How to Avoid Diastasis Recti During Pregnancy

So what is diastasis recti during pregnancy?

Diastasis recti during pregnancy is the divarication of the rectus abdominis (your “six pack”) muscles along the linea alba. I'm sure you have noticed that the tissues of the abdominal wall must stretch considerably to accommodate your growing baby. This is more than just your muscles stretching. The mid-line connective tissue, the linea alba stretches lengthways and laterally, causing it to become thinner and less able to transmit load from the left and right side of the transversus abdominis and obliques. All women have this, in various degrees, at the end of their pregnancy.

If your abdominal wall cannot transmit load efficiently it can lead to back pain, pelvic pain and instability, discomfort at the linea alba itself and a more miserable third trimester. Who want's that!

For this reason, I am not going to try and train my abdominals while pregnant. I don't want to risk causing a larger gap than what will naturally occur. I have already cut out a lot of the exercises that I love doing because I can feel that they are not benefitting me and are slightly uncomfortable at my midline while doing them and the following day.

Who is most at risk of diastasis recti during pregnancy?

• Those who gain more than the recommended amount of weight during pregnancy.
• Multiple pregnancies (twins, triplets, etc).
• Back-to-back pregnancies.
• Those who are older than 35 and pregnant.
• Those who perform incorrect exercises during pregnancy.
• Those who perform exercises with poor technique during pregnancy.
• Those who lift too heavy for their fitness level during pregnancy.

For general prenatal exercises guidelines you will enjoy my first post:
The Do’s and Don’ts of Exercising Throughout Pregnancy

Which exercises should we avoid while pregnant?

Any exercise in which your abdominal wall or pelvic floor cannot resist the increased intra abdominal pressure or gravity's pull. Any exercise in which you cannot maintain proper alignment, excellent form and breathing. An inappropriate exercise will cause the abdominal wall to bulge out further or pressure downward on your pelvic floor. If a diastasis recti is present a cone or a bread loaf shape will appear along your mid-line. Not the result we want to achieve!

Please note, some women will have the proportions and the required muscular strength to keep doing these exercises into their second trimester and some exercises all the way through. Remember that every woman's body and pregnancy is unique to them, the rules are different for every one. If you are unsure if an exercise is suitable for you, it is safer to leave it out as a precaution.

I suggest leaving out the following exercises in your second and especially the third trimester if you are unsure if you are maintaining all of the above.

