Abdominal muscle separation or ‘Rectus Diastasis’ is such a HOT topic at the moment! When I started seeing women in hospital after having babies almost 15 years ago, most had never heard of rectus diastasis, or even the pelvic floor for that matter! So I love the fact that women are now talking about this and doing what they can to educate themselves about what it is and what it means for them.
Of course, with more information comes more bad information (or at least outdated information). So to reduce some confusion about the matter, I would like to dispel a few myths when it comes to abdominal separation!
MYTH 1: Abdominal Separation is not normal
Your Rectus Abdominis is your six-pack muscle at the front of your abdomen (yes, you have them even if you can’t see them!) They are actually two separate muscle bellies joined together by a band of connective tissue down the middle called the ‘Linea alba’.
During pregnancy as the belly grows, the linea alba has to stretch out to allow room for the growing baby. This is a completely normal part of pregnancy and occurs for the majority of women (to one extent or another).
MYTH 2: Abdominal separation involves the muscles splitting / tearing
For most women, as the Rectus Abdominis muscle bellies move away from each other, the linea alba thins and stretches. I like to imagine it’s like a sheet of pastry that you have rolled out; it’s thinner in some places than others, but it’s still held together.
Hernia: a different issue
When the linea alba has a particularly weak spot in it (or even a small hole) some women may develop a hernia. This involves the protrusion of an organ or bit of tissue from its normally contained space. Sometimes, but not always, these require surgery to repair.
MYTH 3: It’s all about the size of the ‘gap’
You will have probably heard tummy separations measured in centimetres or finger widths. This is a great way for us to get an objective measure that we can write down on paper (although there are some problems with consistency here, especially when two different people are testing), but it is by no means not the only way to assess a rectus diastasis.
A ‘gap’ of 1.5-2 fingerwidths post-partum is considered normal and not classified as a diastasis (I like to think of it as a little reminder that your body was once pregnant). But it really is less about the width of the separation and more about the feel of the connective tissue between the muscle bellies. I have seen women with tiny separations but soft, squishy midlines, and those with larger separations but good, firm tension at the midline.
The main aim of treatment for rectus diastasis is improving the tension between the muscle bellies (i.e aiming for a nice firm linea alba). This gives your abdominals a much better chance of doing their job well (i.e controlling the pressure in your abdomen and working with the body to transfer load.)
MYTH 4: You can prevent a Diastasis by wearing a tummy support during pregnancy
Your linea alba has to stretch to allow room for the growing baby, so any external support you wear during pregnancy is just going to be fighting a losing battle! Post-partum however, it’s a different story. In the first 6-8 weeks, a tummy support can be incredibly helpful in holding your muscles in a better position while healing of the tissues occur. Your physiotherapist can recommend a few good options for support.
MYTH 5: You should avoid all abdominal exercises during pregnancy
As your muscles start to stretch you might notice that you get doming / bulging / triangling down the middle of your tummy with certain movements, but especially those that involve your abdominal muscles working. Many women notice it when they sit up to get out of bed, or when they lean back to wash their hair in the shower. This ‘doming’ is a sign that your linea alba is not coping with the pressure on it, so it’s a good idea to avoid any exercises that cause this to occur. As a general rule, I would recommend avoiding sit ups, crunches, oblique twists, planks, double leg tabletop and chin ups.
But this doesn’t mean you have to avoid ALL abdominal work. There is some evidence to suggest that maintaining strength Transverse Abdominis (i.e your deep abdominal muscles) can help reduce Rectus Diastasis after birth, or at least improve recovery. Your physiotherapist can show you how to activate these muscles correctly and show you how to incorporate them into your day.
MYTH 6: You should wait 6 weeks to start exercises
It is a common misconception that you should wait 6 weeks (or until you’ve had a doctor’s clearance) to begin any kind of exercise. I would certainly agree with this when it comes to returning to group exercise, but there is so much good work that can be done in the first 6 weeks for diastasis recovery, pelvic floor rehab and general conditioning and mobility! Most of the natural healing of a rectus diastasis occurs in the first 6-8 weeks after pregnancy, so this is the time to get good advice on facilitating the recovery with abdominal support and guided exercises. After 8 weeks, most of the improvement will come from a tailored exercise program. Ideally, this will be a program of exercises that are prescribed for you after an assessment with a good physio, because no two women (and no two separations) are the same!
MYTH 7: Your separation will get worse with each pregnancy
This is simply not true! Each time you have a pregnancy, relaxin and other pregnancy hormones help your connective tissue to soften and relax, so even if you managed to ‘close the gap’ after your last pregnancy, your muscles will still need to move apart on the next pregnancy. Even though it can be disheartening to see your muscles separating again (and often earlier with each pregnancy), just remember it is a normal part of pregnancy. It is not a sign that all your hard work has been undone!
After each baby you have a fresh opportunity to facilitate healing and work on improving the tension between the muscles again. And it is never too late! I have seen improvements in women who are many years ‘postpartum’ with the right education and exercises.