissue that may be compensating for core activation. 

There is hope if you’ve been struggling with diastasis recti for a long period of time. You can absolutely fix a diastasis recti years later.

With the right diastasis recti physical therapy plan aimed at addressing not only the diastasis recti but also compensations that may have developed overtime, successful core retraining is possible.