It’s no secret that the body changes a lot during pregnancy.
One pregnancy change we often see at The Brisbane Spine Clinic is Diastasis Recti (DR), more commonly known as abdominal separation.
Abdominal separation is when the left and right sides of the rectus abdominis muscle become separated. Research shows that up to 60% of pregnant and post-partum women may experience abdominal separation. Pregnancy, Birth and Baby report that 1 in 3 women still have problems with separated abdominal muscles 12 months after the birth of their baby.
While it might sound scary, abdominal separation is a normal part of pregnancy as your muscles move to allow space for your growing baby.
With the help of a women’s health physiotherapist at The Brisbane Spine Clinic, you may be able to retrain your muscles and minimize any long-term effects of abdominal muscle separation.
Here we will explain exactly what abdominal separation is, what it feels like and what exercises you can do to minimize it. We will also explain how The Brisbane Spine Clinic physiotherapists can test for and treat abdominal separation.
What is abdominal separation?
The rectus abdominis muscle, commonly referred to as your ‘six pack’ muscle, runs from your chest to your pelvis, down the front of your abdomen. It is separated, down the middle, into left and right sides by a band of connective tissue called the linea alba.
During pregnancy, as your tummy grows, your abdominal muscles are stretched and the linea alba thins as the space between the muscles gets wider.
This separation usually happens in the later half of pregnancy. It occurs because of the pressure of your growing baby as well as the hormonal changes that happen during pregnancy allowing your muscles to relax.
After the birth of your baby, the muscles may retract back on their own, with time. For some, the linea alba is overstretched and the muscles don’t come back together. This is abdominal separation.
If you have abdominal separation, you might be able to see the gap between the two sides of your abdominal muscles.
It will be even more obvious if you lay on your back and gently lift your head. If you have abdominal separation, this activation of your abdominal muscles will cause a bulge to appear in the middle of your stomach.
While abdominal separation is most common in the pregnancy and post-partum period, anyone can experience it, including men and newborns. This is because the abdominal muscles can become separated by activities like lifting very heavy weights or incorrectly performing abdominal exercises.
What does abdominal muscle separation feel like?
The separation of your abdominal muscles is not painful, however, some women experience lower back pain because the separation stops the stomach muscles from supporting their back.
Some women find it more difficult to do everyday tasks, like lifting their children because of their weakened core and painful lower back.
Some other symptoms of abdominal separation include:
- Painful sex
- Hip or Pelvic pain
- Urinary incontinence
- Poor posture
The good news is that abdominal separation is treatable by physiotherapy, and surgical repair is rarely required.
Testing for abdominal separation
At the Brisbane Spine Clinic, one way we test for abdominal separation is by asking our patients to lie flat on their back, knees bent and feet roughly in line with their hips
- We place our fingers on the stomach midline
- We then have the patient lift their head and shoulders up while relaxing their abdominal muscles while we probe gently for a bulge or a gap along the line running through the belly button.
- We should be able to detect the muscles contracting on both sides of our fingers. If you have abdominal separation, we will feel a gap between the muscles that is 2.5 cms wide or greater.
- To assess the connective tissue’s condition, we check how deep the gap is between the fingers and the spine. The deeper they go, the frailer the connecting tissue is.
If the gap between the bands of abdominal muscles exceeds two fingers in width, we may recommend avoiding outer abdominal exercises until the pelvic floor and core stabilising muscles have been strengthened.
Treating abdominal separation
The first step to abdominal separation treatment is to have a physiotherapist conduct a thorough assessment.
An ultrasound may be required to provide more information on the pelvic floor and deep abdominal muscles.
Individually tailored abdominal separation exercises are prescribed to improve core stability, and abdominal muscle tone and strengthen pelvic floor muscles.
Abdominal muscle compression garments can be an option to manage abdominal separation although they’re not always required. Garments delivering the best outcomes have medical-grade compression providing supportive pressure to the abdominal muscles, back and pelvis.
Exercises for abdominal separation
Abdominal separation might be decreased by activating your abdominal muscles through gentle exercise. It’s important to see a physiotherapist before beginning any exercise program as some exercises can make the separation worse.
A women’s health physiotherapist at Brisbane Spine Clinic will work with you to tailor an exercise program to your specific needs and teach you how to do the exercises safely.
Some exercises your physiotherapist may have you begin with include:
- Heel Slides– This exercise aims to stabilise and strengthen your core.
- You will start on your back with your knees bent and feet flat on the floor. Tighten your abdominal muscles as you slowly and gently slide one leg out straight while keeping the sole of your foot in contact with the floor the whole time. Bend the knee back up, then repeat on the other side. Remember to keep your abdominal muscles engaged and stable the whole time.
- Pelvic Tilts– This exercise helps with the lower back pain caused by abdominal separation.
- You will lay on your back with your knees bent and feet flat on the floor. Start with your lower back pressed against the floor. Tighten your abdominal muscles then slowly rock your pelvis forward. Hold it there for a few seconds then rock it back. Repeat.
Consult your physiotherapist
It doesn’t matter if you’re pregnant, you have a newborn or you’re ten years post-partum. You can improve your core strength, the appearance of your tummy, and your posture many years after giving birth, it’s never too late!
Here at the Brisbane Spine Clinic, we understand the challenges abdominal separation can pose. Book in today to have one of our physiotherapists carry out an assessment. By identifying the degree of your abdominal separation, we can recommend a treatment plan designed specifically for you. Book in today.
*Please note, the content within this article is for educational purposes only, and the treatment and advice mentioned may not be suited for everyone. Please consult a team member at The Brisbane Spine Clinic or your General Practitioner for specific advice.
Sperstad, J. B., Tennfjord, M. K., Hilde, G., Ellström-Engh, M., & Bø, K. (2016). Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British journal of sports medicine, 50(17), 1092–1096. https://doi.org/10.1136/bjsports-2016-096065
Physiopedia. (2022). Diastasis Recti Abdominis.
Pregnancy, Birth & Baby. (2020). Abdominal Separation: Diastasis Recti.