Healing Diastasis Recti With Compassion

My personal journey of rediscovering a resilient core

Plus: 5 exercises you can do to start healing now!

My Diastasis at 10 Months Postpartum

Diastasis Recti. It's Personal.

I grew up in the dance studio - physical fitness and using my body as a tool has always been a part of my life.

When my professional dance career ended, I went through college and ended up working for a Physical Therapy practice, where I was introduced to something that would become a true love and passion.

Pilates.

As I became certified and first began to teach physical therapy patients, Pilates seemed like some magical set of movements that caused people to feel better, helped them heal, even made them stand taller and move with more confidence!

I was hooked. Once again my body was my tool, and I was also able to teach others how to use their own bodies to help them heal. I felt Strong. Confident. Capable.

Six years after beginning my Pilates journey, I got the most wonderful news - I was pregnant! I was SO excited to go through this process, and to meet my baby on the other end! Given my background of dance and Pilates, I thought: “Pregnancy? Birth? I know it won’t be easy, but I’m strong, I’m flexible! I’ve got this. No problem.”

Diastasis Recti wasn’t even an inkling in my mind.

Sometime early in my second trimester, as I was doing more research into pregnancy-related conditions to be aware of, I came upon the term “diastasis recti.” I checked myself, and lo and behold, I felt a line of weakness in the middle of my stomach, right above my belly button. “Uh-oh,” I thought.

It was time to get serious. I decided to expand my Pilates knowledge to specialize in the perinatal period, which includes the onset of pregnancy through to two years following birth. I learned that diastasis is a normal part of pregnancy but that it can cause problems if not properly managed.

In many cases, diastasis recti does actually resolve on its own in the months following birth. That was the case for me after my first pregnancy - I was able to build back my strength with Pilates and return to teaching. However, my second pregnancy has left me with a diastasis that I am still struggling to heal, 12 months later.

You Know The Saying: Doctors Make The Worst Patients?

In the months following the birth of my second child I struggled, a lot, with my self-image.

Despite going through training specifically for perinatal Pilates and for diastasis recti, I found it difficult to set aside any time to help myself through the postnatal healing period. Even though I had spent years using patience and compassion to help others through times of pain and injury, I could not find it in myself to apply the same patience and compassion to my own body as it recovered.

I felt Weak. Unsure. Inept. I felt like my body was failing me.

Finally, I made the commitment to myself that I would spend at least 15 minutes each day doing modified Pilates that would target my diastasis. I went through my training materials again, and told myself I could do this. Sure, in reality that 15 minutes is often broken up throughout the day. Many days I don’t get to do more than 15 minutes, and truthfully some days I don’t even get to do that. But it is a start.

Maybe most importantly, I have been making a conscious effort to practice positivity and understanding. I have found compassion for myself and my body. More on that later.

So... What Is Diastasis Recti?

Diastasis recti, or DRA (diastasis rectus abdominis), is a widening and thinning of the Linea Alba - that’s the thin line of connective tissue in the center of your abdominals. The tissues are weakened, but it is NOT an actual separation or hole in the tissue, as is commonly indicated when searching for information online.

DRA occurs and is made worse when there is a large amount of pressure pushing from inside the abdomen towards the outside. This pressure causes the connective tissue in the center of your stomach to weaken, and it is no longer able to hold things in place like it once was. Now, what’s a condition that causes large amounts of internal abdominal pressure, due to an organ that may expand to 1,000x its normal size? Pregnancy!

That’s right, during pregnancy the uterus can expand up to 1,000x its normal volume!

So let’s be clear - separation of the abdominal muscles is NORMAL during pregnancy. Your body has to expand somewhere to make room for baby! The separation is NOT the problem. The problem comes when we are no longer able to properly manage our intra-abdominal pressure, which stresses the already weakened tissues, causing doming (the center of the stomach bulging out) or invagination (the center of the stomach falling in).

Doming

Invagination

TVA Engagement

Have you heard of the “two-finger check”? This is a method commonly recommended online to check for diastasis. However, new research is showing that this isn’t the best or most informative way to determine whether your core is functional and resilient, or whether it is able to manage your everyday movements in a healthy way. Again, we want to focus less on whether there IS a separation, and more on whether that separation is causing instability and weakness in your core system.

