Help for Gymnasts with Diastasis Recti is Here

How to Measure a Diastasis and the Prevelance of Diastasis Recti

A medical professional or Postpartum Certified Personal Trainer can tell if you have a diastasis – but what if you don't have access to such a person? The good news is you can measure it yourself. A diastasis recti is measured by checking the width and depth between the two rectus muscle bellies when barely lifting your head. Technically anything over 2.5 finger widths is considered a diastasis (this means a measurement of 2.5 fingers or narrower is normal!). A diastasis that is healthy and doesn't need intervention feels like a trampoline to the touch. The fingers shouldn't sink in upon testing. Checking with fingers is somewhat accurate, but an ultrasound is the gold standard way to test.

It's normal to have a diastasis after pregnancy. Every single woman has a diastasis upon her due date.¹ 60% of postpartum women still have one have one at 6 weeks postpartum, and 32% have one at 12 months postpartum.²

While Surgery is Available, Corrective Exercises are a Great First Step

If you are still in the throes of dealing with a diastasis and you try a higher level activity such as many of the ab conditioning exercises in gymnastics, you will find that the midline of the abdomen will dome out. This can also happen during skills with more pressure directed toward the abdomen such as kips or front or back tucks. Even something as simple as a back drop on a trampoline can be a massive amount of work for the abs to handle.

While it may seem to make sense to try drawing in the belly button toward the spine as a preventive, that’s actually the last thing you want to do. For one, drawing in our stomach isn't actually a great strategy to reduce the distance between our abs.³ There are other problems with drawing a belly button in. This action when done repeatedly over time can make your middle transverse abdominus too strong compared to the rest of your abs and lead to a "lower belly pooch." There are particular exercises such as dead bugs, hands and knees breathing, chin tuck head lifts, and half kneeling rotations that can help close the diastasis without interfering with healing. Eventually working up to performing some ab exercises while blowing up a balloon will up the ante and get those abs ready for more strenuous activities.

Many women and girls who are in gymnastics learned to draw their belly button in from a young age between the self-consciousness of being in a leotard, combined with coaches ordering them to pull their bellies in. The truth is, resetting your rib angle actually goes a lot further than simply pulling your belly in. That’s really what coaches want to get the line that judges love. You'll learn more about how to restore proper rib positioning below.

The truth is, we need balance in the abdominal system to reduce a diastasis recti and be able to return to the exercises and activities we want to do safely. Drawing in our belly button doesn’t get to the root of the problem and will only lead to additional problems down the road when repeated as a strategy over time.

Another thing you’ll want to know as a gymnast with a diastasis is that the pelvic floor and the transverse abdominus need to work together for optimal function. The pelvic floor is an anticipatory muscle which means that it should fire just prior to the transverse abdominus firing. The transverse abdominus wraps around our entire core and is what holds everything in. During exercise we need our transverse abdominus to be on board to act as a natural "corset" and keep our abs safe. Women with a diastasis have a deep inner core system that is not firing properly, and oftentimes that includes their pelvic floor. This can show up with telltale signs such as leaking while tumbling or vaulting. If this happens to you, please check out my pelvic floor article for gymnasts as well.

It's best to work on the pelvic floor first before diving into the core too much, because it's common for women who are working on healing a diastasis with exercises to inadvertently cause a prolapse when their pelvic floor can't handle the pressure. This is much more likely to happen postpartum, but it can happen in other circumstances as well.

I know a lot of this sounds like doomsday. However, fear not! The cool thing is, if we work on our breathing patterns, we can help the natural function of our pelvic floor and core. It can be a bit tricky though, because some women and girls need to tighten their pelvic floor to bring it back to neutral and others need to loosen theirs. Gymnasts more often than not will have overly tight pelvic floors. Either way, learning how to breath all the way down to the pelvic floor will help, as having the breath reach the pelvic floor is the best way to teach it to function normallly again.

Having a diastasis can also stem from a place that has nothing to do with the pelvic floor. Sometimes other muscles such as the serratus, the middle and lower traps, and the glutes are weak and are contributing to a diastasis that has formed or one that has not yet healed.

Gymnastics is amazing at strengthening our muscles - however those muscles listed above aren’t the target of a lot of traditional gymnastics conditioning. In fact, those muscles sit at the opposite side of most of the muscles that gymnastics conditioning and gymnastics skills work, which can really leave the body out of balance. A few simple corrective exercises can really tip the scales in your favor and balance out the body once again.

