Does Exercise Really Help Abdominal Muscle Separation?

Repairing torn abdominal muscles after pregnancy can leave you feeling desperate for answers. Many women with postpartum muscle separation struggle to get rid of the belly bulge, back pain, leaking urine, and gastrointestinal issues that come with the condition known as diastasis recti.

One popular solution for diastasis recti is exercise, but it is not without controversy. You may be confused about what you have read online about whether or not exercise can repair your abs…leaving you stuck wondering whether your tummy will ever appear “normal” again after pregnancy.

The question is, can exercise truly help remedy abdominal muscle separation? Today’s post will help separate fact from fiction. This article will tell you all about how and why your fitness regimen may help repair separated abdominals after giving birth. We will explore the latest scientific research to get to the bottom of this controversial topic. And finally, Dr. Beldholm, a leading tummy tuck surgeon, will weigh in with valuable advice to help new mothers like you say goodbye to diastasis recti once and for all.

Can abdominal separation exercises really help?

The short answer is that certain exercises seem to offer a promising solution for women suffering from diastasis recti. Based on existing medical research, it appears that postpartum ab workouts can give real results, as many of Dr. Beldholm’s patients can attest.

But not just any old exercise will do. The most effective fitness routines for diastasis recti are not based on guesswork. The theory of exercise for muscle separation is that targeted exercise can help bring separated abdominals back together. The goal is to activate your transverse muscles and pelvic floor first. Later, you can add different exercises such as planks and crunches. (Hint: Have you heard that you should avoid planks and crunches for diastasis recti? Keep on reading — It turns out this tidbit of information may not be entirely true after all.)

OK, so we’ve given you the quick answer. But quick answers often raise more questions, especially when you’re talking about a complex issue like postpartum muscle repair. What are the transversus muscles, anyway? Why do you need to stabilize your ab muscles before moving on to traditional exercises? And which exercises are useful for bringing separated ab muscles back together?

This article will answer all this and more. But first, many of you will find it helpful to know a bit about the anatomy of your abdomen. Doing so will help you make greater sense of how you can repair postpartum muscles with certain exercise for a more beautiful, healthy tummy.

Your body core and why it is important for diastasis recti

Your body’s core encompasses your entire midsection. It includes all the muscles found in this area — front, back, sides, and all. Your abs, pelvic floor, and various muscle groups within your back make up your core. Your core has many important functions, such as stabilizing your body and allowing you to move. Core stability is vital for your body to have proper balance and weight bearing in your spine and pelvis.²

Diastasis recti causes the two sides of your superficial abdominal muscles to split along the connecting membrane, called the linea alba. Aside from causing an undesirable cosmetic defect on your tummy, it weakens your body core, leaving you with pain, poor posture, alignment issues, and putting more pressure on other core areas to make up for it.

Exercising for diastasis recti works two key parts of your core — your abs and pelvic floor. These exercises target these muscles specifically. Strong abs and a strong pelvic floor help your entire core perform optimally. The core muscles found in your back, front and sides work synergistically to keep you strong, balanced, and pain free. If any part of the core (in the case of diastasis recti, your abs and pelvis) is weak, it throws everything off. A strong core affects other body parts, too. Core stability gives your body the power to move your limbs properly, which prevents injury.² It’s no wonder new mums with diastasis recti face so many problems, including pain.

Ab muscles are more than just a “six pack”

Your abs go much deeper than just the six pack abs you see at the beach. Did you know that you have four groups of abdominal muscles? These include the transversus abdominis, rectus abdominis, external obliques, and internal oblique muscles. Here is a brief overview of the four muscles.

Rectus abdominis: The most famous of all abdominal muscles, these are the muscles that make up “six-pack” abs. But these muscles give you more than just a great bikini body. Located between your ribs and pubic bone, the primary function of the rectus is to allow your body to bend by pulling the ribs and pelvis inward. Coughing, bowel movements, curling exercises such as crunches, and even delivering a baby rely on the rectus abdominis. They give your trunk stability, and even help support your back and organs. When you look at a stomach with diastasis recti, this is the muscle where you will see a separation at the tummy’s midline connective tissue. When the connective muscle stretches sideways during pregnancy, it often tears. This weakens the support system for your back and organs, resulting in back pain and digestive issues.

Transverse abdominis: This is one you definitely need to know if you are considering exercise for diastasis recti. It is the deepest set of muscles. The transversus sit above your rib cage, but below other abdominal muscles. Its function is to give your body good posture and lumbar support. Working this area of the abdomen is a good way to reduce back pain, a classic symptom of diastasis recti. It also helps keep your tummy organs where they are supposed to be.

External obliques: Located on either side of your rectus abdominis, the external oblique muscles give your body the ability to twist and turn. Think of these as your dancing muscles.

Internal obliques: Your internal obliques can be found just inside your hip bones, below the rectus abdominis. These muscles also help your body twist when they contract, albeit in the opposite way of external obliques. (You’ll need these for dancing, too.)

