Exercises to Avoid if You Have Diastasis Recti While Pregnant
Abdominal wall separation, also known as Diastasis Recti Abdominis (DRA), is a condition commonly known for its appearance during pregnancy and postpartum (although it can occur otherwise). It is measured by the inter-rectus distance (IRD), which is the width of the linea alba (a band of connective tissue in the midline of our abdomen located between the left and right rectus abdominis muscles). This distance normally measures 1.0-2.2cm at rest. In someone with diastasis recti, this distance measures 25mm or more (two or more finger-widths).
DRA is characterized as functional and non-functional depending on whether your left and right abdominis muscles can communicate by generating tension across the linea alba when contracting. This is an important distinction as individuals who have recovered with a functional DRA have a fully-functioning abdominal wall and can participate in most if not all activities as normal.
During pregnancy, not only does your abdominal wall stretch to accommodate your growing baby, but you will likely start to breathe differently and move differently because your abdominal wall contents are shifting and your centre of gravity is changing. With all of these small changes, you become more susceptible to developing DRA.
Signs and symptoms of DRA include:
Tenting or coning at the midline of your abdominal wall when you contract your ab muscles
Notable core weakness or inability to contract your core
Lower back pain
Difficulty lifting and/or carrying
Difficulty with certain exercises
If you are pregnant and you have been diagnosed with DRA or you’ve been experiencing several signs and symptoms on this list, here are the exercises I recommend avoiding:
1. Planks
Planks require you to continuously contract your abdominal wall muscles in order to support your full body in a static position. Because of this, planks tend to raise your intra-abdominal pressure (IAP) — the pressure contained within your abdominal cavity — and place strain on your linea alba. In the case of DRA, your linea alba has widened and your outer abdominal muscles aren’t communicating well, meaning increases in IAP can lead to greater separation of these muscles. This far outweighs the benefits you get from planking, so it’s best to steer clear. The good news is not all planks are off-limits! You may be able to continue modified planks and side-planks with one or both knees on the mat.
2. Sit-ups and Reverse Sit-ups
The same goes for sit-ups and reverse sit-ups (getting up from lying and lowering onto your back from a sitting position). These exercises generate increases in IAP, and just like planks many individuals hold their breath during the working phase of this exercise which increases IAP even more. I consider these more dangerous than any other exercise for DRA because we do these movements constantly throughout the day, not just during structured exercise sessions. Be careful when you are getting out of bed or off the couch, lying down at night to sleep, and getting in and out of the bathtub (to name a few), as these movements can add up throughout the day without you even realizing!
3. Double Leg Raises, V-ups, and Hollow Holds
These exercises all share similar features requiring you to lift both legs and/or arms simultaneously while being on your back. In addition to being prone to holding your breath during these movements and generating high IAP, your core tires more easily leading you to compensate through your low back and hip flexors. If you are experiencing DRA, I advise you to stick to single-leg and single-arm movements and avoid static exercises that require you to hold a sustained position. Making these modifications gives you greater control and helps you recruit your deep core (improving tension across the linea alba that I mentioned earlier).
4. Running and/or Jumping
This may come as a surprise to some, but running and high-impact exercise isn’t great if you have DRA, especially during pregnancy. The reason why is that changes in IAP doesn’t just affect your core, it affects your deep core unit which involves your pelvic floor muscles. Running requires you to continuously recruit your core for stability to manage the impact on your hips, pelvis, and axial skeleton. If your deep core unit isn’t functioning well due to DRA, you are less able to manage this repetitive impact and you are putting yourself at risk of developing issues in your back, pelvis, pelvic floor, and the joints of your lower extremity. Being pregnant or postpartum, you are already at risk of joint pain and pelvic floor issues. Lastly, similar to the exercises above, you are putting yourself at risk of worsening the degree of abdominal separation.
5. Heavy Lifting
What is considered “heavy” will vary from person to person, but I typically recommend that my clients with DRA avoid lifting greater than 20lbs. Sometimes I recommend less and sometimes more, but it all comes down to your severity of DRA, your level of fitness and history of exercise, whether you are currently pregnant, your medical history, presence of other musculoskeletal issues, and your current goals. “Avoid lifting heavy” is sort-of a blanket statement as it can include a lot of different exercises, so it’s important to listen to your body when it comes to this one. If you are lifting heavier than what your core can handle, even if the rest of your body is strong enough, you can make the same mistakes like holding your breath, compensating through other areas of your body (hips, back, pelvis, and shoulders), and generating high IAP. This puts your abdominal wall and pelvic floor at risk, as well as the other areas of the body that are taking on any extra strain.
This list isn’t exhaustive and it may not apply to every case of DRA, but if I had to choose these would be my top 5 to avoid! You can get a GREAT workout without doing any of these exercises, so if you’re ever unsure about whether an exercise is safe, it’s best to modify or substitute.
If you are pregnant and looking for a movement that is safe for your core and pelvic floor and will help you to prevent (and manage) DRA, I encourage you to book a Yoga session at Higher State. Our founder, Hayley, is a registered physiotherapist and pelvic floor expert with a special focus on pre and postnatal movement. We can provide safe modifications for you during pregnancy.
If you are unsure of whether you have DRA during or after pregnancy, I recommend seeing a Pelvic Floor Physiotherapist (you can click here to book a session with us at Higher State). Your Pelvic Floor Physiotherapist can provide you with an individualized treatment plan based on your assessment, including guidance on which exercises are safe and which exercises to avoid.
Have questions? Send an email to admin@higherstatehealth.ca