How can you tell if you have diastasis recti? To know for sure, check in with a perinatal exercise specialist, pelvic health physical therapist, or your doctor or midwife. But a very good indicator is the occurrence of doming or invagination that occurs when there is any sort of pressure in your core. For example, when you sit up from a laying down position, does the center line of your stomach push out more than the tissue around it? Or does it fall inward?

If you see doming or invagination, you can do a further check for DRA using the following method:

Lay on your back with your knees bent and feet on the floor. With your head down, use your fingertips to feel along the very center of your abdominals - from the bottom of the ribcage down to the top of your pelvis. Notice how things feel. Does that center line feel bouncy and firm? Or do your fingers sink in? How does the feeling change as you move down that center line? We ideally would have that bouncy, firm feeling all the way down.

Next, you will do the same thing in a slightly different position. All you will do is lift your head. If this hurts your neck at all, use one hand to gently support the head. Now do the same check again. What do you feel? Do things feel about the same, or do your fingers fall deeper into that center line now? If you do find that your fingertips sink deeper into your stomach when your your head is lifted, you may want to seek out someone who specializes in diastasis recti so you can start working to regain a resilient core.

So You Have Diastasis Recti. What Now?

First, don’t panic! Whether your diastasis is brand new or many years old, you can work to regain a more resilient, functional core. Once you are armed with the proper knowledge and tools, you will no longer have to avoid certain movements or be afraid to exercise.

According to the American College of Obstetricians and Gynecologists (ACOG), modified Pilates is one of the best forms of exercise for the perinatal population. Modified Pilates is also excellent for the management and resolution of diastasis recti because it can teach you how to manage your intra-abdominal pressure and engage the proper muscles to assist in your recovery. And there’s more - Pilates will teach you how to engage your pelvic floor muscles, which are the leader of your deep core system and can provide stability and support for your linea alba (that center line in your stomach) when they are properly conditioned.

Whether you want to do your best to prevent DRA during pregnancy, or you need to heal from a current diastasis, a Pilates teacher who specializes in the perinatal population could be a game-changer for your recovery.

Listen. Some people DO need surgery. There are some bodies that will just not respond, even with targeted exercise and professional guidance. And that’s OK! If this ends up being the case for you, your body is NOT failing you. Sometimes we just need a little extra help to get to a point where our body will allow us to truly start the healing process.

But please, before considering surgery, understand that MOST people will be able to heal and get the results they are looking for, simply through targeted, modified exercise.

Five Exercises You Can Do To Start Healing Now

360 Breathing

360 Breathing, also known as Lateral-Thoracic Breathing, is the important foundation of every Pilates exercise. Plus it teaches you to engage the muscles essential for proper core support.

Find a comfortable position. You can be sitting, standing, or laying on your back. Place your hands on your ribcage, and relax your jaw.
Take a deep inhale through your nose, feeling the breath expand your ribs to the front, back, and both sides; as well as down into your pelvis.
Now exhale all of your air, until you can’t exhale any more. At the same time, gently hug the belly in and up towards the spine. At the same time, engage your pelvic floor muscles. This can take practice! Keep working until this feels smooth and natural
Repeat this sequence 10x; relaxing the belly and filling your whole abdomen on the inhale, and hugging the belly in and up with your full, complete exhale.

Inhale

Exhale

Table Top Toe Taps

This seemingly simple exercise can really get you in touch with your core. Try to feel the difference between a supported, stable core and an unengaged core. Check the center line periodically, avoiding that doming!

Start by laying on your back with your legs bent and feet on the floor. Prepare with a 360 breath; exhale and lift one leg, then the other, to a table top position (see pictures).
Continuing your 360 breathing… Inhale and lower one leg down until your toes tap the floor.
Exhale, engaging the abdominals and pelvic floor, and lift the leg back to table top.
Repeat 6-8x on each side, watching for doming or invagination.
If you see doming or invagination, try keeping one leg down and tapping just one leg at a time.

Modified Spine Stretch

Let's create some space in your spine and your abdomen!

