Diastasis Recti –

How to Limit Risks During Pregnancy and Heal Post-Partum Using the BASI Pilates Method

Dinah Zuckerman

May 10, 2018

2017 Sydney, Australia

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Pregnancy brings about many changes to a woman’s body, not only during the 40

weeks while the baby is in utero, but for many weeks and sometimes years after the baby is

born. A very common result that is vaguely understood by much of the general public is a

condition called Diastasis Recti. This is commonly found in women during and after

pregnancy and occurs when the linea alba, or connective tissue that runs down the midline of

the abdominals stretches, causing separation of the rectus abdominus muscle. The most

common symptoms are the appearance of a belly bulge, feeling weakness in the core,

compromised function of the pelvic floor muscles (leaking), and lower back pain. Women

can unknowingly exacerbate this condition with common exercises during and after

pregnancy. The BASI Pilates repertoire provides a safe way to exercise during pregnancy, as

well as restore strength post pregnancy assisting in healing the diastasis recti.

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Table of Contents

Abstract – Summary of Diastasis Recti Page 2

Anatomical Description Page 4

Case Study: Nicola Williams, 12 Weeks Post-Natal with Diastasis Recti Page 8

BASI Block Program Page 9

Conclusion Page 14

Bibliography Page 15

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Contrary to popular belief, Diastasis Recti is a condition not only affecting the

abdominals but the whole body as it changes the body’s pelvic and hip stability. It is most

common in later stages of pregnancies; however, it is not the pregnancy itself that causes the

separation but the excessive intra-abdominal pressure or IAP as its commonly referred.

Surprisingly, it can occur in newborn babies as well as men and non-pregnant women,

however it is most commonly seen during and after pregnancy.

Diastasis Recti occurs when the linea alba, the fibrous structure that runs down the midline of

the abdomen from the xiphoid process to the pubic symphysis, stretches and the rectus

abdominus or “6-pack” muscles separate. The linea alba has a lot of stretch vertically from

sternum to pubic bone, however if too much pressure is applied to the horizontal direction

(common with large babies, twins/multiples and multiple pregnancies) it can tear and cause

distortions in the fibres. To be diagnosed as diastasis recti the separation is typically greater

than 2 centimetres anywhere along the linea alba; usually the separation occurs just above or

below the belly button. The separation can also affect the depth of the linea alba so the wider

and deeper the separation, the more time the client will need to heal.

Figure 1 below depicts three potential stages of pregnancy: normal abdominals with

no abdominal separation typical in early pregnancy, abdominals during pregnancy as the

uterus has expanded due to the growing baby causing diastasis recti, and post pregnancy

showing diastasis recti of showing the stretched linea alba that has lost elasticity and failed to

return to its original state.

Figure 1

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To check for diastasis recti, the client should lay supine, with their knees bent, and

feet on the floor. The client will then come in to a chest lift with their hands supporting the

head. Once they are in flexion you can check the separation between the “6 pack” muscles

by moving your fingers above and below the belly button to see how many finger widths can

fit between the gap, and also noticing how deep you can press. Ultrasounds can also check

for diastasis recti with more accuracy. Anything greater than 2 centimetres should be further

evaluated. Figure 2 below depicts a physical evaluation for diastasis recti and shows the

client with a 2-3 finger width separation that is also quite deep and should be cautious of

exercises that can exacerbate the condition.

Figure 2

It is believed by pelvic floor physiotherapists that up to 96% of women have diastasis

recti in their third trimester of pregnancy, however this drops immediately postpartum to up

to 56%. The female human body is designed to stretch to accommodate for a growing baby,

however connective tissues (made more elastic due to relaxin, a hormone produced during

pregnancy) can only stretch to a point before beginning to lose the ability to “bounce back.”

While the abdominals may be the part of the body most greatly affected by the

separation it can cause issues in the entire body such as pelvic floor dysfunction, back pain,

hip and pelvic instability, as well as emotional problems and negative body image. Figure 3

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depicts the muscles in the core and how they lay in relation to one another. The transverse

abdominus is the deepest muscle layer and acts as an internal girdle. It is located under the

internal obliques which are then covered by the external obliques, which wrap around the

spine creating stability and protection.

