Last week, we went LIVE on Instagram to clear up many of the misconceptions regarding diastasis recti and “the gap”. Diastasis rectus abdominis, or DRA, refers to the thinning and widening of the connective tissue, or linea alba, between the left and right sides of the abdominals. It is a natural adaptation that occurs during pregnancy and will persist in 33% of women one year postpartum.
Traditionally, there has been a lot of fear surrounding diastasis and particularly the phenomenon of “coning” in which the person exercising visually observes a tenting and distortion along the midline during core-focused exercises. Much of the general information online recommends blanket lists of exercises to avoid including planks, sit-ups, crunches, and heavy lifting.
In the past, diastasis rehab has been very focused on strengthening the abdominals and particularly targeting the deepest abdominal layer called the transverse abdominis, or TrA, in order to create tension through the midline.
But in more recent years, there has been a shift in thinking regarding addressing DRA. There should be no blanket list of exercises to avoid when a person has diastasis. Strengthening should be progressive and include appropriate increase in challenge and load in order to actually start to change the connective tissue and balance of the abdominal muscles. Observing coning during exercise is not inherently “bad”, “harmful”, or “damaging” and avoidance of exercise due to fear of coning likely has far greater devastating effects.
Improving the appearance of the abdominals and addressing a diastasis should include much more than core strengthening. A comprehensive rehab program should address any areas of mobility restriction that may also be holding back the abdominal muscles’ ability to work cohesively, and this may include looking at areas such as the spine, ribcage, posture, scar tissue, breathing, diaphragm, pelvic floor, lats, and psoas to name a few.
And of course, a complete picture would also need to include impact on mental health and self-confidence, function, and specific goals beyond “closing the gap”. It may need to include addressing constipation, bloating, nutrition, hydration, and sleep as these lifestyle factors can additionally contribute to the appearance and function of the abdominal area.
And despite what the plethora of quick fix programs out there would have you believe, the healing rate of connective tissue (the linea alba) is extremely slow and can take 1-2 years and beyond to fully change. Genetics also plays a role in the ability of the connective tissue to return to its prior elasticity and tension. So unfortunately, appearance goals are not something that any program should be guaranteeing, because in reality, each person will be different and we won’t know what will ultimately happen until we try.
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Dr. Julie Berube is a pelvic floor physical therapist who is on a mission to revolutionize the standard of healthcare for women in Central New York and the Syracuse area.
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