66% of those with diastasis recti also have pelvic floor dysfunction*
Is your exercise class or online program missing something?
Why not treat it together? Pelvic Physical Therapy can help!
MOST people with DRA have an additional condition of the pelvic floor that needs to be addressed to make your program and healing complete!
What is Diastasis Recti Abdominus (DRA)?
DRA is the separation of the abdominal wall, most commonly associated with the abdominal muscles and tissues not fully recovering after pregnancy. You may notice a deeper dent between the muscles, or bulging along the the abdomen. This bulge can look like a tent or a dome when doing a crunch, or even in standing. You may still look pregnant, even when you are exercising and eating well. The pelvic floor works closely with the abdominal wall and diaphragm. It helps stabilize the spine and pelvis and control pressure in our “canister”. Therefore, DRA can cause or effect a pressure problem.
Do I have Diastasis Recti?
Types and severity of separation can vary, and testing can be inconsistent. Basically, if you can place fingers in the center of the abdominal wall and feel them sink into the abdomen you may have DRA. This tissue won’t tighten and close as well as the surrounding muscle when you try to tighten your stomach. To know for sure, check with your OBGYN, pelvic Physical Therapist, Doula, Midwife, or other trained provider.
I think I have diastasis recti. What do I do?
Not all professionals agree on the best way to treat this, or if we even need to. If yours is bothering you, either aesthetically, or impacting your function, then get it treated.
How do I treat diastasis Recti?
Before starting a program, consider whether or not you would be in the 36% that need no further assessment. If you are, great! Go ahead, but promise yourself that you will seek care if you notice one of the pelvic floor conditions listed below. If you’re in the majority, you will find your best recovery by seeing a qualified pelvic health Physical Therapist first, or in addition, to these programs.
How do I know what program is best?
There are videos and classes that have excellent information. Many are put out by Physical Therapists or highly trained exercise professionals. As a consumer how do you tell who is a highly trained professional? Simple – if they are, they will say so, and if they are not, they won’t. If someone claims to be an expert and you cannot find their qualifications or training, steer clear. The best videos/programs will clearly state that this SHOULD NOT replace a comprehensive exam by a qualified provider. You can trust a program developed by (or with) a pelvic health specialist who supports getting your own individual exam and encourages you to address potential pelvic floor issues. Knowing whether you are performing a contraction correctly is critical to the success of the program. Doing “core” work incorrectly could make DRA or the pelvic floor issue worse.
Please note: There is a difference between a general Physical Therapist and a pelvic health (Women’s Health) Physical Therapist. Just because a PT has done an excellent job helping you with your shoulder doesn’t mean they have the training to fully understand and treat your pelvic floor. (some do both and that’s ok) Again, even general Physical Therapists are claiming to be DRA experts, so it gets hard to tell who to find. I recommend using a PT Locator/Find a Provider through www.aptaapps.org or www.pelvicrehab.com
Who/what exercise programs do you recommend?
Awaken Studios. Awaken offers multiple classes of varying intensity: Pilates (mat and reformer), yoga, anti-gravity, TRX, high fitness, Barre, and more. They even offer child care! The owners and instructors at Awaken have additional training and include the pelvic floor in their class instruction. They are trained to modify exercises for correct performance and individual success. They know when to refer to a specialist so that you can continue your program without interruption.
I recommend the MUTU program for several reasons. It meets all criteria listed above, plus, I used it personally after each baby and for exercise while traveling. Even as a health care practitioner myself, I benefitted from having a program to follow that I knew took little time and equipment. Use this link for more information on how MUTU can help.
How do I know if I have an additional pelvic floor dysfunction?
If you are experiencing any of these symptoms (even if you’ve never had a baby), see a pelvic Physical Therapist or your health care provider:
- Incontinence – stress, urge, urine, stool, gas…any amount of leakage
- Pain – pain with sex, abdominal pain, scar pain
- Prolapse – bulging sensation or pressure of the pelvic organs
- Musculoskeletal issues – back, SI, sciatic, knee or foot pain
- DRA itself can be a symptom of a pelvic floor dysfunction because it can indicate a pressure control problem
- Endometriosis, PCOS, painful periods, fertility challenges
- Traumatic/complicated pregnancy and/or childbirth
What can I expect from pelvic Physical Therapy?
An evaluation generally lasts an hour or more and should be able to identify all factors that could be contributing to the DRA and what exercises are appropriate for you. Some things may be too difficult initially, but should focus on being able to as much as you can as soon as you can. Concerns I hear often are: “I don’t know where to start”, “I don’t know what is ok”, and “I don’t want to make it worse or do the wrong thing”. All are reasonable concerns, and a PT can clearly answer them. You should leave your first appointment knowing exactly where to begin for your body. Once you have a good foundation and know how to coordinate the floor as it relates to the other structures, you can continue your program and get those strong beautiful abs.
I often supplement physical therapy appointments with these online or in-person programs. They can help promote long-term exercise habits once you started and no longer need regular physical therapy visits, but want to continue with consistent information. When added to Physical Therapy, online programs can be a great way for tired, time-strapped moms to get in a workout while in the comfort of their own home. If you would like to attend an in-person class, find a PT and instructor who are willing to talk to each other. I often work with instructors to make sure we are consistent. I have attended patient’s classes, and had instructors come to client appointments. It’s a fun way to work together for your best interest.
Make sure you are starting any program with the knowledge of whether or not it will be appropriate for you and the person selling it knows that you may have additional needs. Set yourself up for success and have resources for complete care based in true professional skills. There are many people claiming to be “experts” and make a lot of money doing so. Be aware if you may have underlying needs. Better yet, go see a Physical Therapist first, then apply your knowledge to any program you choose, as well as to other aspects of your life, movements, and activities. The programs aren’t all bad, I promise, but when you may missing 66% of your problem, it would be nice to know what is best before spending the time and money.
*Int Urogynecol J Pelvic Floor Dysfunct. 2007 Mar;18(3):321-8. Epub 2006 Jul 26.Prevalence of diastasis recti abdominis in a urogynecological patient population.Spitznagle TM1, Leong FC, Van Dillen LR.
*I have not been paid for my opinion of Awaken