Add this to your list of workout injuries you’d rather not get: diastasis recti, the splitting of your abdominal area, which can cause anything from mild discomfort to significant pain. Diastasis recti repair can require weeks or months of rehab or even surgery to fix. Luckily, in milder cases, diastasis recti exercises that target the abs can help.
If you’ve heard of diastasis recti at all (which likely you haven’t), it might have been in conjunction with your wife’s delivery. The condition most often affects pregnant people (about 60% of them develop it, according to the Cleveland Clinic), most commonly during their third trimester as the growing fetus presses up and out against the abdominal wall. When this happens, the rectus abdominis — those two vertical bands of muscle that make up the so-called six-pack — begin to separate. After childbirth, bowling ball having been removed, the abdominal muscles pull back together. Or at least, they should. When they don’t, this is called diastasis recti.
“Diastasis recti is the abnormal separation of the rectus abdominis muscles,” says Dr. Lorenzo Masci, a sports medicine specialist based in the U.K. “Usually these muscles — also known as the six-pack muscles — are joined in the middle by connective tissue.” This tissue holds the muscles together, giving abs their definition, he explains, and it’s designed to stretch if the size of the abdomen grows.
But in some cases, the tissue loses its elasticity and no longer contracts. Instead, a bulge forms. “Generally, you see a visible lump between the rectus muscles,” Masci says. “Usually, the bulge is worse when standing and lessens when lying flat.”
Pregnancy is the leading cause of the condition in women, and men can get it when they carry extra weight around their midsection. “In men, obesity or diseases of the abdomen organs such as liver or spleen enlargement can cause a diastases,” Masci says. Repeatedly gaining and losing pounds can also cause the condition.
And if you’re carrying a little extra around the middle and you also happen to lift weights — watch out. “Generally, we see diastasis recti in sports where the men are larger and have to use their abdominal muscles to increase pressure, like in powerlifting and field athletics such as discus or shot put,” Masci says.
Diastasis Recti Repair
When repetitive strain of the abdominal muscles leads to their separation, over time it can cause weakness in your core. In turn, this leads to difficulty lifting objects and an increased risk for lower back pain, pelvic pain, discomfort, and urinary incontinence. If you’re experiencing any of those symptoms, it’s worth talking with your doctor because in mild cases, the diastasis recti can be harder to spot if you don’t know what you’re looking for. Ultrasound may be used to help with the diagnosis, Masci says.
Treatment for diastasis recti depends largely on the size of the separation, which is measured both above and below the navel. A gap of greater than three centimeters is considered abnormal, Masci says. Greater than five centimeters may require surgical intervention to fix. Your doctor will likely also look to see if the connective tissue has torn and a hole has formed — this is known as a hernia and will likely require surgery.
Diastasis Recti Exercises
For gaps smaller than five centimeters, your doctor may suggest physical therapy exercises to help bring your rectus abdominis muscles closer together. Perform the moves here at least three times a week, for about 15 minutes total, to help improve diastasis recti (but, of course, talk to your doctor first).
How to: Get down on all fours. Drop down onto your elbows as you extend your legs behind you, resting on your toes. Form a long straight line from your head to your feet; hold for 30-60 seconds. Repeat two times.
How to: Lie on the floor on your right side, propping your torso up with your right elbow. Extend your legs so that the outside of your right foot is pressed into the floor with your left foot stacked on top of it. Lift your hips off the floor to create a straight line from your shoulders to your feet. Hold 30-60 seconds. Switch side and repeat.
How to: Start in an extended plank position (arms and legs straight, hands below shoulders). Bend your arms so your elbows point to the back of the room and lower your chest to the floor. Straighten arms and return to start. Do three sets of 10 reps.
How to: Lie on your back, knees bent, feet flat on floor. Pressing your right heel into the floor, slide your right foot forward until leg is straight. Again digging your right heel into the floor, engage your abs and pull right foot back to start position. Do five times on the right, five times on the left.
How to: Lie on the floor, knees bent, feet flat. Keeping your spine in a neutral position, tense your stomach muscles and hold for five counts. Relax. Repeat 10 times.
Pelvic Floor Exercises
How to: Kegels — not just for women! Sit or lie in a comfortable position. Take a deep breath in. As you exhale, contract your deep pelvic muscles like you’re trying to stop the flow of urine or block a fart. Hold for the count of five and release. Repeat 5-10 times.
How to: Lie on your back, knees bent, feet flat on floor. Exhale and curl your shoulders off the ground, keeping your lower back in contact with the floor. Research shows that performing this exercise regularly may help decrease the space between your rectus abdominis muscles. Hold three counts and release. Do 10 times.
These exercises on their own should help bring your abdominal muscles back together. If they’re not doing the trick after several weeks, talk with your physical therapist about using braces and neuromuscular electrical stimulation, Masci says. Research shows that the use of muscle stimulators with exercises is better than exercise alone for getting your abs back in healthy shape.