Diastasis Recti in Gymnasts is a Full Body Issue

How a person moves, breaths and loads the body all contribute to whether or not a diastasis forms, or whether or not it sticks around after it's developed. Learning the best loading techniques when working the midline of the abs is super helpful. There is unfortunately no list of "safe" and "unsafe" diastasis exercises since every case is different. It depends on how your body looks at the midline of the abs while doing the exercise.

That said, the most common exercises that cause difficulty for a diastasis are ones that are heavily front loaded, such as:

• Front planks
• Push-ups
• V-ups
• Rolling in a ball shape
• Pike ups on a ball
• Leg lifts
• Crunches or sit-ups

Additionally, some exercises are front loaded indirectly such as:

• Pull-ups
• Squats
• Deadlifts
• Rope climbs

Yoga transitions such as chaturanga as well as cardio such as running and swimming can also be difficult on a healing diastasis.

However, have faith! You will likely be able to return to these activities one day. If you can fix your breathing and turn it into a 360 style (for 360 breathing back, front and sides of ribs all move) that will go a long way. If you can improve your posture so that your ribs are stacked over your pelvis that will take you even farther.

You may notice that a lot of gymnasts stand with archy backs, hips that jut forward and hyperextended knees. This posture is the exact opposite of what you want to do to heal a diastasis since that type of posture puts all the pressure in your system out into your belly, which simply exacerbates the diastasis and prevents it from healing. And if you stand that way, chances are you do a lot of your skills that way too! Besides the strain on a diastasis as well as on your lower back and knees, you’re inviting deductions from the judges on body line!

Exercises to support good stacked posture will be helpful. That is something a corrective exercise specialist can teach you, and you should see the benefit in your symptoms as well as how you look and feel as you perform skills. I know my scores went up across the board when I improved my posture with some of these corrective exercises! You will want to make sure to do exercises that work the pelvic floor, external obliques, internal obliques, rectus and transverse abdominus to help with posture. Once learned, you can incorporate the principles into your gymnastics conditioning and skill work so that you won’t have to maintain two different sets of exercises forever.

Depending on how your diastasis formed, different strategies of how to fix it will be necessary - and that is where a professional comes in! For example, a woman who is a shallow breather who has never been pregnant can form a diastasis, just as a woman who is an all-belly breather. The two women will each need different exercises to overcome their diastasis and allow it to heal. Our bodies are designed to heal on their own when the right circumstances are in place. Once you stop putting pressure out on your diastasis, it will have the optimal condition to heal.

Healthy breathing has other benefits, too. It has the power to protect our spine by providing appropriate intra-abdominal pressure. It even helps to lower our stress hormones! Healthy breathing will be your best friend when it comes to calming competition nerves or feeling confident before trying that new skill. Good breathing techniques can promote tissue healing by bringing more oxygen to all of our cells. That’s something that gymnasts for sure need. 😊

The last piece to this puzzle is that some of us have a wider rib angle and others have a more narrow one. You can evaluate your rib angle by feeling for the underside border of your ribs. It can help to draw a line on the border to be able to easily determine the angle. We want that angle to be as close to 90 degrees as possible. There are particular abdominal exercises that will help bring your rib angle back to the ideal. If you use the wrong ones, you may inadvertently make your problem worse!

When looking at posture, a simple tip is to think of is lifting up through the pubic bone. This helps support the spine much better than drawing in the abs does. The lower portion of your transverse abdominus must maintain a low level of continuous contraction to help support standing posture, and it also will have concentric and eccentric contractions while breathing. This means that you can actually strengthen your abs all day long and all practice long just by breathing correctly!

The abdominal area should move while breathing. Holding your breath is easy to fall into if you are trying to be tight and hold perfect form. However, there is no way you’ll get through a challenging routine if you never take a breath! Work with your coach on finding places in your routine to get a good breath, such as during a squat on on bars or during choreography on beam and floor. By holding in the belly button, you stop natural transverse abdominus function! The more we can bring natural abdominal function to the table, the better our pelvic positioning will be as well.

Having great pelvic positioning takes away some of the sway back you often seen in gymnasts and also helps take a ton of pressure off the hip joint which is helpful for minimizing hip injury, SI joint difficulties and back pain. Many athletes have to learn to use their hamstrings more to help with pelvic tilt as well, since most of gymnastics conditioning and skills prioritize working the quads and hip flexors over the hamstrings. A cool thing is that, by building up hamstrings, you will find that it helps reduce knee pain and injury too! Building better hamstrings also will allow overactive back muscles take a bit of a break, which can help with chronic back pain and tightness. There are many payoffs to working on posture and balance in the body!

