Promote better core function and get great results with this technique to help with healing diastasis recti

Treatment techniques to aid in healing diastasis recti are essential for working with postpartum clients. Studies vary, but 24% – 39% of women experience diastasis recti six to twelve months after having a baby. Learning techniques specific to healing diastasis recti will help your postpartum clients improve core function quicker, heal faster, and prevent long-term damage to their abdominal tissues. I will go over what happens to the abdominal muscles in pregnancy, tips to help support your pregnant clients, and a video with instructions for the Oblique Release that is specifically designed to help with healing diastasis recti in your postpartum clients.

What is Diastasis Recti?

The rectus abdominis consists of two muscle bellies called recti muscles which run from the end of the sternum to the pubic bone. They are held together by connective tissue called the linea alba. When there is prolonged excessive pressure on the anterior abdominal wall, it can cause separation of the recti muscles resulting in diastasis recti. “Diastasis recti is the partial or complete separation of the rectus abdominis, or ‘six-pack’ muscles, which meet at the midline of your stomach” (Healthline).

Soft tissue work can help with healing diastasis recti quicker and more fully for postpartum clients, and it can also help alleviate over-stretching during pregnancy.

Pregnancy’s Impact on the Abdominal Muscles

The transverse abdominis muscles are the stabilizer of our core. In pregnancy, the transverse abdominis muscles get stretched out as the uterus grows. This constant state of expansion can cause the muscles to weaken unless they are actively contracted and relaxed during pregnancy to keep strong. The larger the stretch and strain the harder it is to activate and strengthen these muscles and the longer the process will be for healing diastasis recti in the postpartum.

The oblique muscles are traditionally the movers of the core and are responsible for enabling trunk rotation in the body. During pregnancy, the transverse abdominis muscles will get stretched much more than the obliques and are unable to do their job of stabilizing the body optimally. The obliques will step in as the body stabilizers. They will constrict and tighten to keep the belly upright and the core stable while the transverse abdominis muscles are in this overstretched state.

The rectus abdominis is responsible for trunk flexion and is the muscle group impacted by diastasis recti. In the pregnant state, the tightness of the obliques causes the oblique muscles to shorten and stretch the rectus abdominis muscles away from the midline. This separation occurs along the linea alba, and the more the recti muscles get stretched, the harder it is to heal fully.

How to Protect the Pregnant Belly

As the belly gets larger, the rectus abdominis naturally separates to allow expansion of the uterus. The farther apart the recti muscles separate, the less support there will be to keep the baby in an optimal position for labor. In addition, the muscle expansion will prolong the postpartum recovery time for healing diastasis recti and can increase the likelihood of organ prolapse for postpartum clients. Supportive posture, core activation, and minimizing rib thrusting can help your clients get on track quicker to healing diastasis recti in the postpartum.

Posture

Collapsed postures make it very tough to activate the transverse abdominis. When shoulders are slouched, the back is hunched, or the pelvis is in an anterior tilt it will create more abdominal muscle strain. When the transverse abdominis is constantly elongated, it stops working at its full capacity of contraction and relaxation as it is too stretched to perform these functions at an optimal level. Posture that supports the core and pelvic floor can set the body up for healing diastasis recti quickly in the postpartum.

Core Activation

Core activation is essential to supporting the abdominal muscles and can help facilitate a smoother birth by keeping the body and pelvic floor aligned properly. Advise your pregnant clients to hug their baby toward the belly/spine before every movement. Encourage activation of the inner core before every movement. Breath exhalation when lifting and contracting will help activate the inner core.

If the inner core is not activated correctly, it can result in doming. You can check your client for doming by having them activate their inner core muscles and bring a leg or both legs up to a bent knee position. If you notice a bulging out or doming in the midline of your client’s body, they are experiencing separation. A slight amount of bulging of where there is soft tissue can indicate that there is tension in the linea alba which is what we want. If the tissue is hard where the bulging is occurring, though, then this can indicate that there may be too much strain on the muscles. This strain can cause the recti muscles to separate farther and make it a longer process for healing diastasis recti. As practitioners, we must help our clients learn what is too much strain.

Clients who are carrying multiples or who have a smaller trunk will likely have more strain on the interior abdominal wall, but you still want to encourage these clients to activate their core.

Rib Thrusting

The way a pregnant client holds their ribcage is one of the biggest contributors to the development of diastasis recti. Clients may have slouching postures or inadvertently lift the lower ribcage to make more room for their baby, especially if they are shorter-waisted, which can strain the abdominal muscles and separate the recti muscles.

