Diastasis Recti

I have several students who come to me specifically for Postnatal yoga, and it’s been amazing to see how they have benefited from our sessions together! Adapting one’s practice while pregnant can allow a person to continue to do yoga all the way through pregnancy in most cases. In many cases, one should modify the practice after having a baby as well...especially in the case of diastasis recti.

Diastasis recti (DR) is a stretching of the connective tissue between the abdominal muscles, called the linea alba, which results in an abnormal widening of the gap between the six pack abs (rectus abdominis). It should come as no surprise that a common cause of this is pregnancy. DR is caused by excessive inner-abdominal pressure. During pregnancy, the expanding uterus and pregnancy hormones stretch out the abdominal muscles and connective tissues. Pushing during the delivery can also cause it. In the past, BMI, the amount of weight gained during pregnancy, the size of the baby, and maternal age were considered increased risk factors for DR. However, a study in 2015 found no connection between these factors and the likelihood of developing DR. We do know that women who have multiple pregnancies/births are more likely to develop it due to repeated stretching of the tissues.

Because our abdominal muscles play such an important role in postural control, spine and pelvic stability, trunk movement, and respiration, it’s not surprising that DR can adversely affect a person both on and off the yoga mat. Studies have shown a decreased ability of the abs to provide stability to the pelvis against resistance both during pregnancy and up to 8 weeks postpartum. Studies have also shown that people with DR have a lowercapacity to rotate and flex the trunk. Some studies have found that weak abs can cause lumbo-pelvic pain and dysfunction during pregnancy.

It’s believed that beginning exercises prenatally to maintain tone and control over the abs can help to decrease some stress on the linea alba. More recent studies have shown that the goal should be to increase the tension of the linea alba as opposed to trying to decrease the gap between the rectus abdominis. In people with DR, the linea alba is slackened and distorted when just the gap is reduced. Pre-activation of the deep transversus abdominis before the rectus abdominis causes an increase in the gap, but also an increase in the tension of the linea alba. This increased tension of the linea alba is more important to support the abdominal contents and spine. So just closing the gap is not the answer! We need to increase the tension longitudinally.

A consensus study in 2019 emphasized the use of “inner unit” exercises during the prenatal, early postpartum, and late postpartum periods for management of DR. The inner unit muscles include the transversus abdominis, multifidus, diaphragm, and pelvic floor. Emphasis is first placed on achieving controlled isolation of each muscle within the unit, followed by co-contraction of the whole. In addition, after pregnancy, many women tend to stand with an exaggerated anterior pelvic tilt and with the pelvis pushed forward. So restoring the neutral pelvis is a must.

Much of this is exactly what we do in the beginning when we are in bridge, and with our low lunge series, and continue throughout the flow! Having experience teaching many people who have given birth, I have seen the firsthand effect of a decrease in DR over time practicing yoga with this methodology.

If you’re interested in postnatal yoga with me, you know where to reach me :)