Updated: Jul 25, 2022
Now that the concept of abdominal separation, or Diastasis Recti, is better understood among birthing people, many find themselves wondering if it can be prevented.
The answer is probably not.
Most women will develop some level of separation along the linea alba, or fascia that connects the rectus abdominis muscle, by the end of their third trimester.
This is a normal part of pregnancy that is not necessarily a problem in and of itself.
So what's the point of doing physical therapy during pregnancy and early rehabilitation postpartum?
The stretching of the abdominal wall is simply an anatomical response to pregnancy. It's whether or not the muscles are functioning normally despite the pregnancy changes that will prevent or predict future dysfunction and a lingering "pregnancy" belly postpartum.
We should expect our muscles to function well despite the changes they undergo during pregnancy.
Dysfunction arises when abdominal separation occurs and underlying faulty core activation systems exacerbate the issue.
For example, if I have very little core strength going into pregnancy, there will not be much support for my expanding belly during pregnancy, and a likelihood to utilize poor activation techniques that reinforce my abdominal separation.
This can create a thinner and wider abdominal separation, and reduce the ability of the abdominal wall to generate tension.
In short, poor mechanics going into pregnancy that are exacerbated by pregnancy will result in more "mommy pouch" and more pelvic or musculoskeletal pain.
The role of physical therapy during pregnancy is to ensure correct function of the core throughout the entire pregnancy and after.
This makes sure that despite some normal separation of the rectus abdominis and stretching of the linea alba, the overall core system is strong and healthy. The linea alba heals in tensile strength postpartum, and "mommy tummy," or the sensation that the abdominal wall is not functioning at all is avoided.
If I can't prevent it, then why should I modify exercises during pregnancy?
Because the abdominal wall is stressed during pregnancy, further stressing it by performing crunches, sit ups, or other core exercises is too intense for many women and may result in poor core activation.
Signs that you should modify or stop doing your activity include pain, pee leaks, or coning of the abdominal wall during that activity.
Don't forget that pregnancy itself is the ultimate physical challenge, and as such you will likely need to modify or reduce the intensity of your workouts as you progress throughout the pregnancy in order to continue doing them correctly.
Your pelvic floor physical therapist can help guide you through this.
When Diastasis Is A Problem
Your abdominal separation is an issue that needs addressing if:
Separation is wider than 2 fingers
Separation feels deeper than 1 cm
There is little tension in the gap
You are concerned about your abdominal muscles
You experience bulging at the abdominal muscles
Many if not all women will experience abdominal separation during the third trimester.
This is not a problem unless the core isn't working as a system and the separation becomes too large.
Working with a pelvic floor physical therapist will help to reduce core dysfunction and long-term consequences of a severe DRA.
If you are worried about your abdominal muscles, make sure you reach out to me here for an appointment!