Start by sitting tall with your legs straight in front of you, slightly wider than your hips. If this feels uncomfortable, you can sit with your legs slightly bent, or sit on a yoga block or small pilates ball.
Inhale, press the hands into the floor, and lift the top of your head towards the ceiling.
Continue the feeling of lifting the head while your hands press down, and then exhale and dive forward.
You want to feel your rib cage lifting, while the top of your head reaches toward the floor, continuing to press your hands down. You should feel a lovely stretch through your spine.
Inhale and return to the starting position. Repeat 5x, taking it nice and slow.

Modified Hip Twist

Regaining strength in your obliques is very important to help resolve DRA, and this exercise helps with just that!

First, work to find the proper starting position. You will start sitting with legs bent and arms supporting you. Let yourself totally relax - slouching the spine, and letting the shoulders rise up around the ears. Take a big inhale here.
On the exhale, press down through the hands and hips, lifting the head towards the sky and lifting the heels off the mat, while pressing the shoulders away from the ears. Repeat a few times, working to create length in the spine.

Next, inhale and let the knees fall to the right, allowing the left hip to lift off the floor and maintaining length through the spine. Exhale, and bring the knees back to center. Repeat to the left.
Repeat 8x on each side. As you get more comfortable with the exercise, you can increase the speed of the twist.

Modified Leg Pull Front

With DRA, the typical plank position will likely be too difficult to maintain without causing doming or invagination. This exercise allows you to work back towards planks in a more supported, safe way.

Start on hands and knees, pulling your abdominals gently in and up, and watching for any doming. Take a 360 breath in and out to prepare.
Inhale and reach one leg back, placing the toes on the floor and keeping the shoulders over the hands.
Exhale - rock back away from the hands, moving the whole body as a unit and maintaining a stable plank-like position, then reverse the movement, rocking the body forward, and return the leg to the starting position.
Repeat with the other side, repeating 6-8x on each side.

If you are unable to maintain good core control during this exercise, or if your wrists get sore, try coming down to your elbows, and doing the same series of movements.

Finding Compassion For Your Amazing Body

Exercises are great, but there are more pieces to the puzzle of regaining healthy core function.

Let’s take a second to reflect on the incredible human body. YOUR incredible human body. You are capable of growing a little human inside you - maybe you already have! You are further capable of then caring for this tiny human, and giving them everything they need to survive and thrive. Your body goes through vast changes in the perinatal process - hormonal, physical, mental… And somehow, you are able to handle it all.

You have the power to bring life into this world; you can use that power to find love and compassion for yourself, and that power can also be used to help heal your amazing body.

For our tissues to begin to heal, our body needs to be READY to heal. We have to try as much as possible to set ourselves up for success. This means fueling your body with nutritious foods, taking a little time for yourself each day, and getting as much sleep as you can!

Impossible, you say? It may be difficult, sure. But also very important!

Healing can only happen when your body goes into “rest and digest” mode. Of course, it can be difficult to tap into this important bodily system with today’s go-go-go world, especially when you add caring for a little person at all hours of the day!

To give yourself the best chance of recovery, make an effort to take at least a few minutes, a couple of times a day, to tap into your body’s healing system. It can be simple, and it can be short. Here are some ideas:

Take 5-10 minutes to meditate
Find a few minutes of conscious alone time, preferably outside, to just observe; either yourself or the world around you
Here’s the hard one - get as much nighttime sleep as possible! Our body does its best repair work during deep sleep
Try to sit down when you eat, and take three deep, calming breaths before your first bite

Remember, even though I had ALL the tools and ALL the exercises at my disposal; it took making a commitment to myself before I was able to start seeing progress.

Above all, do your best to speak positively to yourself. Do your best to give your body the patience and space to heal. Remind yourself that you are resilient; your body is resilient; your core is resilient. Lay this important foundation of helpful, encouraging thought, and then allow the ‘magic’ of Pilates to help you regain a strong, happy, functional core.

Be Strong.

Be Confident.

Be Capable.

Want to learn more? Contact Shauna Grasso at Bump to Baby Pilates - shauna@bumptobabypilates.com.

Shauna Grasso is a Nationally Certified Pilates Teacher and Perinatal Pilates Specialist. She has been teaching Pilates since 2014 and is constantly amazed by the power of Pilates and the resiliency of the human body. She lives in the Nevada mountains with her husband, their dog, and their two beautiful children.