I covered this in the podcast episode of 22-08-21 but thought it would be worth writing a little blog post for those of you who don’t listen to podcasts.If you enjoy listening to podcasts then here’s the link to the episode of the Healthy Post Natal Body podcast that covers this.
There is a lot of false information about diastasis recti online. Jess sent me 10 things through that she came across on one support forum alone.
As an aside, I have spoken about support forums before. They definitely serve a purpose, it’s nice to be able to relate to others and identify with them. However they are a terrible source of information. Quite often a support forum is like the ward of a hospital; loads of patients that sound knowledgable and can tell you many things but..and the end of the day..they don’t have a medical qualification and therefore quite often doesn’t really understand what they are talking about. Think Joe Rogan but in a hospital setting.
So we’ll go through the 10 in no particular order.
No, it isn’t. Diastasis recti is a condition caused by muscular dysfunction or weakness. In layman’s terms; the muscles aren’t all working properly or some are weaker than they should be. This is good news!
Almost all muscular issues like this can be fixed by working the right muscles and doing the right exercises.
A good post-partum program accomplishes this by first working on muscle activation. Making sure all the muscles work and work at the right time. Assuming you’re starting relatively soon after giving birth and don’t wait a few years to start your recovery this stage usually takes about 3-6 weeks.
Then, in stage 2, it’s about increasing the muscle’s strength and conditioning. Making sure the muscles are strong enough to do the things required to do and that they can do it for long enough. This stage usually takes about 4-8 weeks, depending on what your starting point was.
This is why a good post-partum program is at least 12 weeks long. To make sure that, not only is everything working properly, but that your core is strong enough to deal with the pressures of daily life. An excellent post-partum program, like HPNB, runs for longer because there are other issues that need ironing out. The reason we do a 3 month free trial is because we believe every woman should at least have the chance to get through those first 2 stages for free.
Once you have good muscle activation and the muscles are back in place and strong enough to deal with life, you no longer have diastasis recti. Your diastasis recti will be fixed at that point!
There is no “life long condition”. If you broke you leg 15 years ago you wouldn’t say “Well the Dr healed it but I’ll have to deal with this for the rest of my life” so why would diastasis recti be any different? It doesn’t make sense and that’s not how it works.
The reason for this myth is the language a lot of medical professionals, including physios and personal trainers, use with regards to “closing the gap” when they talk about diastasis recti. What they should say is “bring the muscles back to where they belong, and potentially narrow the gap”. But that isn’t as catchy.
Look at the image below and you will see that there has always been a gap. Even if you had rock-hard abs pre-natal you still have a gap between the muscles on the right and those on the left, you just weren’t aware of it because it wasn’t an issue. This is why medical professionals don’t class anything below 25mm as diastasis recti.
Absolutely not. I see this mentioned a lot on support forums, as soon as someone can squeeze a finger in to the skin above their belly button they get told “That’s diastasis recti”, in some cases followed by “You need surgery”. As I mentioned above, there is always a gap. The gap is not the problem, muscle functionality and weakness is the issue.
Variations on a theme here, I’ll admit, but an important one. Too often do I hear women say “Well, I never had diastasis recti after my first pregnancy but it was really bad after my second”. This is because of the dreaded “I bounced back” statement and this is the one that gets most women in trouble in the long run. You can still have muscle weakness and dysfunctional musles when you have a flat stomach. In fact, it is extremely common for women to get a flat stomach soon after they gave birth to their first child but the find they have no core strength or activation. And, if you don’t resolve those issues they come back much worse second time around.
This is why I always try to hammer home the “wider definition of diastasis recti”.
Nonsense and poppycock! As the Queen would say “One can always get a flat stomach, if one puts the effort in!”. This goes for absolutely everybody. If, and it’s a big if, you’re willing to put time and effort in you can get a flat stomach. Of course, after a C-section the scar might create a little ledge, but that’s about it. The real question is; “Are you willing to put the effort in?” It’s perfectly acceptable for the answer to be a resounding NO! But that doesn’t mean it’s impossible. It just means doing the right exercises, at the right time and consistently.
In my 10 years of training post-partum women I have only come across 1 case where this was true. Someone who came to me 8 years post-partum, after having had 3 kids. She still had 7cm separation, and all the problems that come with that, and had some muscle damage due to a traumatic labour. After our initial consult I just advised her to go get diastasis recti surgery and I recommended a good surgeon in her area. That is the ONLY TIME I have ever seen that. I am sure there are many women out there who have had a traumatic birth-experience and they would be the only ones for whom a flat stomach would be unachievable without surgical intervention. This is why I am opposed to the NHS providing diastasis recti surgery in most cases as it simply isn’t necessary.
Rotation and anti-rotation exercises are at the core of every good post-partum program so why would anyone say they’re a nono? To be honest, I’m not sure but it seems to be one of those “I don’t quite know how the body works” sort of deals that sometimes crops up. The reason given for telling women to not do any twisting seems to fall along the lines of “it lengthens the linea alba and therefore stretches the connective tissue even more when it’s already weak”. And that sounds like a thing but it isn’t really. Yeah muscles, and therefore connective tissue, lengthen and contract when exercising but not to the extent that people think it does. And, assuming you move with good form, rotating exercises such as woodchoppers are actually very beneficial.