I want to finish up by explaining that there are different types of diastasis as well. Some athletes have a wide but firm diastasis. Others have a narrow but squishy one. You can also have a wide and squishy diastasis. Then there is the matter of where. Is the diastasis above, at or below the belly button? All of these things affect which exercises work best to heal it.

No matter what, mastering 360 breathing will pay dividends for all types of diastasis recti. 

Improving posture and rib angle will also go a long way. Once these basics are in place, we need to add strength to help the changes hold. Finally, we need to incorporate the newfound movements into our gymnastics conditioning and skills. Once this has occurred, the new ways of moving will feel like second nature and the athlete won’t even need to think about it anymore!

Sometimes something that seems unrelated such as resting head position can also be the culprit. That's why a full body assessment is needed whenever someone is working on fixing a diastasis. Healing a diastasis with corrective exercise is possible for the majority of women and girls. For others, they might not heal it completely, but they can still feel better and get back to doing what they love. Surgery is available, but it's not foolproof and it doesn't excuse you from working on everything mentioned above!

If you have surgery and simply return to the faulty patterns that allowed the diastasis to develop (remember, a lot of women naturally heal from theirs postpartum) then the condition is at risk to come back. The process and timeframe to heal from surgery, build back base strength and then return to sport is very similar to the process and timeframe to heal from a diastasis with corrective exercise. For this reason, I personally would never try surgery for a diastasis until I had worked on corrective exercise first. In fact, I have a large defect in my abdomen due to two emergency abdominal surgeries that left me with a scar the width of a ruler and about 5 inches long on my abdomen. I had a hernia in the area before beginning corrective exercise. Less than six months into doing the exercises (keep in mind, my scar made a C section scar look like child's play) my hernia was completely gone via ultrasound! My doctor had told me that the hernia would only continue to get worse and worse unless I got a Total Abdominal Wall Reconstruction with mesh, but happily that turned out not to be the case.

Set Up Your Consultation with Gina Paulhus, CPT and Corrective Exercise Specialist Today.

It warms my heart to see an athlete overcome an obstacle such as pelvic floor difficulties!

Appointments are available Monday through Friday, 7:30am through 6:30pm ET and are conducted via Zoom. You may request a Price Quote via the form below or you can book a Free 15 Minute Discovery Call to see if we are a good match. Taking care of this part of the body is essential to any gymnast's success in the sport (and functioning in life, too!). 

What Will I Get During My Session?

The sessions are one hour and are conducted over Zoom or in person in select locations. If the client is a minor, an adult will need to be in attendance in the same room during the call.

During the consultation we go over:

• Your current symptoms or issues
• The recommendation of which exercises you'll need to move forward
• Expectations for results from the exercises as well as timeframe
• Instruction on how to perform the exercises

After your appointment, you will be sent a written plan via email that includes links to video that you can follow as you perform your exercises on your own. Follow-up visits may be scheduled as needed. At the beginning of your session you may request a recording of the call to refer back to if you'd like.

You can always start with a Free 15 Minute Discovery call if you are not ready to book an appointment.

Schedule your free call now - to be conducted over audio call, Zoom or Facetime. You'll have a chance to ask questions and make sure the program is a good fit.

Finally, feel free to contact us if you have questions about this program!

¹ Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Jorun Bakken Sperstad et. al. 2016 Sep;50(17):1092-6. doi: 10.1136/bjsports-2016-096065. Epub 2016 Jun 20.

² Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Patrícia Gonçalves Fernandes da Mota 1, et al. 2015 Feb;20(1):200-5. doi: 10.1016/j.math.2014.09.002. Epub 2014 Sep 19.

³ Abdominal exercises affect inter-rectus distance in postpartum women: a two-dimensional ultrasound study. M F Sancho et. al. Physiotherapy. 2015 Sep;101(3):286-91. doi: 10.1016/j.physio.2015.04.004. Epub 2015 May 6.

⁴ Diastasis of the rectus abdominis muscles in postpartum: Concordance of patient and clinician evaluations, prevalence, associated pelvic floor symptoms and quality of life. Claire Cardaillac et. el. Observational Study Eur J Obstet Gynecol Reprod Biol. 2020 Sep;252:228-232. doi: 10.1016/j.ejogrb.2020.06.038. Epub 2020 Jun 23.