Abdominal Exercises and Diastasis Recti: What the Evidence Says
Diastasis recti is a common condition that affects many women during and after pregnancy. It is characterized by the separation of the rectus abdominis muscles, which can result in a noticeable bulge in the midline of the abdomen. As a result, many women are advised to avoid abdominal exercises in fear that they may worsen the condition. However, recent research has suggested that there may be insufficient evidence to support this claim. In fact, some studies have found that properly executed abdominal exercises may be effective in treating diastasis recti. In this blog post, we will examine the current research surrounding abdominal exercises and their potential impact on diastasis recti in pre and postpartum women.
Oftentimes, abdominal exercises such as planks and curl ups are cited as being unsafe for pre and postnatal women. However, there is actually limited evidence to support this, with more recent data suggesting that the opposite is actually true. In other words, abdominal exercises can be effective in treating diastasis recti, and should not be avoided by these demographics for this reason*.
A 2020 study published in the Journal of Physical Therapy Science looked at the effects of curl ups on the inter-rectus distance (IRD), or the distance between the left and right rectus abdominis muscles, in women with diastasis recti. The study found that curl ups did not significantly increase IRD, suggesting that they may be a safe and effective exercise for individuals with diastasis recti. In addition, a 2017 study published in the Journal of Women's Health Physical Therapy looked at the effects of planks on IRD in postpartum women with diastasis recti. The study found that planks did not significantly increase IRD, suggesting that they may also be a safe and effective exercise for individuals with diastasis recti.
A recent systematic review with meta-analysis by Gluppe et al. (2021) aimed to evaluate the effectiveness of abdominal and pelvic floor muscle training for treating diastasis recti postpartum. The study included 7 randomized controlled trials with a total of 381 women.
The results showed that abdominal and pelvic floor muscle training was effective in reducing the severity of diastasis recti postpartum. Participants who received the training had significantly greater reduction in inter-recti distance, which is the distance between the two rectus abdominis muscles, compared to those who did not receive the training.
Despite this, it is worth noting that while the available evidence suggests that properly executed abdominal exercises may not necessarily worsen diastasis recti, there is currently insufficient evidence to suggest that any particular exercise program is definitively better than another. Additionally, while exercise may be helpful in reducing the severity of diastasis recti, it is unlikely to make a major difference in all cases.
That being said, it is important to emphasize the potential benefits of exercise for improving overall health and fitness during and after pregnancy, which can ultimately contribute to a faster recovery from childbirth and may help to prevent or manage other health conditions (both physical and mental). As with any exercise program, it is important to approach abdominal exercises with caution and seek guidance from a healthcare professional or qualified exercise specialist to ensure safe and effective exercise progression.
*It is important to note that while abdominal exercises may not necessarily worsen diastasis recti, there are certain precautions that should be taken, particularly during pregnancy. For instance, lying flat on one's back (supine position) is generally considered contraindicated during the later stages of pregnancy, as it can cause compression of the inferior vena cava, which can impede blood flow to the uterus and the developing foetus.
As such, pregnant women should avoid exercises that require them to lie flat on their back, and instead, focus on exercises that can be performed in a seated or standing position, or use a prop such as a pregnancy wedge to elevate themselves. It is also recommended that pregnant women seek guidance from a healthcare professional or qualified exercise specialist to ensure safe and effective exercise progression throughout their pregnancy.
References:
Benjamin DR, van de Water AT. Effects of exercise on diastasis recti abdominis in pregnant and postpartum women: a systematic review. Physiotherapy. 2014;100(1):1-8.
Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther. 1988;68(7):1082-1086.
Chiarello CM, Falzone LA, McCaslin KE, Patel MN, Ulery KR. The effects of an exercise program on diastasis recti abdominis in pregnant women. J Womens Health Phys Therap. 2005;29(1):11-16.
Gluppe S, Engh ME, Bø K. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis. Phys Ther. 2021;101(2):pzab007.
Gruszczyńska D, Truszczyńska-Baszak A. Exercises for pregnant and postpartum women with diastasis recti abdominis – literature review. Advances in Rehabilitation. 2018;32(3):27-35.
Lee DG, Lee LJ, McLaughlin L. Stability, continence & breathing: the role of fascia following pregnancy and delivery. J Bodyw Mov Ther. 2008;12(4):333-348.
Parker MA, Millar LA, Dugan SA. Diastasis rectus abdominis and lumbo-pelvic pain and dysfunction-are they related? J Women’s Health Phys Therap. 2009;33(2):15-22.
Pascoal AG, Dionisio S, Cordeiro F, Mota P. Inter-rectus distance in postpartum women can be reduced by isometric contraction of the abdominal muscles: a preliminary case-control study. Physiotherapy. 2014;100(4):344-348.
Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(3):321-328.
Wu WH, Meijer OG, Uegaki K, et al. Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. Eur Spine J. 2004;13(7):575-589.