Monday, August 29, 2011

Wrong diagnosis of Diastasis recti

I have been motivated to write yet another blog on this subject after the poor testing by a midwife on my client.

I’m not sure how many post natal women are aware of diastasis recti- abdominal separation.

Diastasis recti is a condition where the two right and left sides of the rectus abdominis (your "six-pack" muscle) spreads apart at the body's mid-line (the linea alba). Separation occurs in response to your uterus pushing against the abdominal wall and pregnancy hormones soften connective tissue. Separation can occur at any time in the last half of pregnancy but is most problematic after pregnancy when the abdominal wall is weak, when there is no longer a baby inside to aid support.
As separation occurs during late pregnancy women who give birth prematurely before 33 weeks may have minimal separation were as women who carry up to 40 weeks, carry a multi and are not aware of posture or the benefits of exercise can increase the separation during their pregnancy.
Many women aren’t aware of the separation occurring as you feel no symptoms or pain during pregnancy it is only when baby is out that many women start to suffer from lower back and hip pain or notice many months late that they can’t get rid of their post baby tummy.

My client had a 2nd emergency C section and after being recommended by her specialist to wear a surgical belt for 2 weeks post her midwife tested her separation at 3 weeks post operation and said she was fine. I had my doubts but my client was very happy so I didn’t want to disappoint her just yet.

It was the following week at 4 weeks post baby that I tested her. She had a 6-7 cm vertical gap and a 3 cm horizontal gap. Her midwife had completely misdiagnosed her separation, fortunately for my client she has me as her trainer so has now been recommend to do the correct exercises to re-hab her correctly and she should have minimal if any gap in 6 weeks.

If my client was not under a post natal specialist after the diagnosis from her midwife she had the right to assume that she could go back to any form of exercise and possible do exercises that can increase the separation.

Education and the correct testing of this condition is the key. If you exercise correctly and have good post natal posture then you can decrease your diastasis recti completely. If you do the wrong exercises such as planks and crunches, continually hold poor post natal posture, push a buggy with poor form and technique then you are setting yourself up to have lower back pain and a tummy that won’t go away. Along with a gap in your tummy that could still be there 5 years later.

I am not suggesting that all midwives wrongly diagnose this condition what I am saying is that your midwife or LMC needs to correctly assess if testing you for diastasis recti. If in doubt get checked by a professional or contact me for further advice on testing for separation

12 week post natal exercise programs which include exercises to decrease diastasis recti and correct poor post natal posture available on my website


  1. I read everywhere that the plank is an exercise that helps close the diastasis, you say is wrong, what exercises are right then?

  2. Hi there, thanks for your comment. This is by far the worse exercise you can do. In a plank position you push the abdominal muscle out onto the already separated and weakened linea alba, you can increase the diastasis with this exercise especially when relaxin is still in your system 4-6 months post.
    There are many other exercises that are far more suitable.You need to close the gap first. Have a look on this blog at the 3 Exercises you need to do post pregnancy and also have a look at the 12 week post pregnancy program on my website

  3. Thanks for posting about this... i have a gap still after three years and seeing a physio (womans health) doing exercise etc the gap is still 5 finger wide and extends above and below the belly button, when i engage my abs it reduces to 2.5 (almost 3) fingers wide. This is causing other problems and I don't know what more I can do to correct this or who to go to, i don't have the spare income to see someone privately, can you please point me in the right direction?

    1. Hi Millie,

      Isn't this a great site!?! I send so many of my mommies over here for advice and Lorraine's programs. I have a good "tummy safe" path of workouts on my site, but it sounds like your gap needs some real physical therapy. I don't always point people to the Tupler Technique, but she has the therapy bit down pat. Just don't be afraid to move on to harder things again once you're done. You can also look into the MuTu Sytem, since Wendy over there has a 12-week system you can do all online. My site is more for AFTER you've closed the gap. Lorraine ROCKS the prental programme, though! She knows her stuff!

  4. You are welcome Millie, have a look at the blog if not done so on the '3 exercises you need to do post pregnancy' and the most recent blog. This will give you some more info and a couple of exercises.
    The gap should start to close quite quickly if you do the correct exercise and work on your posture, can you do this?

  5. I'm glad I found this site. I'm a little confused. My abs have been separated since I had my younger daughter 2-1/2 years ago (I didn't do *anything* about it for two years, but now I'm getting fit.)
    I don't understand what 'normal' is for this. I heard that 1-2 fingers between the abs is normal, but is that when the abs are fully engaged or not? When I start to contract my muscles to test, all four of my fingers fit in there. But when I'm fully contracted, they're a little less than two fingers. How "bad" would you describe that condition??

  6. Hi Melissa, check out my website too :-)
    Normal is no gap. If there is more than a 1cm gap engaged I do not reccomend any planks, crunches, full press ups. There also has to be good activation of transverse abdominal, rectus and obliques. You should see and feel all the muscles activating. 4 fingers is much too wide and you could be suffering from an achey lower back?

  7. My lower back does bother me, but only from time to time. It has improved as I've lost some weight and started doing a "post natal core conditioning" video. I'm just upset because I thought my condition had improved MORE than it actually has because my muscles were getting closer when contracted. I hadn't realized how far apart they were to start - that is, I didn't understand how to do the test. Oh well. Just means I have more work to do than I thought. At least I know now.