Combat diastasis recti by exercising these muscles

Pelvic floor and deep core (transversus abdominis muscle) exercises are the traditional recommended treatments, particularly in the early phase of recovery. These two body parts are linked. Let’s go over both.

You can use your pelvic floor muscles to stop the flow of urine. This is key for new mothers who suffer from leaking urine when they laugh or sneeze thanks to diastasis recti. Postpartum incontinence is a classic sign of a weak pelvic floor. Pelvic floor muscles are also essential for giving birth. Unfortunately, they often stretch and weaken during labor to accommodate the baby. A loose pelvic floor from delivering a baby can be pretty traumatic to the body.

These muscles work alongside your back and abdominal muscles to give support to your spine.⁶ If you have lower back pain from diastasis recti, these exercises would appear to be beneficial. In fact, strong pelvic floor muscles are important, whether or not you have ab muscle separation.

Pelvic exercises focus on strengthening these muscles. To activate them, you can repeatedly contract the pelvic muscles as if you were stopping the flow of urine, and hold for a few seconds. It is a rather easy exercise to do. You won’t even need to break a sweat! This technique can be performed anytime and anywhere. No gym time required.

Some of the most promising muscle separation exercises are those that engage the deep core muscles — specifically your transversus abdominis. There is evidence that working out the deep core muscles can improve diastasis recti. Engaging your transversus abdominis was shown to reduce the gap between the muscles by bringing together the linea alba, which is the connecting membrane that splits when you have diastasis recti.⁶ The transversus abdominis muscles are the deepest of your tummy muscles. When you activate your innermost abdominals during exercise, it will help stabilize your middle and rebuild strength deep within your body.

The transversus is also connected to your spine by fascia. A strong transversus abdominis gives your spine lumbar support and proper alignment, helping to alleviate lower back pain. Low back pain is a classic complaints among new mothers with diastasis recti. Weak transversus abdominis muscles are linked to pain in the lower back. Working these muscles can give you back pain relief.⁵

Transverse abdominis muscle exercises

When it comes to healing diastasis recti, working the transversus abdominis muscles are key. The purpose of these exercises is to rebuild your deep muscle strength, which is likely to be highly beneficial for women hoping to repair separated abdominals. The transverse is reported to have a major role in core stabilization during rehabilitation.⁴ Working these muscles will also improve spine stability.

Most common ab exercises do not work the transversus. The exercises that do work these muscles tend to involve hollowing your abdomen. There are many “deep core” exercise variations that work your innermost abdominals. (Tip: Check back soon, because Dr. Beldholm will soon post his top exercises for diastasis recti on the blog.)

How to engage your transverse abdominis

While performing deep core exercises, technique matters. Simply sucking in your stomach is not the answer to engaging your core. To trigger your TrA muscles, draw your belly button inward while shifting your pelvic floor upward slightly. You want to pull your belly button in towards your spine while continuing to breathe – very important! — and hold the position.

Making a mind-body connection is important when working out these muscles. This comes easier with practice. It is all too easy to “forget to breathe” (i.e. start holding your breath) when making the movements. If your notice that your stomach pooches during the exercises or if you’re holding your breath, you aren’t activating your transverse properly.

Dr. Beldholm’s advice for recovery

As a specialist surgeon, Dr. Beldholm is well versed in all aspects of abdominal repair. He is a big believer in the power of exercise to heal diastasis recti after pregnancy. Based on an extensive review of current medical research, diastasis exercises seem to help.

He advises the following strategy for bringing ab muscles back together so you can get your body back after pregnancy:

Step 1: Start a deep core exercise program as soon as possible after pregnancy with a qualified physiotherapist or certified training program. The primary focus of your initial exercise regimen should be on the transversus and pelvic floor muscles. You can even add interior and exterior oblique moves. Various medical studies prove that working out soon after pregnancy can help close the gap on rectus abdominis distance.¹

Step 2: Once you’ve completed built your deep core (this usually takes about 8-12 weeks), you can add further exercises such as the plank and crunches.

A word of caution: If any exercise causes you pain, stop!

What about exercise programs?

The advice if you have diastasis recti is to schedule a visit with a qualified physiotherapist. These are highly trained specialists, and the personalized care you can receive for your individual symptoms is unmatched.

But not everyone has the time, proximity, medical insurance, and/or finances to make that appointment. For patients who want to do something about it at home, The MUTU System is a great place to start. This 12 week exercise program is designed exclusively for new mums with diastasis recti. It is also medically reviewed.

You deserve to have access to all the wellness resources possible. Dr. Beldholm has carefully reviewed a lot of the online programs out there for diastasis recti, and he strongly believes in the MUTU system. He stands behind it so much that he even became an Ambassador for the program this year. You can sign up to start healing your ab muscles at home with The MUTU System by clicking this link.*

Controversy: What about Crunches and Planks?

A lot of the information you’ll read about diastasis recti workouts online seems to say that crunches and planks are a terrible idea. The internet really seems to be committed to that notion. Yet some medical research suggests that may not be the case.

