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Don’t Just Squeeze

diastasis recti Post partum fitness physical therapy

NPR recently highlighted an exercise for diastasis recti.

As a mom, I’m tempted by the plethora of ‘flatter tummy’ promises out there. As a Women’s Health Physical Therapist, however, I want to critique this particular article on several points.

But first, what is diastasis?

Diastasis recti is a thinning of the linea alba: the central tendon running up the middle of the abdomen. All of the stomach muscles attach onto it and pull against it to allow your body to transfer force from one side of your trunk to the other. In situations where there is increased pressure internally this tendon can stretch out or become thinned. It happens often during pregnancy and post partum (one recent study found that 60% of women had a mild diastasis at 6 weeks post partum). It can also happen with: excessive bearing down with weight lifting, increased abdominal girth, and some abdominal exercises. Many exercises and exercise programs have been designed for the purpose of shrinking the linea alba back to its ‘pre-pregnancy’ shape.

So what’s wrong with the simple exercise highlighted in this article?

1) The tighter the abdominal muscles are squeezed the more pressure is exerted downward onto the pelvic floor muscles and organs. This is because the abdominal area is like a container with a top, sides, and floor. Just like when you squeeze a tube of toothpaste at one end and the toothpaste comes out the other. If you tighten up the side and top muscles (abdominals and diaphragm) you force pressure downwards, pushing all of the internal organs down onto the pelvic floor muscles. If someone has any issues with pelvic organ prolapse or incontinence this squeezing could make those issues worse.

2) Diastasis is not always the cause of the ‘mama tummy’ look. In my practice I often notice that the upper abdominal muscles are easier for women to engage post partum. This is likely the case because they aren’t stretched out until near the end of pregnancy. So when I instruct women to “suck in your belly muscles” they will often engage only the upper muscles. This makes the upper oblique muscles and the diaphragm tight and leaves the lower muscles lax and soft looking even in people who don’t have a diastasis.

3) Some of the latest research in the physical therapy community shows that there may actually be more ability to produce tension in the linea alba if the “gap” is maintained. In other words if you “close the gap” you may actually have taken the thinned out tendon, squished it into a smaller area, and made it all loose and floppy. Think of the difference between a taunt rope and a slack one. The research is still very new. But it does bring up the question of what our goal should be. Should we just be concerned with “closing the gap” or should we be more concerned with the overall function of the core muscles during normal life activities. It may be that the abdominal muscles function better when the thinned tendon remains thinned and taunt.

diastasis recti post partum fitness physical therapy

Correct form is very important for abdominal exercises post partum

4) My last concern is with the mention to “don’t ever again in your life do crossover crunches or bicycle crunches.” With all exercises, there are times when they might not be appropriate or safe. It’s important to pay attention to performing an exercise correctly as poor form could result in injury. But to tell all post partum women that “You can’t ever do this particular thing again” seems to be fear mongering. I’ve seen women who have been terrified to even bend down and pick up their baby for fear of ” making the gap bigger.” It doesn’t seem helpful.

On a personal note I have a two-finger wide diastasis recti myself from my first pregnancy. With my diastasis, I have PR’d in two half marathons, backpacked with a toddler, completed three 200-mile bike rides, and had a second pregnancy with no back pain or pelvic girdle pain while carrying my 3 year old around the whole time. So for me “the gap” is certainly not the whole story.

It is very important to regain the strength, control, movement, and function of your body after pregnancy and birth. If you need help with that please seek it out whether it’s a mom friend, the internet, a personal trainer, or a physical therapist. Please don’t simply “squeeze”.

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