How Do You Know If Your Diastasis Is Functional and How Can You Strengthen?

Diastasis Rectus Abdominis (DRA) is somewhat of a hot topic at the moment; awareness increasing, research and education continually developing, with more specialists in Women’s Health and Fitness focusing on ‘healing’ or improving DRA. So much so, that many postpartum women are gaining their knowledge and trialing exercises from social media! At least many of the mums I have contact with or have trained with… 

To recap, DRA is a completely normal outcome from pregnancy (to accommodate that lovely growing baby). It is where the Linea Alba (connective tissue along the midline) thins and a ‘tummy gap’ occurs between both sides of the Rectus Abdominis (RA) muscles, also known as the 6-pack muscle. The size of the gap typically needs to be >2cm or 2 fingers (subjective!) to be classified as DRA, medically speaking.  

Historically, the focus used to be on ‘closing the gap’ which can create hyper-vigilance and fear around movement for the individual with separation. It is important to note that the RA is not one solid muscle. In women that have not given birth, 1 cm (or 1 finger) separation at the belly button and 0.5 cm above and below is common or ‘normal’, and following pregnancy, it is common or ‘normal’ for the separation to be 1.5-2 cm at the belly button (of course different research will provide different stats!). 

More recently, alongside new research, there has been more focus on the depth of the gap between the RA muscles i.e. tension present, which brings us onto functional vs. non functional. Both width and depth are important to assess with a view to bringing balance, or harmony let’s say, back to the abdominal wall.

A Functional Diastasis is when tension is produced across linea alba e.g. it is firm like a trampoline. 

A Non-Functional Diastasis is when the Linea Alba is still squishy i.e. the slack is not taken up in the connective tissue so your fingers can sink deeper. This is where more targeted exercise selection takes more of a role. For example, in supine one might find it more difficult to take up the slack due to lack of ability to tension the fascia circumferentially (in line with gravitational forces). 

Transversus Abdominis muscle (TvA) strengthening is typically the initial pathway for getting a diastasis ‘functional’, and has been the focus of most clinical studies to date. So let’s hone in on this widely talked about muscle!

It is the deepest layer of abdominal muscles, part of the ‘inner core’, and runs between the ribs and the pelvis. It is often referred to as the “corset muscle” because it wraps around your sides and spine. There are 3 distinct regions (lower, middle, upper) inserting into the Linea Alba with orientation of the muscle fibers more horizontal in nature with a slight downwards slope (middle, lower). The Linea Alba acts as a central anchor for load transfer.

When thinking about creating tension along the midline and therefore working towards a ‘functional’ diastasis, we need to look at ways to strengthen the TvA so it can be helpful to understand how it functions. I’m highlighting here the most relevant when considering exercise selection:

1. Stabilises the spine; the TvA switches on for postural demanding movements i.e. it presets the torso for larger movements.
2. Preparation for movement; TvA pre-activates before rapid movement of the arms, rather than slow, as well as more difficult positions challenging postural stability e.g. upright.
3. Stabilises the Linea Allba against the pull of other trunk rotators and therefore can operate more unilaterally. 
4. Protects against rises in Intra Abdominal Pressure (IAP) which comes from within
5. Forced Expiration as an accessory respiratory (expiration) muscle. It turns on during resisted expiration e.g. pursed lips, “shhhh”, “ssss” noises etc. and other closed mouth movements. In addition, the TvA also comes on during elevated breathing rates 
6. Synergy and co-contraction with pelvic floor, diaphragm and other abdominal muscles  
7. Resistance to strengthen; every muscle needs to fully relax to be able to contract, to stretch and recoil through full range of motion. In this case the resistance needs to come from inside i.e. intra abdominal pressure (IAP)

So if you are struggling to generate tension (squishy DRA), here are some tips worth considering with regard to movement prescription. To keep it simple, I’m splitting it into 2 PHASES i.e. the slower reconnection & breathing focus vs. strengthening with more challenging movements, resistance and load.

PHASE 1:

• Reconnect with breathing and abdominal drawing in i.e. corset motion of flattening abs from bottom up, at a slower pace initially 
• Use of isometric exercises, squeezes, counter resistance and approximation techniques
• Use pelvic floor, diaphragm and TvA together 
• Focus on Eccentric (lengthen) and concentric movements i.e. don’t just ‘activate’, focus on those deep inhales also
• Use of forced or resisted expiration; blowing through a balloon, different breath sounds, mouth positioning etc.

PHASE 2:

• Strengthen the entire abdominal wall i.e. including internal & obliques, and rectus abdominis
• Increasing IAP (under control) e.g. more ab wall loading (e.g. prone), add more weight or resistance
• Faster paced movements of limbs
• Challenging postural stability which is positional e.g. you might consider upright vs. supine
• Unilateral loading

In both PHASES outlined you’ll want to check different positions and identify in which positions do you, does your body, find it easier to produce a change in tension and this will also vary depending on where your diastasis is occurring along the midline. I always focus on testing 4 groupings based on position relative to gravity:

1. Chest Up – Supine, Bridging, Backwards Leaning
2. Chest Down – Prone, Hands & Knees 
3. Chest Out – Side Lying, Side Plank
4. Upright – Standing, Sitting

So test, retest, gain some awareness of your body and work in a variety of positions initially that challenge your body while producing tension. Work up to other positions as your strength, and therefore control, improves and don’t forget to introduce transitions between movements (e.g. working different planes of movement including rotational). Progress to harder exercises as soon as it becomes easy!  

Don’t be afraid of doming or bulging. It is likely to occur at some point but what we are looking for is how much time are you spending in the doming/bulging phase? Is it soft or hard i.e. the latter being close to max tissue stretch? Do you have control to bring it back in through simply engaging or exhaling more or altering position/posture? If not, simply modify the exercises if excessive uncontrolled doming or bulging occurs, gain more strength and then reintroduce at a later date.

Remember when it comes to DRA, there is no ‘good’ or ‘bad’ exercise but possibly a ‘wrongly recommended’ one based on your situation and your diastasis. So, play around with it, have fun not fear. If you can generate good tension with control during challenging and even high impact activities, then there is no reason why you cannot achieve your goals and get back to the activities you love. 

I appreciate this can be an overwhelming area to navigate so do seek professional help if you need the support. Any questions, I’m always happy to answer, just pop them below.

With love,

R x

Want to work with me?

re|BIRTH to 6 weeks is FREE and with quick 15 min exercises you can do from home straight after birth.

The re|BORN Postpartum Method is a 12-week comprehensive corrective and functional fitness programme suitable for those with a mild or functional diastasis, incontinence and mild prolapse.

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Or get in touch for other options such as consults and remote coaching.

Sources:

Diastasis Recti & The Postpartum Core Professional Certification, Dr Munirah Hudani

Benjamin D.R., van de Water A.T., Peiris C.L. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014 Mar;100(1):1-8. https://doi.org/10.1016/j.physio.2013.08.005

Pascoal A.G., Dionisio S., Cordeiro F., et al. Inter-rectus distance in postpartum women can be reduced by isometric contraction of the abdominal muscules: a preliminary case-control study. Physiotherapy. 2014 Dec;100(4)344-8.  https://doi.org/10.1016/j.physio.2013.11.006