Planks, crunches and sit-ups are the go-to “never do these or they will make your diastasis recti worse” exercises on most support forums and in a lot of, badly written, blogs. To be honest, it’s been a long, long time since I have done a sit-up or had anyone else do one. They are a silly, outdated exercise that causes more grief than it’s worth. But the other two are fine IF you have good muscle activation and your body is strong enough.
There are a lot of different plank variations, including some that are very beneficial for healing diastasis recti, and crunches never cause doming if executed properly. But knowing why you do them is important. Quite often standard crunches are not useful when trying to heal diastasis recti as the upper abs are already strong and over developed. And certain planks are better than others, we do a lot of side planks and the “rocking plank” is one of my absolute favourites to give to clients who are ready for it as it is very effective “at the front end”.
The only exercise, if we can call it that, that helps heal all forms of diastasis recti is the core breath. Other than that it’s a bit more complicated. As you probably know; there are several different forms of diastasis recti. Above-navel diastasis is a different beast from below-navel diastasis. Yes there is some overlap in the muscles involved, and the approach is the same, but the focus is slightly different. That means that a post-natal program has to be carefully designed to make sure that everybody can heal their diastasis using the program, no matter what their diastasis actually is. When I do 1 on 1 personal training with clients things get a lot more specific. Unfortunately an online program does not allow to get into the level of detail personal training does but that does mean I had to spend a VERY long time making sure everybody can get the results they want from the program. This is important to realise because it also explains why just following a random bunch of “diastasis workouts” on Youtube will almost never work. You don’t know whether those workouts target your particular form of diastasis recti.
This is a bit of a yes but no sort of situation. I MUCH prefer the core-breath as I use and demonstrate it because you get a lot more lower core, and TVA, activation when you do that. Diaphragmatic breathing is fine but it’s not as effective for the vast majority of people with a weaker/dysfunctional core.
As I mentioned, diastasis recti is a muscular condition which can healed by diet and exercise. This is true in the vast majority of cases BUT you have to put the effort in. And, being brutally honest, most people I have seen complain on support forums are just not willing to do that. This is why there is soo much shouting for surgery on support forums, because people with diastasis recti didn’t put time and effort in soon enough. That’s not always their fault though. A lot of women still don’t know dr is even a thing. This is why I keep arguing that every ante-natal class should have some sort of “these are post-partum issues and this is what you can do about it” element. And why I think that expert post-partum advice, like HPNB offers, should be freely accessible for all women, at least for a certain period. In Scotland we have a thing called the “baby box” which is a box of stuff and information new mothers get from the government. I have offered free HPNB memberships to be included in this, I have even offered to pay for educational leaflets for these boxes myself. But I have never had a response from anyone involved with these things. And that’s fundamentally what the problem is; we have to start seeing mothers as more than just mothers. Just because you have given birth that doesn’t mean you, and your issues, should be invisible. There should be more support available when it comes to this sort of thing and then we can stomp these ridiculous myths out.
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I fought for ~3 years to get surgery for my diastasis recti under the NHS.
My husband has private health insurance so I am contacted them (AXA) – They told me they don’t cover abdominal wall reconstruction surgery because diastasis recti isn’t considered a medical condition under NICE guidelines.
I checked on the NICE website and diastasis recti doesn’t even come up in a search. I’m horrified!
Your website is great. It’s so encouraging!
I’m not sure where to start in getting this changed so women with diastasis recti are properly supported – referrals from their GP to physio, getting surgery if they need it, etc.
Any suggestions who I could contact / what I could do? Do you know anyone else working on this? (I’m a Mum who has a bit of time now my son has started nursery!)
Apologies for not responding sooner, I’ve been rather busy with one or two things.
I’ve been struggling with the same tbh.
Realistically I don’t think the NHS can do much with regards to referals to women’s health specialists and physios because there just aren’t that many of them in the UK.
So I reckon the “educate and give women access” approach is the best way forward. Let women know that diastasis recti is incredibly common and then tell them that exercise can resolve their issues in 9 out of 10 cases. Ideally this would happen ante-natal, but I haven’t been able to get NCT on board.
I am currently in the process of writing MSPs in Scotland in an effort to get something in the Scottish baby box to at least give women some information. I have reached out to party leaders and spokes persons on Health of all major political parties (In Holyrood and Westminster) but they’ve understandable been rather busy with other things over the past few years. I have offered free lifetime access to this program to all diastasis recti support groups on facebook (but they turned it down) and have been in touch with various women’s advocacy groups (pregnant then screwed etc.) but they are also not interested in the issue.
I think it all requires abit of a shift away from the current mindset that women are only vessels for their babies or that women’s rights/post-natal rights are all about money.
If you have any thoughts or ideas I’d love to hear them though.