Diastasis Recti (DRA) is normal neurophsyiological process that occurs in pregnancy.
The linea alba widens as the baby grows. It’s a beautiful adaptation.
For some women, their Linea Alba doesn’t return to baseline ( less than 3 cm of inter recti distance) after 12 months postpartum.
There are all sorts of hypotheses as to why. Certain exercises have wrongly been blamed during pregnancy and postpartum as the cause for DRA. However, exercise has been thoroughly researched and is by no means a risk factor for Diastasis.
In fact, a recent study on the effects of abdominal and pelvic floor exercises during pregnancy on DRA concluded that pregnant women may safely exercise both abdominal and pelvic floor muscles during pregnancy, as they do not have any lasting clinically important effect on the DRA!
Interestingly research has pointed to Gestational Diabetes as a risk factor for DRA. Due to a combination of things like fat mass, BMI, cortisol, and blood glucose that pose a bigger influence on the state of the tissue than what type of exercise one does.
Diabetes is known to reduce muscle mass and muscle function so it stands to reason this may have a correlation to how the Rectus Abdominis muscles function during or after pregnancy.
While Gestational Diabetes (GDM) is not the sole cause of Diastasis, it is a risk factor worth considering.
For the past 10 years, the focus for DRA treatment has been on restoring the gap and improving the coordination of the “canister” meaning diaphragm, pelvic floor, and deep core muscles.
The bigger picture however points to exercise as a strong component of improving endocrine factors, improving physical and mental health, reducing fear, improving abdominal wall coordination/strength/function in activity, and improving quality of life.
Scroll down for research below.
It is time to move beyond the structure and fear based language for women with DRA.
Research
- Du et al 2023 showed that women with Gestational Diabetes had a larger inter recti distance above the umbilicus. They suggest, controlling the fasting oral glucose tolerance test level may help reduce the severity of postpartum DRA.
- Sartori et al 2024 In a survey of 4,629 women it was confirmed that the severity of diastasis increases with increase BMI and number of pregnancies.
- Vesentini et al 2020 shows that Gestational Diabetes reduces collagen distribution in Rectus Abdominis muscles and in another research of this same author states Diabetes causes morphological, biochemical and physiological changes in the Rectus abdominis muscles – specifically increasing slow twitch fibers and reducing fast twist fibers.
- Wu et al 2021 states the incidence of Diastasis among women with Diabetes Mellitus is 2 x higher than those without.
Exercise Benefits Diastasis and GDM
Unfortunately, around 80% of pregnant women are physically inactive.
Inactivity also affects postpartum women with Diastasis due to fear and avoidance behaviors. They will commonly experience dissatisfaction with how their body looks and feels and be overwhelmed with the right exercise for themselves.
As physical therapists, we should create open conversations about lifestyle health during and after pregnancy and offer women informed consent on the evidence.
It is out of the scope of Physical Therapists to directly change someone’s blood glucose or cortisol levels. However, we can guide and prescribe exercise which has tremendous benefits on improving stress, blood sugar regulation, sleep health, inflammation, and most importantly, quality of life.
A combination of resistance and aerobic exercise is shown to reduce the rate of GDM and effectively control gestational glucose, HbcA1, and insulin.
The World Health Organization physical activity guidelines for the pregnant and postpartum population (without contraindications) are as follows:
- 150 minutes weekly moderate-intensity aerobic physical activity
- or 75 min of weekly vigorous-intensity aerobic physical activity
- choose from a variety of aerobic and muscle-strengthening activities
- replace sedentary activity with light physical activity of any kind.
Exercise has enormous benefits for pregnant and postpartum women. Research has given us the confidence to help pregnant women confidently keep exercising and help them safely reengage with exercise after pregnancy as it is associated with decreased Diastasis.
Our language around Diastasis should lead people away from fear and toward safety thus empowering women to return to what they love in sport and life.
For personalized help with Diastasis in person or virtual, head here.
