Treating Diastasis Recti

Hey there! This week’s post is all about waking up that lazy transverse abdominis in women who have a diastasis recti! If you’re not sure what that is, go back and read this post. Go ahead, I’ll wait. Alrighty, now that we all know what it is and how to screen ourselves, let’s get to chatting about how to treat it. 

In last week’s post I briefly talked about a few treatment options. While this post will be about working the abdominals, I do want to spend a little more time discussing treatments. I want to reinforce just how important it is that you 1) screen yourself and 2) find a trained healthcare professional to work with. 

Don’t worry, you’ll have more than enough “homework” from your physical therapist or trainer to do at home as part of your treatment. There are many different types of healthcare/fitness providers who can help you return to activity and your goals. But as I mentioned before, many of these providers do not have additional training/knowledge about DRA. When deciding which provider you want to work with, be sure to ask:

* What training have you had to work with people who have DRA?
* How many people like
me have you treated before?
* What will treatment involve? 

These are just the basic questions you should cover. If you ask the first question and get this kind of look then please POWERWALK as fast as you can out of there. (No running till we address the DRA!) If that provider tries to talk to you about purely passive treatments like relying on belts and binders for long term/forever use, then again, this is not the place for you. Using binders/belts may be beneficial in the short term, but the key to treatment is muscle activation and you aren’t going to do that in any way if you aren’t well… activating muscles! 

Also, keep in mind that returning to any type of exercise after having a baby AND a DRA is going to require some time and careful progressions. If you are 6 weeks postpartum and/or have a DRA and the trainer you are seeing wants you to start squats, sprints, over/unders, 45mins of Zumba or whatever it is… beware. Everyone has a different baseline fitness level, which will in part dictate how quickly you are able to resume those previous/new activities. Maybe you were an Olympic powerlifter pre-baby. That’s awesome, let’s totally get you back to that! But treat the DRA first. 

So without further ado, let’s chat about the transverse abdominis (TA for short). 

The TA is the deepest of your core muscles and wraps around your back and ribs like a corset. It often gets ignored because it’s not responsible for the 6 pack. Even more importantly, it provides stability to your low back, internal organs, and pelvis. 

Transverse Abdominis

This is a tough muscle to work because it doesn’t “do” much. Let me explain. Because of the structure of the muscle, what it does it cinch together when it activates. It’s not as dramatic a motion as when you twist or do a crunch. 

The easiest way to activate you TA is by laying on your side. Now keep your ribs soft (i.e. don’t move them!) and draw your belly in. You can feel the TA to make sure you are doing this right. Find the top hip bone, and move your fingers about 2 finger widths in and down. When you contract, you should feel tension or a hollowing under your fingers. If you feel like the tissue is pushing UP INTO your fingers, then you are trying to use the other abdominal muscles instead. Still not sure what I'm talking about? Keep your fingers in the same spot and now cough. That's what you want the contraction to feel like, subtle but a tightening. 

If you aren't getting anywhere in sidelying, you could also try laying flat on your back. Think about zipping up a zipper from the bottom of your belly up to your ribs, nice and slow. Another great position to start in is on your hands and knees. Start with your belly low, back round and then draw your belly in. Imagine that you are trying to pull your belly up to your spine. 

First, start by simply doing reps of the exercises. Work your way up to 30 reps on each side (if you are laying on your side) and on your hands/knees. If you start to get tired and cheat (i.e. use the other abdominal muscles, hold your breath, etc) then do fewer reps and more sets. 

For example, if I can only do 4 reps on my side before I start cheating, then I would do 4 reps 6-7 times a day, on each side. 

Once you can do that, add in a hold. Work up to a 5 sec hold x 30 reps. Once you are able to do that all the way through with good form, you can progress to doing the exercises on your back, then sitting, then standing. As you get stronger, you ideally want to do a rep of the TA squeeze before you move, something we call a “precontraction.” This is the key which ties muscle activation to function. 

In an ideal world, your TA, back muscles, and pelvic floor kick in before you move to provide stability, such as when you reach forward for a glass, bend down to pick up your baby from the floor, blow dry your hair, etc. But in women with DRA, this automatic precontraction is lost. Simply put, that makes other muscles work harder in your body. You can restore this precontraction by thinking about and performing it before movements. This will strengthen the mind-body connection and improve the way you move. 

If you have pelvic floor problems, working with a pelvic floor PT will be crucial to your recovery. If you address the DRA but ignore the pelvic floor, then again, something is “gonna have to give.” Working with a pelvic floor therapist is going to cut down on the number of providers you work with (i.e. not having to see someone for the DRA and then someone for the pelvic floor) and will speed up your recovery time as well.

Again, if you have identified a DRA, please find a trained professional to work with. Even with this post, I wish I could work individually, face to face, with each woman in order to provide the best care. I wouldn't churn out a cookie cutter workout "for everyone" because each woman has a different backround, experience, and set of goals during and after pregnancy. With that said, this post gives you enough basics to start kickin' in that oftentimes lazy transverse abdominis muscle!