Let’s review the previous article regarding Diastasis Rectus Abdominis (DRA).  DRA is the separation between the two bellies of the rectus abdominis at the linea alba and this condition may occur with more than half of all pregnancies.   

How to know if you have Diastasis Recti?
To check to see if you have DRA first lie on your back with your knees bent and feet flat on the floor. Then place your fingers with the palm facing you on your belly button. Lift your head and neck just slightly off of the floor like you are doing a crunch while you press down with your fingers. If there is a gap this would mean you have a diastasis.  You should conduct the test just above your belly button and just below the button since the gap can measure differently in these places.  Talk to your doctor to confirm your findings and to make sure you are doing it correctly. 

Once you know that you have DRA you need to know how to treat it.  There are exercises that can help to decrease the size of the diastasis and there are exercises that may not help but that may also make the condition worse. 

The exercises that you should avoid include the following: Traditional abdominal curl or sit up, incline sit-ups, intense abdominal exercise machines, oblique sit-ups/machine, exercise ball sit-ups/ball leg raises, bicycle legs, double leg raise, hanging knee raise, pilates table top or “The Hundred” and intense core plank or hover exercises.  This is not a comprehensive list but these are the types of exercises that should be avoided since performing these exercises can stretch the abdominals and make the condition worse. These activities can increase strain on the upper abdominal muscles which will cause them to separate rather than heal. You should avoid any intense abdominal or core exercises. You need to start with low level abdominal contraction exercises and avoid anything that puts too much stress on the abdominal wall.  

Related: PostPartum Exercise Recommendations: How, When & Why

Exercises for diastasis recti 
Exercises that are safe to perform include exercises that will draw the abdominal muscles closer together and decrease the size of the DRA. You will need to understand how to correctly contract the transverse abdominis muscle in order to perform the exercises correctly. This is the deepest of the three muscles in the side body wall. In order to engage the entire muscle and to perform the contraction correctly, the ribs should be flushed with the body wall and the spine and pelvis should be in neutral meaning that when lying down on your back your pubis and pelvic bones are even.  Think about trying to pull your belly button back to your spine.  It may help to perform the contraction on the exhale phase of a breath.  Make sure you keep your pelvis level during each contraction.

Exercise One
The first exercise is activating the deep abdominal muscles in a side lying position. Start by lying on your side and then use your fingers to feel your abdominal wall just inside your pelvic bone. Activate your lower abdominal wall by gently drawing inward the lower abdominal muscles.  Maintain this abdominal activation or contraction for up to 10 seconds. You can start with a 5 second hold and then progress to 10 seconds as tolerated.  Make sure you breathe normally throughout the exercise and then relax your abdominal wall back to a resting position in between repetitions.  Your upper abdomen should remain relaxed throughout the exercise. To progress this exercise extend the duration of this hold for up to 10 seconds at a time as long as you are correctly able to activate the lower abdominal muscles. 

Exercise Two
The second exercise is to activate the deep abdominal muscles when lying flat.  Start by lying on your back with your knees bent and feet flat. Keep the normal curve of your lower back throughout.  Place your fingers on your lower abdominal wall just inside your pelvic bones.  Gently activate your deep abdominal muscles (the same technique as exercise 1). Maintain this abdominal activation/contraction for up to 10 seconds and continue to breathe normally throughout the exercise and then relax your abdominal wall back to resting.  Just like the previous exercise your upper abdomen should remain relaxed throughout the exercise. Make sure you learn to correctly activate your deep abdominal muscles before extending the duration of this hold for up to 10 seconds at a time. 

Exercise Three
The third exercise is bent knee fall outs. This is a progression of the first two exercises. You want to start by lying on your back with your knees bent and feet flat while again keeping the normal curve in your lower back.  Activate your abdominal muscles like in exercises 1 and 2 and then gently lower one leg out the side while keeping the other leg bent and pointing upwards towards the ceiling.  Keep your pelvis stable throughout this exercise and try to avoid trunk rotation.  Return your leg to the starting position as soon as you feel you compensate with trunk movement.  Relax your deep abdominal muscles and then repeat 2-3 repetitions on each side and progress to increased reps as tolerated.  Increase the challenge by increasing the number of repetitions without releasing your abdominal contraction.  

Exercise Four
The fourth exercise is heel slides.  This will also further progress the challenge for your core muscles.  Start in the same position as the last exercise.  Place your fingers to feel your abdominal muscles just inside your pelvis.  Gently activate your deep abdominal muscles as you extend your right leg (sliding your foot until your knee is straight). When you feel your low back begin to arch bring your leg back to the starting position by bending your knee. Relax your deep abdominal muscles. Repeat 2-3 repetitions on each side when just staring out and you can progress by doing a number of repeated exercises in a row without releasing the abdominal contraction. 

These are the first four basic exercises to start out with and then you can continue to progress to more challenging exercises including straight leg raise with an abdominal contraction and seated heel slides with abdominal contraction.  Further progressions are available but just remember to avoid intense core exercises. 

Before enacting any exercises, self diagnosis or treatment plan, always talk to your personal health care provider who has all of your health care information.

L. Augustyn, Physical Therapist

References
https://www.pelvicexercises.com.au/diastasis-recti-exercises/
http://www.alignforhealth.com/blog/how-to-contract-your-deep-abdominal-muscle-the-transversus-abdominis