Uterine growth during pregnancy stretches and weakens the abdominal muscles. Maintaining the tone and strength of these muscles is crucial, as they support the lumbar spine and assist in childbirth. They also provide support for internal organs, and without them, laughing would be difficult.
It is important to emphasize that pregnancy is not a time for intense abdominal muscle strengthening. The approach to exercise is quite conservative. Exercises are performed slowly and in a controlled manner to avoid stress on the fibrous band called the connective tissue band or linea alba. Before any exercise, however, we must test for diastasis recti. Exercises are then tailored to the individual.
With diastasis recti, we must strengthen the core, which crunches DO NOT strengthen. In fact, crunches only worsen the condition.
What exactly is diastasis recti?
Also known as abdominal muscle separation. This is a pathological condition where the superficial abdominal muscles separate. In diastasis recti, the intervening connective tissue, called the linea alba, stretches and thins. It thus loses its ability to create “tension,” which can make our belly appear constantly bloated or as if we are halfway through pregnancy. The result is the separation of the abdominal muscles, hence the name.
For some women, this separation of the abdominal muscles does not return to normal after childbirth. The condition of abdominal muscle separation can be dangerous primarily due to reduced functional support of the abdominal wall, which can cause or worsen lower back pain, including pelvic instability (Three Sisters for a Balanced Pelvis). Diastasis recti can be corrected with proper strengthening of the deep muscle systems, but it requires physiotherapist treatment.
Pelvic floor muscle training and deep abdominal muscles can begin immediately after childbirth, and there is no need to wait 6 weeks postpartum. Diastasis recti itself does not pose any dangers. Problems arise if the muscles remain chronically separated and daily activities overload the woman’s body. Therefore, the correct choice of physical activity during and after pregnancy is essential (deep abdominal muscle, pelvic floor muscle training, as well as back and gluteal exercises). Also, posture, lifting heavy objects, and carrying.
If diastasis recti is present, exercises are performed by protecting the abdominal wall with hands across the abdomen. The test is performed as follows:
- Lie on your back with your head on the floor, knees bent, and feet flat on the surface.
- Perform the exercise on bare skin.
- Place one palm under your head and the other palm on your abdominal area with fingers positioned in the middle of the linea alba, parallel to the waist area just above the navel (for proper diastasis assessment, separation is measured in three areas; here we present only one of the examination points).
- With your abdominal wall relaxed, place your fingers on the area where you will measure the diastasis. You may feel minimal pressure on your fingertips, which you should not forcefully push into your torso, as this would excessively separate the abdominal muscle in the initial phase, and the test would not be accurate.
- Then, exhale and lift your head (do not do crunches), activate your pelvic floor muscles (CORE).
- Move your fingertips back and forth along the middle of the linea alba to feel the outer edges of the rectus abdominis muscle and thus assess the size of the separation (perform above the navel, 3 fingers above the navel, and 3 fingers below the navel).
Check every 2 weeks to monitor any changes in separation.
Even if there is a separation and it remains after childbirth, it is important that the LINEA ALBA IS FIRM! To regain the tension it lost during pregnancy.
Therefore, correct exercises (postpartum) are extremely important. Otherwise, you can worsen the firmness or lack thereof of the linea alba, which will result in worsening lower back pain, even poorer pelvic and core stability, pelvic organ prolapse, urinary incontinence..
In a non-pregnant woman
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SOME GENERAL INFORMATION:
The core, in this case the deep abdominal muscle (transversus abdominis or TrA for short), is responsible for activating first, even before trunk flexion (a crunch occurs), to stabilize the trunk and pelvis. The TrA, or all deep core muscles, are harder to activate or do not activate at all if the spine is not in a neutral position (S-shape, not C).
Because, firstly, lifting the torso is inherently an exercise with a curved spine (= a large load on the lumbar discs between the vertebrae!) and because, secondly, even if it weren’t, a person with diastasis has a dysfunction in activating the deep abdominal muscle, the TrA does not activate. Because the TrA does not activate, the rectus abdominis and obliques (superficial straight muscle and side abdominal muscles) must lift the torso off the ground themselves, which means, firstly, that they strengthen significantly while the TrA becomes even weaker, and secondly, because they attach to the pelvis below and the ribs above, they will pull the pelvis with them.
What follows?
The abdomen collapses, and intra-abdominal pressure (which the TrA does not contain) finds its way towards the linea alba (the midline between the left and right halves of the abdominal muscles) and/or towards the vertebrae and intervertebral discs, where nerve roots are located. In diastasis, this is most often seen as a ‘ridge,’ while in others, the entire abdominal wall lifts SOURCE.
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