  8. I have been searching for help online about this, I know I have it, it's a little under a finder wide horizontally at the belly button (worst spot). Do I honestly have a chance of closing it all the way, I keep being told that you can close a bigger gap to a 1 or 2 finger separation but that you can never close it all the way without surgery. I am down to 16% body fat and weigh right under a 100lbs (I'm only 5'0) and want to get into competing in figure competitions, and this is so frustrating, I do not want to have to have surgery to fix it. I am 6 months postpartum and an exercise freak, it's killing me not being able to start toning my abs back up! I have been doing the tupler technique for months and I'm still measuring the same. Any help would be greatly appreciated!!!

  9. Hi Heather thanks for your post. You are only 6 months post relaxin the pregnancy hormone can still be in your system 4-6 months post so there is a definate chance you can close your gap. Make sure you are staying away from crunches and planks and perform other core work instead. What ab and core exercises are you doing at the moment?

  10. Glad to have found this site- just the info I have been looking for.
    I am 7 months pregnant and have noticed my linea alba is wide- about 3 cm that will close to 2 cm if I tense my abdominal muscles. Rather foolishly I have been doing planks till recently, so no doubt have made this much worse under my own steam. Gutted.
    Is it possible this gap will decrease after birth- or is it more likely it will get worse? Is there anything I can do in the last months of pregnancy to reduce the problem? I have also been suffering pelvic girdle pain which is improved with exercises and being careful about what I do. I am still swimming daily and can only do frontcrawl due to the pelvic pain- is this still ok to do? I can't face sitting around doing nothing!
    Many thanks

  11. Hi thanks for your post,
    Thankfully you have stopped planks! You can reduce further separation by doing the right exercises and watching your posture.
    Your SPD pain will be related to your core and glute weakness so its best to keep up your strength exercises 4 times a week for the rest of your pregnancy. I would suggest:- Side leg lifts, one leg drop downs with hip hitch, wall kick backs and semi wall squat sits :-)
    have a look at my site for programs to heal your diastasis and decrease back and hip pain.
    Hope helps Lorraine

  12. I'm so happy to find your site, Lorraine. I'm not happy with the condition of my tummy after almost three years given birth to my youngest one, I still have the pooch. I have tried planks, crunches, and sit ups, but the pooch is still there. My work at the farm used to be just right for me to get rid of that pooch for my first and second post pregnancy tummy, but this time it is not working. In so desperate. Until I saw your video on you tube, I know I have a chance to make a change, in a correct way. Right now, I still have a gap about 4 fingers. I hope I could soon squeeze in the gap to as close as possible. I wonder if my tummy will go back normal size? I used to have flat tummy before pregnant.

  13. Hi Arfi, thanks for your post. It can go back but it actually depends how much damage you have done doing crunches and planks etc. You actually make your DR far worse with these exercises than doing nothing. Whay don't you try the first 2 exercises in this YT playlist of mine for 2 weeks and read how to activate your transverse abdominus muscle which is on this blog. Let me know how you go and you may want to purchase the full 12 week post pregnancy program birth2fitmum from my site. Here are the links for you:

  14. Hi Lorraine
    I'm almost 23 wks pregnant with my second child and was diagnosed with this last week by my GP. Some days I am completely fine - no bulge - and others I am in a ton of pain and the bulge is very visible. Last night I couldn't even handle changing my toddler's diaper, my husband had to it. I'm just wondering if there's anything I can do now that won't hurt the baby? Also, how much worse is this going to get over the rest of me pregnancy?! I've still got 17 weeks to go and I'm scared about how bad this pain is going to get.
    Hoping you can help!

  15. Hi Talie, yes there are many things you can do first of all have a look at my article in this blog on preventing Diastasis during pregnancy that will really help. I would also suggest you start to wear a support belt for 2-4 hours only during the day and do your exercises. The exercises and wearing the belt along with good posture will reduce the increase in separation. You should have a look at the Fit2birthMum program on my website and you can follow the exercises from that I will also include the reduce lower back pain 20 min video link, if you purchase. Hope helps

  16. Hi there, I'm at a bit of a loss. I am from New Zealand and nowhere along the way did I ever get checked for diastasis recti post pregnancy. However, when I check now (my son is now 2 years old) it is at 3–4 fingers gap. My dilemma that I am facing is I did the Julian Michaels 30 day shred (which involves planks, bicycles, side planks etc. etc.), while I got insanely fit my stomach seemed to be getting bigger. I've since stopped all exercise as I have come to realise that I have diastasis recti. I need a quick and effective workout like JM's 20 minute ones, but which have a rehab program included that I can do at home. Do you have anything like this, or could you point me in the direction of what I'm looking for? Thanks so much! Liza.

    1. Hi Liza,

      You have just saved me replying on the blog!

      Even though you are strong you actually do really need to go right back to basics to close your gap. Other muscles are probably dominating and you have most probably made your DR much worse.
      You need to connect with your inner core and strengthen from the inside out to allow your body to heal. It can be done!

      You can still continue with your cardio exercise, running is especially ok where as twisting movement and cycling are not.

      You need to spend around 20mins 4-5 times a week on the strength program and build slowly.

      I have rehabbed many cross fit athletes and they too have had to start at the beginning so don't worry about that,

      If your gap was less than 2cm then you could go on to superfitmum first but this doesn't really teach you the basics,

      There will also be 3 new videos added to b2fm this week. There is a special if you purchase both programs,

      Once you have healed if you want you can go back to crunches and planks :-)

      here is an article of mine on not crunching