Figure 3

Throughout each trimester of the pregnancy it is important to take precautions to

ensure the diastasis recti isn’t exacerbated. During the first trimester, the client should start

to limit the engagement of the rectus abdominus with forward flexion exercises and instead

focus on exercises that will engage the transverse abdominus and pelvic floor. In the second

trimester, the client should avoid any direct abdominal exercises as the abdominal wall is

beginning to become stretched during this time. Oblique activation exercises can still be

performed as well as sitting or standing pelvic floor and stability exercises. During the third

trimester, all abdominal exercises should be avoided, as well as any exercises while lying

prone or supine due to the growing foetus. Side lying positions can be made more

comfortable by using a support like a ball or pillow to take pressure away from the rectus

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abdominus. Heavy overhead exercises should also be avoided as additional stretching to the

rectus abdominus can further exacerbate the diastasis recti.

Once this separation has occurred (regardless of the stage of pregnancy or post-

partum), there are many contraindicated exercises that can worsen the condition. Forward

flexion which engages the rectus abdominus can cause further separation by placing

additional intra-abdominal (IAP) pressure on the linea alba. Exercises and treatments that

will help correct the diastasis recti include re-learning to engage the pelvic floor and the

deepest layer of the abdominals, the transverse abdominus, (see figure 4) practicing good

posture, learning to come into a standing positon safely by bending the knees and rolling to

your side (getting out of bed or standing up from the floor), and avoiding any heavy lifting or

further strain on your abdominals.

Figure 4

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Case Study

Name: Nicola Williams, 35 years old, 3.5 months post-partum

My case study is based on my client, Nicola Williams, a 35-year-old healthy woman with no

injuries, who started weekly private sessions at 14 weeks pregnant with myself and another

instructor at our studio in Manly.

Prior to becoming pregnant Nicola attended group Pilates classes, walked daily, and

regularly practiced yoga. She has great body awareness and takes instruction very well. She

is extremely motivated to regain her strength and flexibility post pregnancy. At the

beginning of her third trimester she started to develop diastasis recti and was also having SIJ

problems resulting in a slight left anterior tilt through her pelvis. We worked to minimize her

diastasis recti and lessen the effects as she continued to grow into her third trimester. We

also worked to strengthen her pelvic floor, gluteals, and hips to stabilize her pelvis. At the

end of her third trimester the diastasis recti was about 4 centimeters. Her baby, Lulu Sophia

was born vaginally 2 weeks past her due date and Nicola has returned to her weekly session

12 weeks later. Her diastasis recti closed somewhat naturally after she gave birth to but

remained at about 3 centimeters. She is now working to strengthen her transverse abdominis

to regain her abdominal strength and close the diastasis recti as much as possible. Below is a

BASI Block Program I’ve put together to help achieve our goals.

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BASI BLOCK PROGAM TO HEAL DISTATIS RECTI

Roll Down to check for postural alignment and imbalances

Warm Up on Mat:

• Pelvic Curl

• Spine Twist Supine

• Leg Lifts

• Leg Changes

To avoid forward flexion, I’ve replaced the Chest Lift and Chest Lift with rotation with Leg

Lifts and Leg Changes to increase transverse abdominus engagement which will help close

the diastasis recti. Pelvic Curl teaches basic transverse abdominus activation, spinal

articulation as well as creating a nice stretch for the hip flexors. It also provides the instructor

with a visual of the pelvis and if the client is able to stay level through the hips when in the

highest point of the pelvic curl. The Spine Twist Supine begins to engage the transverse

abdominus as well as the obliques which are crucial in helping heal diastasis recti.

Foot Work on Cadillac:

• Parallel Heels

• Parallel Toes

• V Position Toes

• Open V Heels

• Open V Toes

• Calves

• Prances

• Single Leg Heel

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• Single Leg Toes

I used the Cadillac Foot Work sequence to support pelvic-lumbar stability and to provide a

strong focus on the hamstrings as during pregnancy they are a neglected muscle group. The

Cadillac foot work series also allows me a nice point of reference and tactile cue opportunity

to maintain a level pelvis by gently pulling the hips down away from the upper body.

