Closing the Gap: How to Rebuild Your Core After Pregnancy
Got a stubborn bulge in your tummy that won’t go away—together with pelvic and back pain? You could have diastasis recti. Here’s how an expert goes about putting you on the road to recovery.
The pain was sharp. On the worst days, when I was extra tired, it felt like an extra slim razor blade being wedged into a crook somewhere in my lower back. Whenever I moved certain sections of my back, it would strike like lightning, its fluctuating intensity eliciting reactions that ranged from a full-face grimace, to a sharp intake of breath, to some sort of involuntary, guttural growl. Such was living with the back pain caused by my two-and-a-half-finger-wide abdominal gap, or my diastasis recti, after my second pregnancy.
Diastasis recti, according to OB-GYN and pelvic floor specialist May Anne Tabaquero, MD, FPOGS, FPSURPS, is the separation of the two halves of the rectus abdominis muscle from its fibrous or fascial attachment in the middle, called the linea alba. Licensed physical therapist Charmaine Geronimo, PTRP, RPT, founder of Re-Hub Physical Therapy Clinic, who is certified in advanced pelvic floor rehabilitation, shares that it’s a condition that over 60 percent of women experience after pregnancy.
“In layman’s terms,” Dr. Tabaquero explains, “your abdominal muscles get stretched out.” Allure Philippines recently spoke with Dr. Tabaquero and Geronimo about the basics of diastasis recti—what it is, who it affects, and what it does to your body.
I have been pregnant three times, have had three C-sections, and each time, a case of diastasis recti of varying degrees. With my first child, the only symptom I experienced was an overstretched belly with a gap, that I was able to close more or less on my own, with some professional advice, although the muscles were definitely not as tight as before.
Four years later, after the birth of my second, the gap heralded its presence with the aforementioned back pain, which spurred me into private sessions with a licensed physical therapist. I was still hard at work at these sessions when I discovered I was pregnant with my third, the news of which I shared with my PT, who reacted with an amused gasp and a giggle.
Today, about a year after my third C-section, I am still toiling. The back pain returned, and was banished once again. Hip pain has made recurring appearances, and is still being worked on. My core is stronger than it was a year ago, but I still have a way to go before my gap is closed.
If, like me, you have diastasis recti—either caused by pregnancy, being overweight, or lifting heavy objects with a very weak core—and are suffering from back pain, pelvic pain, a leaky bladder, among other symptoms, the question in your head probably is, How do I fix this?
Dr. Tabaquero answers that treatment will depend on the severity of the gap. “The most severe cases will need abdominoplasty or a tummy tuck, or mesh placement, where mesh material is used to reinforce and support the abdominal wall.” The less severe ones, she says, can be managed by doing core strengthening exercises and pelvic floor therapy, supported by lifestyle changes. Geronimo shares that it’s important to consult with a licensed physical therapist, preferably one who is certified in pelvic floor therapy, to figure out how to begin recovery, and to safely and effectively close the separation.
But while nothing can replace an expert’s guidance, it’s not always within our budgets to bank on private sessions. Geronimo knows this, and has graciously shared with Allure Philippines her entire process for when patients come to her, seeking to close that gap. Read on for more.
How do I know if I have diastasis recti?
Physical therapists, Geronimo included, check for, and measure, the separation of your abdominal muscles in terms of finger widths. The process involves pressing down above and below your below button to see how many fingers fit into the gap.
Geronimo shares a step by step process on how to check for diastasis recti from this diagram published by her clinic, Re Hub.
What can I do to recover from diastasis recti?
There’s a very important flow that should guide your recovery from diastasis recti, according to Geronimo. Given that there is separation, that already means that the abdominal muscles are weak. It’s crucial for recovery to start slowly, and then work one’s way up to the more difficult exercises. “If people skip the steps,” Geronimo explains, “they have leaking, they have back pain. They can get injured because they’re not strong enough yet to do those exercises.”
Here is Geronimo’s general guide that she follows when helping clients recover from diastasis recti, regardless of their previous level of physical activity.
Phase 1: Abdominal binders
If patients are only a few weeks postpartum, Geronimo starts them off by making them wear abdominal binders or corsets. “At this stage, it’s about support and making the muscles stick together, because they’re very weak,” she says. “Sometimes, we do taping.”
Phase 2: Breathing exercises
Diaphragmatic breathing, meaning breath that comes from inside of the diaphragm, is also very important at the beginning of the recovery process. “The diaphragm is the roof of your core,” Geronimo says. She explains that it has to be involved in the process, and that learning proper breathing is essential to the rest of the exercises.
Phase 3: Pelvic floor exercises or isometric exercises
Isometric exercises are, essentially, exercises where you tighten or contract the muscle without lengthening it or moving it. Pelvic floor exercises, on the other hand, target the muscles supporting your pelvic floor.
At this stage, Geronimo explains, it’s important to recognize that muscles are still very weak. “They’re overstretched,” she says. “If you contract them too much, you’ll get bulging and separation, when what you want is for them to come closer together. That’s why you want to do isometric exercises.”
Geronimo has patients do hip exercises such as bridges or clam exercises, and glute exercises. “Glute exercises are very important,” she stresses. “Your glutes support your core, your abdominals, your hips. You can’t really have a holistic strengthening of your core if your glutes are weak, because when you’re activating your core during most core exercises, you’re also contracting your glutes.”
She also avoids exercises that use the high abdominals, such as sit-ups or V-ups too early, and instead recommends hook lying head lifts with abdominal bracing, which entails pushing your belly in, with your knees bent and flat on the floor, while lifting your head. “They’re not crunches or sit ups,” Geronimo cautions. “You’ll be too weak for those. Usually the patient can’t even lift the head or body at this stage. With the head lifts, you’re just lifting your head and neck, not your trunk.”
Start with fewer repetitions, Geronimo suggests, like five to six repetitions, and build up to 10, and then repeat it two to three times, eventually increasing the hold of the position for longer periods of time. “You can do it every day or every other day, as long as you’re not getting too sore,” she says.
Phase 4: Functional exercises and more challenging core exercises
The last stage of rehab, Geronimo says, comes in the form of functional exercises and harder core exercises. Functional exercises are movements that we do in daily activities, such as squats or lunges, and help us complete these tasks better, build strength, and prevent injuries.
“If you feel like you’re getting stronger and the exercises seem easier, you can start with functional exercises,” says Geronimo, explaining the last phase of her system. “For example, bird dog exercises, sit ups, dead bugs, squats, body weight squats, lunges, supine marching.” “But,” she cautions, “if you still feel like you’re too weak, keep doing those basic exercises.”
The road to recovery
It’s important to remember that the path to recovery will probably not be linear, but may come with twists and turns along the way. Don’t be discouraged if your recovery takes longer than you initially thought. What’s important is that you prioritize your safety, to keep your body injury-free and keep you on track.