1. Crunches, sit ups:
   Avoid exercises which concentrically contract the rectus abdominis (RA). This muscle attaches from your breastbone to your pubic bone. It must lengthen the most during pregnancy, why would you choose an exercise which shortens it? Plus, where do you expect the baby to go when you flex your spine forward? A crunch generally displaces the internal organs slightly, increasing intra abdominal pressure. Our torso can manage this. However while pregnant, your growing baby increases your intra abdominal pressure, a crunching movement will further increase this and that pressure will bear down on your pelvic floor or onto your abdominal wall increasing the risk of a diastasis recti. If a diastasis is already present, a crunching exercise will cause the gap to widen! Some examples are crunches, reverse crunches, sit ups, in Pilates the Roll Up, Hundred and Teaser etc.
   I also recommend avoiding any exercise which isometrically contracts the RA against a large force, especially when your bump/baby is bigger. This is an exercise which recruits your RA without flexing your spine forward. Some of these exercises are double leg lowers, single leg lowers, in Pilates the Double Leg Stretch, Single Leg Stretch and Hamstring Pull etc. In all of these examples the RA is stabilising your lower back against the pull of your legs weight. These will also increase the intra abdominal pressure which loads the abdominal wall and cause coning if a diastasis recti is already present.
   A lot of videos contained standing crunches, which cause the ribcage to press inwards like a regular crunch, but do not work the abdominals but instead work the upper back. You can choose a better upper back or core exercise to use your time on.
2. Plank:
   I lost count of the many prenatal workouts on YouTube which correctly began with recommending that we avoid working the RA. Then the first exercises they recommend is Plank....which is intense work for the RA! As I already mentioned isometric contraction against a large force (in this case gravity) can be too much for the abdominal wall and pelvic floor to manage well, pregnant or not.
   Plus the horizontal position of your body will cause the weight of your baby to press forward onto your abdominal wall. This added weight coupled with the position further increases pressure on your Linea Alba (midline tissue). Your really must have great body awareness, deep core strength  and overall strength to be able to do a Plank that will not negatively impact diastasis recti.
3. Push Ups:
   A press up is a plank in which your arms also move (when performed correctly). The same reasoning applies.
4. Strength training the obliques:
   Your oblique muscles must also stretch to accommodate your growing baby. This causes the abdominal aponeurosis (the line down the sides of a six pack) to form a curve. When your obliques contract they will pull sideways and with that curve they will cause a diagonal pull increasing the pressure on the centre of the linea alba, your belly button. If you have read about Diastasis Recti you will know that a lot of women with it have a belly button that has not returned to "normal". Mine certainly took it's time! (<- 2023 update.)
5. Quadruped Positions:
   In a hands and knees position, just like in plank, your baby will press forwards onto your abdominal wall. For some women this is fine, their Linea Alba and Deep Core can withstand the load. But if you have a diastasis recti it is much harder for the abdominal wall to contract against that load. The suitability of a quadruped position will vary from woman to woman. If you feel that the babies weight is pulling your belly to the floor or if you know you have a gap, leave this position out or gently support your belly with cushions underneath you.
6. Deep back-bends:
   One of the most common postural adaptations is lumbar lordosis, increased lower back curve. This increased curve causes even more length to the abdominal muscles and causes the baby to rest on the abdominal wall and pubic bone instead of the pelvic floor where he/she should. It is important to work on reducing lumbar lordosis as much as possible. So why would we choose exercises which reinforce it? When incorporating spinal extension exercises (back-bends), choose those which extend the thoracic spine instead (upper back) and encourage hip extension also. The deeper you back-bend, the further down your spine the extension will occur so reducing your back-bends depth is an approach. Note that in standing back-bends, the Rectus Abdominis must contract eccentrically (as you lengthen them) and then isometrically to hold your position. So I don't recommend these if you have a diastasis recti during pregnancy already.
7. Belly Breathing:
   Two of my clients with Diastasis Recti, one a man and the other a woman with no children had incredibly stiff rib-cages. As their rib-cages were not expanding when they inhaled, their abdominal wall expanded instead. These are the clients I give "homework" to do. They worked on expanding their ribcages rather than their abdomen and gradually they experienced less coning and doming of their abdominal walls in class. From these examples, we can see the relationship of our breath and our core musculature.
   Pregnancy, especially in the latter weeks, reduces your ribcages ability to move, meaning less movement of your respiratory diaphragm which means less natural movement of your pelvic floor and recruitment of your abdominal muscles. Work on maintaining (or gaining) the mobility of your entire ribcage and upper back so that when you are breathing, your ribcage is free to move.
   If there is one thing I keep getting my various clients to do lately (in 2023) it's to work on the mobility of their ribcage and the quality of their breathing mechanics. From pregnancy preparation, postpartum recovery, decreasing neck tension, increasing spinal mobility and reducing stress (which has a role in fat loss) I am getting everyone to work on their breathing.

Honour your bodies needs during pregnancy. It will tell you what it needs, you just have to listen. Only engage in exercises that are comfortable for you to perform. And when your body sends you a signal that it can’t take it anymore, it’s time to adjust. If something feels great, keep on doing it.

Practicing deep core engagement will help you to learn and internalise what the sensation feels like and then as you are performing your regular exercises, you can check in to make sure you are able to maintain your deep core engagement, especially when the exercises get tough!

If you are unable to view the embedded video above please click here.