Journey Back to a Six-Pack (Or in Mom-Terms, Dealing with Diastasis Recti)
I’ve done physical therapy in the past for a number of prior sports related injuries (shoulder, back, etc.). I’ve just recently started it again, this time for a pregnancy related injury, Diastasis Recti (pronunciation varies depending on who you talk to, but I think it’s officially: di·as·ta·sis). What in the world is that? It’s basically a gap between the left and right abdominal wall muscles, and it’s actually a very common issue that I don’t think gets a lot of air time (one study found up to 60% of women may experience it during pregnancy or postpartum).
Diastasis recti (DR) is the partial or complete separation of the rectus abdominis, or “six-pack” muscles, which meet at the midline of your stomach. DR is very common during and following pregnancy. This is because the uterus stretches the muscles in the abdomen to accommodate your growing baby. (Chertoff)
At my 12-week follow-up after delivery of my daughter, my OB-GYN diagnosed me with DR and said that I had about a 4-finger gap up in between my muscles, which she said was about twice what it should be. She told me most women’s DR heals within about 6 months, with at-home exercises and avoiding certain exercises as well. And that if mine hadn’t healed by then, to give her a call and she’d refer me to a physical therapist.
Sigh. I seem to always have some sort of issue related to my body/injury/pregnancy issues, etc. So was I surprised — no, I had a feeling I had DR. But I was disappointed and irritated to have one more thing to try and fix with my body. After my postpartum issues with my son though, it felt very small in comparison so I felt lucky enough in the grand scheme of things. So I started googling, saving exercise ideas, avoiding certain exercises (push-ups / planks / crunches — all the stuff I’d normally do) and started actively working to heal the DR on my own with the goal of not having to go to PT eventually.
I worked on it for a few months, and kept testing my DR at home on my own periodically, and felt like I was making some progress. I hit the 6 month mark though and knew that it definitely wasn’t completely healed. I wasn’t ready to ask for a physical therapy referral from my doctor, as it felt like I was giving up and I kept telling myself I was probably already doing all the exercises they’d tell me to do, anyways. Then COVID hit, and I wasn’t about to start physical therapy amidst a pandemic and then certainly not while I was working full-time with both kiddos at home. Fine by me, because I wanted to keep working on it at home anyways. So I maintained my fairly-regular exercise routine at home, modifying as needed due to my DR for ab exercises.
Fast forward to mid-September when I sent my kids back to daycare. I had my annual OB-GYN appointment, and she confirmed what I mostly knew — my DR was definitely improved from when she saw me last, but still not healed and she recommended I go to physical therapy. You may be asking the question I was asking in the back of my head — why does it even matter? It’s not bothering me. I’m not in pain. Honestly, the part that was bothering me the most about it was how it made my stomach look (misshaped / jutted-out / not flat). I know that’s not good self-love, and my body has been through a lot carrying two children, etc. And 90% of the time I remind myself of that, tell myself I am still working at repairing my muscles and get over it, but at least 10% of the time I dwell on it. And honestly I think I do a decent job of giving myself grace, but maybe 20% is closer to reality.
Why it matters for non-self conscious reasons though, is because it can lead to many other problems such as lower back or pelvic pain because essentially your core is weakened. And in the cases for those who aren’t done having children, if you don’t work to repair your DR and strengthen your core before getting pregnant again, another pregnancy could just make it worse.
Alas, here I am on a Thursday morning coming home from my physical therapy session. I do like my physical therapist a lot. She’s giving me some new exercises to try out and has really helped me better understand DR and the transverse abdominal muscles that I really need to focus on engaging in everyday activities. When I was working on it on my own, I tuned into a few different social media accounts focused on this issue specifically and watched their videos, but it really helped me to have someone physically showing me what I should be feeling when I engage the muscles I need to be, to repair my DR. I’m focused on proper posture, belly breathing techniques, and specific exercises — all things that seem small, but if done improperly can be detrimental to someone with DR.
So, how would you know that you have DR? It often results in a rounded, protruding belly “pooch,” especially when you contract your ab muscles. For example, when I did push-ups, my stomach would kind of bulge and hang, but just in the middle. (Because I know what all you moms are thinking — most of us have some sort of extra “ness” in our belly area. How will we be able to tell if it’s DR or just normal post-baby belly.) You can test yourself at home, to see if it’s obvious whether you have it or not. There are tons of videos and explanations online regarding how to do it.
If you think you may have DR, I encourage you to reach out to your doctor and ask for an assessment. Your primary care doctor can diagnose you, too. I wasn’t diagnosed with this after having my son, but would not be surprised if I had it then and due to lack of awareness and attention to it, made it worse with my second pregnancy. I am not sure how many doctors assess women for it without being asked, but I have talked to a number of women who had little to no awareness of what it is. So I personally classify this as something that needs to be talked about more, as I imagine there are many women dealing with it after pregnancy and don’t realize what diastasis recti is, let alone that it’s something they don’t have to just live with. Read that part again — you don’t just have to live with it.
If you’ve been successful in repairing your DR, or are currently in the same boat I am and working on it, I’d love to hear your story!
Chertoff, Jane. “Diastasis Recti: What Is It, and How Is It Treated?” Healthline Parenthood, 2017, https://www.parents.com/pregnancy/my-body/postpartum/diastasis-recti-the-postpartum-body-problem-no-one-talks-about/. Accessed 7 October 2020.