There is currently no scientific evidence that proves crunches, planks, or any other traditional abdominal exercises are bad, per se. One study even shows that crunches bring the rectus abdominis muscles closer together.⁵ Yet specialists and fitness coaches disagree. Whether their assertions are based on research is not clear.

Yet there is a possible explanation for this discrepancy in advice. Many postpartum exercise trainers and physiotherapist group such as Women’s Health Physiotherapists insist that crunches are not a good way to achieve the results you want. They advise against this type of exercise for diastasis recti…that is, until your core is strengthened enough to stand up to intense exercises like crunches and planks.

That last sentence may hold the key to the controversy. It is not that you should totally avoid crunches and planks, but that they are simply better avoided until later in recovery, when the core has regained adequate strength. Yet many health gurus and bloggers out there seem to hang onto the first part of that statement only, which makes it sound like crunches and planks should be avoided entirely.

Crunches aren’t totally worthless. In fact, quite the opposite. According to a 2015 study, performing abdominal crunches reduce inter-rectus distance (aka separation of the rectus muscle) compared to a body at rest.⁵ It is possible that training your muscles in this way could possibly help them come closer together over time. The researchers from this study do acknowledge that some few past studies report different findings. The takeaway is that crunches for diastasis recti warrant further exploration.

Even The MUTU System, a game-changing online exercise program designed specifically for women with postpartum muscle separation, acknowledges their value, albeit with some words of caution. From the website, “supine spinal flexion (the forward curl-up motion from lying on your back) engages and shortens the rectus abdominis muscle. […] So exercising to shorten it, if performed correctly, is a good thing”.

Like Dr. Beldholm, experts from both MUTU and Women’s Health Physiotherapists advise against crunches in early recovery. You need to build deep core muscles first. They also say it is dangerously easy to perform crunches incorrectly, which can be a problem in early recovery. This might weaken pelvic floor muscles and possibly worsen muscle separation before the deep core has had a chance to build strength.

Another reason for the anti-crunch campaign could be this: It’s common to read on the internet that crunches cause too much intra-abdominal pressure compared to deep core muscle exercises, especially for someone with diastasis recti. Dr. Beldholm believes this assertion does not appear to be logically correct from a medical standpoint. Research also shows that the pressure is more or less the same across a variety of Pilates core exercises, which work both superficial muscles (like crunches do), and deep core muscles.³ So working your surface ab muscles like you would during a crunch probably isn’t causing “too much” pressure compared to any other ab exercises.

There is not much research on the subject of crunches and planks for diastasis recti. While no studies weigh heavily for or against these exercises, it may be safest to skip them in the early phase of recovery.

However, there is something nearly all exercise proponents agree on: Focus on rebuilding the deeper muscles first.

Controversy: Decoding the data from scientific studies

Exercising for repairing torn ab muscles is not without controversy. Some studies show that exercise for diastasis recti works, while other studies report that it does not help much.

Unfortunately, it is a subject that is not well studied to date. The issue with a lot of the research is that it usually consists of a small sample of test subjects. From a medical standpoint, that means studies (both for and against) exercise lack strong statistical evidence to answer a lot of questions.

The final word on exercise

As an expert in tummy tucks and postpartum abdominal repair, Dr. Beldholm believes that diastasis recti exercises for women appear to be an effective, natural solution based on what we know so far.

References:

1. Akram, Javed, and Steen Henrik Matzen. “Rectus Abdominis Diastasis.” Journal of Plastic Surgery and Hand Surgery, vol. 48, no. 3, 2013, pp. 163–169., doi:10.3109/2000656x.2013.859145.
2. Akuthota, Venu, et al. “Core Stability Exercise Principles.” Current Sports Medicine Reports, vol. 7, no. 1, 2008, pp. 39–44., doi:10.1097/01.csmr.0000308663.13278.69.
3. Coleman, Tanner J., et al. “Intra-Abdominal Pressure during Pilates: Unlikely to Cause Pelvic Floor Harm.” International Urogynecology Journal, vol. 26, no. 8, 2015, pp. 1123–1130., doi:10.1007/s00192-015-2638-4.
4. “Functional Anatomy of the Core: the Abdomen.” Human Kinetics, uk.humankinetics.com/blogs/excerpts/functional-anatomy-of-the-core-the-abdomen.
5. Sancho, M.f., et al. “Abdominal Exercises Affect Inter-Rectus Distance in Postpartum Women: a Two-Dimensional Ultrasound Study.” Physiotherapy, vol. 101, no. 3, 6 May 2015, pp. 286–291., doi:10.1016/j.physio.2015.04.004.
6. Thabet, Ali, and Mansour Aishehri. “Efficacy of Deep Core Stability Exercise Program in …” Journal of Musculoskeletal and Neuronal Interactions, Mar. 2019, www.ismni.org/jmni/pdf/75/jmni_19_062.pdf.

*As an Ambassador, Dr. Beldholm may receive commission for enrollment in The Mutu System.