The web is saturated with information on diastasis recti, with controversy over whether or not pregnant women should be doing sit-ups, or crunches, or not.
There are pregnant women who continue to do Cross Fit, run, lift weights, etc. and all with good reason. Without any contraindications, regular activities at a moderate level are safe-moderate level being most important.
Should your pregnant clients do sit-ups?
The answer is not a simple yes or no.
The following information will help you to make an educated decision, based on your client’s individual needs, whether or not sit-ups will benefit them. Here is a preview of what you will learn in part 1 of 3:
- Why sit-ups are a concern
- What is diastasis recti (DR)
- What causes DR
- Why diastasis recti can be problematic
- Rectus Abdominus (“six-pack”) tutorial
- How to check for it
- Resources for further study
Here we go!
Definition of Sit-Ups, “Crunches”, and a Basic Contraction
There are several variations of sit-ups and contractions, depending on the person. For clarity, I will use the following explanations to define sit-up and contraction.
From a laying down position with the knees bent:
Sit-Up and Crunches – Coming up to a full flexion from the hip flexors, the back
leaves the floor. Someone usually is holding the feet.
Basic Contraction – seen in Pilates exercises like “The Hundred” – Coming into a c-curve or pelvic tilt, low-back touching the floor, shoulders and upper back lift into a flexion position from the torso.
Why are “sit-ups” or “crunches” a concern during pregnancy?
Sit-ups can continue throughout pregnancy; just be careful of lying flat on your back in the late second and in the third trimester as this can cause a drop in mom’s blood pressure (vena cava syndrome).
Paige Cook, Registered Nurse FNP-C for Women’s Health Associates of Southern Nevada
From a medical perspective, the sit-up action isn’t the concern. The concern is Vena Cava syndrome, caused when the heavy uterus lays on the vena cava artery, cutting off circulation to mom’s heart. This happens when mom lays flat on her back for too long. (Your client will let you know if she is uncomfortable on her back. When
this becomes an issue, use a partially deflated big ball to rest against.)
For a healthy pregnancy, baby is perfectly safe in mom’s womb during workouts, as long as mom is working at a moderate level.
The Diastasis Recti concern comes from the logic that if the abs are separated, and you do a sit-up, they will strengthen in that position.
The factor is how the abdominals are being contracted-whether or not mom is properly releasing and contracting her transverse abdominals and pelvic floor, what I call Hugging the Baby.
Do sit-ups hurt the baby?
To come up in a basic contraction, just enough to feel the abs, won’t hurt an unborn child.
So, is a sit-up (crunch) beneficial to mom?
A sit-up can be beneficial if mom has been doing sit-ups before pregnancy in addition to proper form and use of the transverse abs, pelvic floor, breathing (diaphragm) and back muscles are being used. Women who have done them in the past should not have a problem.
What is not recommended is starting a sit-up routine during pregnancy. Most women cannot do a full sit-up during the later stages of pregnancy, anyway.
A full sit-up, where you begin to use the hip-flexors, is not necessary during pregnancy.
What about the Basic Contraction?
The basic contraction is a great strengthening exercise for the core during pregnancy, with modification. As the uterus grows, the contraction will get smaller, because mom won’t be able to lift as high.
Doing small contraction exercises during my pregnancy felt really good.
What is Diastasis Recti?
An unnatural stretching of the linea alba, the connective tissue that attaches the right and left sides of the rectus abdominus. (see pic)
To understand DR, we need to understand the rectus abdominus:
Rectus Abdominus “Six-Pack” Tutorial
2 Primary movements:
- Flexion (Roll-Ups, Abdominal Contraction “crunch”, Roll-Downs (standing))
- Posterior Pelvic Tilt (C-Curve)
- Notice in the pic how long this muscle actually is, and where it connects.
- Proper posture depends on the rectus abdominus to keep the pelvis neutral, rather than tilted forward (anterior pelvic tilt) (lordosis). Why this pelvic tilt is common in pregnant women.
- The rectus abdominis muscle assists with breathing and plays an important role in
respiration when forcefully exhaling, as seen after exercise
- These abdominal muscles also help in keeping
- the internal organs intact and
- in creating intra-abdominal pressure, such as when exercising or lifting heavy weights, during forceful defecation or childbirth (Wikipedia)
Back to our definition of DR:
The unnatural separation of the abs is caused by the breaking down of the linea alba tissue. We say unnatural because the linea alba tissue is designed to have some mobility, more so during pregnancy, where a slight stretch is needed to support the growing uterus. It is when this stretch goes beyond what is natural that we get a diagnosis of DR (Diastasis Recti).