How to check if your client is a rib thruster?

The lower rib cage should be in the same plane as the hipbone. Check the bottom edge of your client’s ribcage and see where it is in relation to the front of the anterior superior iliac spine (ASIS). If the ribs are in front of the hip bones, then your client is a rib thruster. If the ribs are aligned with the front of the ASIS then your client is not rib thrusting.

Tips to Stop Rib Thrusting

Advise your client to take the lower point of the ribcage and move it DOWN and back. This movement happens at the spine and not with the abdominal muscles. Have them stand with their back against a wall keeping their shoulders and head touching the wall. See if they can get the lower ribcage to connect with the wall. Have your clients work on keeping their ribcage down and back with everything you do.

When the rib cage thrusts forward, there is increased pressure in the abdominal cavity, which must go somewhere. It can go up into the diaphragm and cause reflex, cause inguinal hernias, or force the abdominal muscles to separate. When the rib cage is brought down, and back, the pressure evens out and decreases the forces in the abdominal cavity.

Treatment Technique to Help with Healing Diastasis Recti in the Postpartum

Although there is no current consensus on categorization, there are varying degrees of diastasis recti. In general, I see two main presentations of diastasis recti:

• Cases where diastasis recti naturally resolves, usually within 3 to 4 months. There are less than 3 fingers of separation in these cases.
• Cases where diastasis recti does not naturally resolve on its own. In these cases there is more injury to the linea alba and greater than 3 fingers of separation. These cases usually require more time and work to repair.

Soft Tissue Treatment

Soft tissue work can help with healing diastasis recti faster in either case. It can promote better alignment to assist with postpartum recovery work, such as core activation and strengthening exercises and posture corrections. It can also help minimize the damage and strain on the abdominal wall.

Using both a recti muscle release and an oblique release, will help unwind fascia and lengthen the recti muscles and obliques to help decrease the separation and aid with healing diastasis recti. Following is a video of the oblique release, and both the recti and oblique releases are available in the Holistic Treatment of the Postpartum Body course for those that are interested in learning more to help their postpartum clients.

Video: Oblique Release to Aid in Healing Diastasis Recti

Oblique Release to Aid with Healing Diastasis Recti

1. The goal of this technique for healing diastasis recti is to release tightness in the lateral fascia and the oblique muscles to allow the recti muscles to move into the midline.
2. When doing the oblique muscle release, have your client lay in supine with their lower rib cage in contact with the table. If the lower rib cage is not in contact with the table, place a pillow or blanket under your client’s head and shoulders until the ribs come into contact with the table.  
3. Have your client anchor down one side of their lower ribcage with their hand and then with their knees bent and feet flat on the table, have your client rotate their knees away from the anchored ribs. In other words, have them slowly drop their knees to the opposite side of the anchored ribs. NOTE: Make sure the ribs stay in contact with the table during rotation of the knees. Only have your client go as far as they can without their ribs coming up away from the table.  
4. Have your client reach around their waist with their other hand. You will use three strokes (along the lower rib cage, in the middle, and along the iliac crest) to gently encourage the lateral abdominal wall tissues toward the midline and up to the umbilicus. 

Additional Tips for Healing Diastasis Recti

1. Core exercises that activate the inner core and do not put extra strain on these muscles are essential to postpartum recovery. Advise clients to zip up the belly to the spine prior to every movement. This will aid with healing diastasis recti by helping fire up the transverse abdominis.
2. Splinting may be needed when there is excessive and constant strain on the abdominal wall. You do not want your client to wear it 24/7, but they will use it when pressure needs to be taken off the abdominal wall (i.e. to give support when exercising; while carrying a baby in a sling). You should still encourage your client to do the core activation exercises and build tension in the muscles across the linea alba even if they are wearing a sling.

Taking Your Practice to the Next Level

The oblique release is one of two treatments that provides immediate results to help with the healing of diastasis recti. Releasing the recti fascia is another important treatment technique that will enable the core muscles to return back to the midline for your postpartum clients. Release work on the abdominal muscles enables the core to fully function and as a result strengthen and aid in healing diastasis recti.

These treatment techniques along with many others, including treatments to close the open birth pattern and restore the pelvic floor, are available in the Holistic Treatment of the Postpartum Body at the Institute for Birth Healing. Take your practice to the next level by becoming the go-to practitioner for pregnant and postpartum clients.