Bridging the Gap: Physical Therapy for Diastasis Recti
Fiona McMahon PT, DPT and Joanna Hess, PT, DPT, PRC, WCS at Beyond Basics Physical Therapy
Mommy pooch aka Diastasis Recti (DR) is the separation of the two 6 pack muscles (rectus abdominus muscles). It can occur for multiple reasons but often times it occurs as a post-partum pregnancy complication and new mothers will go to great lengths to avoid it. Whether it is about your looks or your function, a stubborn DR can be frustrating and for some a little bit scary, but with skilled help from your local physical therapist who has experience in postpartum diastasis recti treatment, there is a lot to be done to help your mommy tummy heal up so you can concentrate on what’s really important to you.
You probably want to know what you can do to keep a DR from ever happening during your pregnancy. The truth is, you can’t. 100% of women have a diastasis recti at the end of their third trimester. What you can affect is postpartum healing with diastasis recti physical therapy. We will get into both risk factors for problems with DR as well as practical steps you can take to facilitate recovery by pursuing PT for diastasis recti.
What is Diastasis Recti?
DR is defined as a separation of the six pack muscles greater than 2 cm below the umbilicus (1) but it can also be seen above or at the belly button. It is usually addressed in physical therapy when patients present with low back pain (LBP), pelvic floor dysfunction, pelvic pain, and or urinary incontinence (2). A couple of studies looking at postpartum women seeking medical care for abdominal pain and pelvic floor dysfunction were more likely to have DR (3,4).
However, this is not to say that the DR causes or predicts these conditions.
So there are a few things that make one more likely to experience an issue with DR, which can alter the diastasis recti physical therapy protocol. Women who are older and heavier are more likely to develop a stubborn DR. People with weaker abdominal walls as well as those carrying multiples are also at increased risk. In addition, women and men that strain a lot with their bowels are at a higher risk to develop a DR.
Postpartum Diastasis Recti Treatment
Our bodies can be amazingly resilient and are constantly adapting if given the opportunity. Think about an ankle sprain—in order for the overstretched ligaments to heal, the ankle needs to be in a position without excessive strain. Conversely, limiting motion over a long period decreases the body’s signal to rebuild the area. We need the Goldilocks treatment—just enough movement and challenge without too much strain.
We can use these same principles for understanding the self-resolving diastasis recti and the resulting diastasis recti physical therapy protocol. We need to move just enough to give the tissue of the abdomen some encouragement to heal but not over do it and cause excessive strain to the newly healing tissues.
Here are some basics to keep in mind while healing and undergoing PT for diastasis recti.
Dance, Laugh, Live.
Regular and progressive 3D movement that requires the abdominal system to stabilize, to lengthen, to contract, to work, is an easy way to load the system. This translates into activities like laughing really hard, reaching up for things on the top shelf, lifting a child, twisting to grab a cookie, or walking really fast with arms swinging.
With some exceptions for pain and loss of the ability to do everyday tasks, limit abdominal bracing techniques such as taping, belly binding, and second skin Spanx. These push pressure elsewhere in the system (and in some cases can contribute to certain conditions like pelvic organ prolapse) and also decrease the signal for the body to rebuild. When considering postpartum diastasis recti treatment, we want as much motion that the body can handle without losing its stability.
Managing Abdominal Pressure.
The abdominal canister—the multifidus muscles of the back, the respiratory diaphragm at the top, the pelvic floor on the bottom, and abdominals in the front—contains most of the body’s organs and manages fluctuating intra-abdominal pressures. Adopting better posture and movement patterns help manage intra-abdominal pressures taking off excess strain and help resolve DR.
Get Help if You Need It With Diastasis Recti Physical Therapy
If you have given it the ol’ college try and still don’t see progress on your DR or you are in pain, it is time to come to PT for diastasis recti. There can sometimes be a good mechanical reason that your mommy pooch isn’t resolving. Rotations in the pelvis, visceral restrictions, and rib malpositioning can all impede your progress on closing the gap and they require a skilled eye to spot and treat.
Visceral Manipulation Technique
Pregnancy causes a lot of changes in the body. Organs move to accommodate your little one and sometimes they need a little outside help to get them back to their original homes. This can be done with diastasis recti exercises in physical therapy called visceral manipulation (VM). VM can have drastic effects on the closure of the abdominal muscles and is sometimes the missing component in an otherwise excellent DR rehab program (5).
Targeted Strength Exercises
Sometimes you also need a targeted and specific diastasis recti exercises in physical therapy to correct any postural deficiencies, boney malalignments, or fascial restrictions that are preventing your two six pack muscles from coming together. Targeted strengthening of the deep core has also been found to improve both the separation distance of DR but also the quality of life of people who are experiencing it. (6)
Find a Partner in a Diastasis Recti PT
Experiencing DR postpartum can be traumatic both because of the cosmetic implications but also because of the functional implications. There is a lot that can be done through postpartum diastasis recti treatment to help accelerate your healing.
What’s really great about PT for diastasis recti is it allows not just your DR are to be treated, but it also takes into account you. By partnering with you in designing your own program, PT can help you meet your goals, whether that be running a marathon, returning to Crossfit, or simply enjoying a little quality time with your new baby pain free. What matters to you, matters to your PT.
In order to find the best diastasis recti physical therapist for your needs, use the BetterPT website or app. And with direct access, you don’t need a physician’s referral to book your appointment, making it as easy as possible to get the treatment you need. See a top PT for diastasis recti without sacrificing convenience or quality, and start your recovery.
Dr. Joanna Hess received her Bachelor of Science in Health and Exercise Science from Wake Forest University and earned her Doctor of Physical Therapy from Washington University in St. Louis. At Beyond Basics Physical Therapy, Joanna contributes to the blog with a goal of spreading good information about regularly avoided subjects.
Dr. Fiona McMahon earned her Bachelor's degree at the University of Maine, in biological sciences with a minor in neuroscience, and earned her Doctorate in Physical Therapy from Columbia University, College of Physicians and Surgeons. Dr. McMahon expands on her passion for pelvic floor health by promoting awareness of various pelvic floor and health topics as the head of the blog at BBPT.