- Diastasis means ‘separation’, recti meaning ‘the rectus abdominus’
- Linea means ‘line’, alba means ‘white’
- It is important to point out that we are referring to diastasis recti during and after pregnancy. Diastasis recti can occur in anyone who has an excessive amount of intra-abdominal pressure, and insufficient core strength (pelvic floor and transverse abdominal strength.)
Movement specialist and biomechanist, Katy Bowman of Nutritious Movement, recently released her book “Diastasis Recti” where she gives an easily understood explanation of DR and how it is created.
- She explains that DR is a symptom of a whole body problem, which is why isolated ab exercises and abdominal wraps won’t correct Diastasis Recti.
- She goes on to say that you must recognize the visible (anatomy) and invisible (forces-movements throughout our everyday life, and internal forces like pregnancy) to properly restore the core (including diaphragm and pelvic floor) and correct the DR.
I could go on forever with the Katy’s expertise, but for copy right purposes, and to add a must have resource to your continuing education library (which we should all be continuously growing,) please, go get this book! You can order it on Amazon. Search under Diastasis Recti by Katy Bowman (I am not an affiliate (yet, lol) I just feel strongly about the genius of this book.)
What causes the separation during pregnancy?
- As the uterus grows, intra-abdominal pressure causes the abdominals to stretch
- The separation can occur in different areas along the linea alba, although it is more commonly found near the belly button.
- Pregnancy hormone, relaxin, causes the muscles and ligaments to relax, allowing for the abdominals to stretch, and the linea alba to separate much more easily then if this hormone was not present.
- If the linea alba tissue is not sufficiently conditioned, which happens over time with proper exercise and movement (and nutrition), it will separate beyond what is normal, causing the DR.
- Many women do not recognize. No pain.
Remember that the linea alba (connective tissue) attaches from the sternum to the pubic bone. That’s the whole length of the core.
Now, think about all of the movements that tug on the linea alba throughout our lives:
- In a car, reaching from the drivers seat to the back seat,
- twisting the torso during exercise, dancing, or while hoola hooping ,
- kicking the legs,
- doing back-bends
- doing front bends-abdominal exercises-crunches, roll-ups
- pushing with force and pulling with force
- even roller-coaster riding
- sneezing, giving birth, gaining weight
- sitting too much or standing too long in one place (sedentary lifestyle)-working in an office, driving long distances, working behind a counter for hours on the feet.
The point is, movement throughout our lives contribute to the amount of force and pressure put on the linea alba, (the facia holding the abs together.) The linea alba was created to be flexible with movement. It is when movement is excessive, and the linea alba is not in optimal shape (which comes from properly conditioning the core) that problems arise.
Why should I be concerned about diastasis recti?
- Diastasis Recti that is not properly attended to can result in
- Low-back pain
- Pelvic pain
- Umbilical hernia
- tummy pooch postpartum, what some call the “mummy tummy”
How do I know if my client (or I) have DR?
A DR during pregnancy causes a bulge anytime pressure is forced out from the inside, usually during an abdominal exercise.
Postpartum (after pregnancy) or with other clients who have not been pregnant.
Do the ‘Rec Check'(Rec standing for rectus abdominus)
The ‘Rec Check’ – Checking for Diastasis Recti
- Lay on back, knees bent, feet flat on floor (see pic)
- Hold head in hands and lift shoulders and head off of the floor. This engages the rectus abdominus muscles, allowing to check for a split.
- With 2 fingers, feel the linea alba (middle of the rectus abdominus) for
- any separation (the diastasis recti) in the following 3 locations: Above, On, and Below the belly button to the pubic bone.
- the depth within the separation
- Come down from the contraction every couple of seconds.
- If the split is more than 2 fingers wide, diastasis recti is present.
- Eliminate flexion exercises (roll-ups, The Hundred, sit-ups) until it is corrected.
- Focus on transverse abdominal work – transverse abs, posture, pelvic floor.
- If the split is less than 2 fingers wide, it is safe to begin gentle curl-up or flexion exercises.
This ends Part 1 in this series of 3 posts on Diastasis Recti.
In Part 2 of this Diastasis Recti Series, we will go over the different educated opinions among pre and postnatal professionals, and go into research and the prevalence of DR.
In Part 3 I will share exercises I have found to rehab DR, and what movements and exercises to stay away from.
Thank you for hanging out with me! Give yourself a high 5 for taking the time to educate your mind! If you are currently working with pregnant women, I encourage you to share this information with them.
If you have questions or comments, please fill in the contact form below, or e-mail me directly at firstname.lastname@example.org
If you haven’t done so yet, please pick up my complimentary PDF THE Pre & Postnatal Pilates Instructor Crash Course
Alison B. Marsh
An in-depth description of diastasis recti. I encourage you to brows this site under the resources tab. It is full of information on pre and postnatal health
Katy Bowman of Nutritious Movement and the author of the new book Diastasis Recti