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When you’ve got an injury, people are gonna ask what happened… and I wish I had a story that didn’t involve a toilet. When I was about 6 months’ pregnant with our youngest, my kids informed me there was a clogged toilet. And since my husband was at work, I sighed and grabbed the plunger. Unfortunately for me, while I was trying to dislodge that turd, my muscles ripped instead. Hello, diastsis recti. I dropped to the floor in pain.
What is diastasis recti (or the ‘mummy tummy’)?
Diastasis recti is also known as the ‘mummy’ or ‘mommy tummy’ or abdominal separation.
Let’s take a step back for a quick, simplified anatomy lesson, ‘mkay?
Your abdominal muscles go in a couple of different directions – they help support your core. Some go up and down along the front of your abdomen (rectus abdominis). Other muscles go side to side around your body (transverse abdominis). And others are horizontal (obliques).
Now, in the middle of any abdomen or six pack is a line that goes up and down through the belly button. That line is where the muscles connect to tissue – in other words, it’s a potentially weak point. That’s where it can become separated.
And, when you develop an abdominal muscle separation, that’s what happens. Those central rectus abdominis muscles get separated too much.
Some separations are small and no big deal, provided you adjust your exercise techniques. In these cases, the separation may be mostly nonsymptomatic – and only visible when you cough.
Others, however, are a bigger deal because the separated muscle increases the risk for other complications like hernias.
Your best bet is to prevent abdominal separation
How do you prevent an accidental abdominal injury of this magnitude? I wish I could say that avoiding plunging toilets was all you had to do… but unfortunately, you can develop this doing everyday activities or giving birth.
So in order to prevent abdominal separation, you need to know that it’s a real, common thing that’s not talked about nearly enough. And you also need to know that the only way to maybe prevent it is to strengthen your core muscles the right way.
What’s the right way? Well, it’s engaging all the core and pelvic muscles – and not relying on a “traditional” exercise that only strengthens one or two muscles and skips all the others. It’s also doing those exercises right, using proper form and posture so you aren’t accidentally injuring yourself.
Treating a separation: surgery and/or physical therapy?
Generally speaking, there’s no “quick fix” for an abdominal separation. It’s considered a physical deformity, so insurance doesn’t usually cover a surgical repair. Physical therapy is generally the best and only treatment.
In some cases, though, the muscles separate enough that you can develop hernias. And then you may need surgery.
That’s what happened to me. I managed to tear two holes (I had an umbilical and an epigastric hernia) in the tissue that lines my abdominal cavity. And my then-2-year-old liked to stick his little fingers into those holes and grab my innards. Y’all, let me assure you how much that hurts. And not in a usual way – it’s an unnatural pain, because nobody should be grabbing that. It hurts just remembering it!
So in my case, I ended up needing surgery to fix the hernias before my kid made them worse. And because there were multiple hernias, the surgeon attached a mesh lining to my connective tissue to help prevent future problems. Then, because of the mesh lining, he threw in a few stitches between my abdominal muscles to further lessen the chance of those hernias recurring.
Recovery was brutal. As I understand it, recovery from hernia surgery alone isn’t awful. But when your muscles are involved? HOLY COW. It took a long time to recover.
And even after having some surgical assistance to repair the separation, I still have to do physical therapy for the rest of my life. Because I still have diastasis – it’s just much better than it was. Instead of being able to stick my fist between my muscles, it’s now down to 2 fingertips wide or so. Even so, I’ve still got it.
Exercises to avoid once diagnosed with an abdominal separation
And now that I’ve gotten a diastasis recti, I get to avoid certain exercises – for life. And I get to avoid others until I’m stronger.
Every diastasis program I’ve seen recommends that I no longer do these exercises:
- Crunches, sit-ups, and other “traditional” core exercises (darn, right?)
- Oblique twists
- Tennis and golf
- Leg drops and scissor kicks
Why not those activities? Well, it’s because they use motions that separate or shear the rectus abdominis muscles further apart. And since that’s what makes a diastasis **worse**, those are the activities to avoid.
So I’m saying goodbye to abdominal-unfriendly movements where I’m:
- Flaring my ribs or arch my back
- Lying on the ground and need to lift my shoulders off the ground (crunches, sit-ups)
- Bending over in half, or jack-knifing
- Doing cross-body motions
I can’t completely avoid those activities, but I do try to minimize them. And, when I absolutely can’t avoid them, I concentrate extra hard on keeping my abdominal, pelvic floor, and back muscles positioned right and fully engaged. That way, I can minimize (or avoid!) any problems.
That being said, will I really be avoiding planks or tennis or golf for the rest of my life? Probably not. My kids love playing mini golf – and so do I. And planks are one of the traditional core exercises I dislike least.
But while I’m in the initial stages of my physical therapy, I’m going to follow the recommendations. Because right now it’s harder for me to do some exercises. That’s mainly because I was out of shape after a long pregnancy from being unable to do much, then giving birth, and then still being unable to do much due to a symptomatic and painful diastasis recti.
As I exercise and get stronger, I’ll be able to do more, modify fewer movements, and complete a full workout as it’s designed. And, I’ll be keeping my muscles engaged properly without as much concentration, so I’ll still be exercising safely – even as I add in the occasional plank or round of mini golf.
Exercises to prevent, improve, and treat diastasis recti
There’s multiple programs out there that are specially designed to help walk you through diastasis related exercises. The ones I’ve looked at all seem to follow the same principles, though.
Takeaway principle: You need to strengthen your transverse abdominis and pelvic floor muscles. This will do two important things. First, it will strengthen your other core muscles. Second, it will also give other muscles and tissue time to realign and heal.
Bonus physical therapy results: Restoring your core will also reduce the pressure your abdomen has been under. This should help alleviate back pain, food baby mode, and issues with constipation.
But how do you do that? Well, first you need to learn is to visualize and engage your transverse abdominis and pelvic floor muscles. Here’s what helps me.
While standing, put one hand on the upper part of your abdomen (above your belly button) and the other just above your pelvis. Imagine your transverse abdominis – it’s like a rubber band that goes around your belly. Now, squeeze it tighter. Or, as they say in yoga class, pull your belly button back towards your spine. And, you should feel it pulling your pelvic floor muscles upwards, too.
I like to visualize that I’m pulling up a string on a zipper – that pulls up the pelvic floor – and zips my rectus abdominis muscles closed. You should be able to feel your muscles contract under both hands. In fact, it should make your posture feel like it’s absolutely amazing.
Once you’re able to reliably visualize those muscles, it’s time to move on to some basic yoga style exercises. Now, please remember that I’m not a yoga instructor. I’m simply a ginger-haired nurse who enjoys doing yoga. Even so, several programs have recommended these next two exercises, so I’ll ‘splain as best I can.
Cat to Cow – I like doing a modified cat to cow. I say modified, because it’s still hard for me to do a full cow pose while I’m focusing on my transverse and trying to avoid flaring my ribs or back. It’s more of a “cat to cow-like”.
Standing Mountain – I also enjoy doing a standing mountain pose – it’s great practice engaging my transverse while standing with good posture, feeling my pelvic floor rising. And, then as I raise my arms, it makes it even harder to maintain good breathing, good posture, and good transverse engagement.
My kids didn’t understand how hard it was until I made them try it, too. But hey… if it prevents them from getting an abdominal separation, it’s worth it. And if this has helped you, too? Then it’s doubly worth it.