Strengthening the hamstrings can help with controlling pelvic positioning which in turn can

help with decreasing a lordotic posture, common during pregnancy. Verbal cueing is used to

remind the client to lift the pelvic floor and engage transverse abdominus whilst focusing on

straightening the legs with each exhalation.

Abdominal Work on Reformer:

Short Box Series (Modified)

• Round Back

• Flat Back (Limit Range)

• Tilt

• Twist

• Round- A- Bout

I’ve chosen the short box series to challenge the transverse abdominus and obliques, avoiding

the more advanced exercise in the series, Climb a Tree as this exercise requires too much

forward flexion as the body returns to an upright position after going into spinal flexion over

the box. Tilt is an especially effective exercise as its relatively simple yet very effective at

oblique engagement. Cueing transverse abdominus activation continually and keeping the

belly drawn in to the spine during inhalation is another effective way to communicate TA

activation.

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Hip Work on Cadillac:

• Frog

• Circles Down, Up

• Walking

• Bicycles

The Basic Legs Spring series on the Cadillac is an effective way to strengthen the hamstrings,

maintain pelvic-lumbar stability, as well as challenging the adductors by keeping the legs

aligned. Keeping the movements slow and controlled, and the circles’ range quite small to

ensure the SIJ well supported as Nicola had issues during pregnancy with her Sacroiliac

Joint. The springs also offer quite a bit of feedback as opposed to the hip work done on the

reformer which further challenges Nicola to maintain controlled movements throughout the

exercises in the series.

Spinal Articulation on Wunda Chair:

• Pelvic Curl

I’ve chosen the Pelvic Curl on the Wunda Chair to safely provide a spinal articulation

exercise whilst also challenging the hamstrings.

Stretches on Ladder Barrel:

• Shoulder Stretch 1

• Shoulder Stretch 2

The Shoulder Stretch 1 and 2 provide a great stretch to an area of the body that is commonly

tight during and after pregnancy, the shoulder extensors and the shoulder flexors (especially

the latissimus dorsi and the pectoralis major).

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Full Body Integration (Fundamental/Intermediate) on Cadillac

• Side Reach

The Side Reach on the Cadillac is a challenging exercise for the obliques, providing a stretch

and engagement as well as a nice pectoral stretch, key after pregnancy. By using the feet as

anchors on the poles, it allows the client to keep the pelvis level and stable.

Arm Work on Reformer:

• Arms Sitting Series

o Chest Expansion

o Biceps

o Rhomboids

o Hug a Tree

o Salute

I chose the Arms Sitting Series on the Reformer to strengthen the upper back muscles,

specifically the rhomboids, and the latissimus dorsi, the biceps, the pectorals and the triceps.

Being a new mom means your hands are always full and you’re now carrying around more

weight in your arms, and also on your body with increased breast size due to breastfeeding.

Strengthening the upper back muscles, the trapezius and rhomboids helps with maintaining

good posture which is so important when so much time is now spent with a baby in your

arms and hunched over breastfeeding.

Full Body Integration (Advanced/Master) on the Cadillac

• Saw

The Saw on the Cadillac provides an amazing hamstring stretch which is important when

doing quite a few hamstring exercises. It also focuses on oblique strengthening with the

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rotation in the exercise. The back extensors also come into action during the extension part

of this exercise which is an important group of muscles for Nicola to strengthen.

Leg Work on the Wunda Chair:

• Backward Stepdown

The Backward Stepdown on the Wunda Chair is a challenging exercise focusing on gluteals,

quadriceps and hamstrings. The gluteals are important to strengthen to support the pelvis,

which has been weakened throughout the pregnancy with the increased relaxin in the body.

Lateral Flexion/Rotation on Ladder Barrel

• Side Over Prep

The Side Over Prep on the ladder barrel is a fundamental exercise focusing on the oblique

muscles while giving the pelvis support on the side of the barrel. It also provides a clear and

easy way for the instructor to visually identify if the hips are square and can easily be

adjusted with a tactile cue. The stretch over the barrel at the end of the exercise also

provides a nice lateral flexor stretch for the client.

Back Extension on the Spine Corrector

• Swan Prep

I selected Swan Prep on the Spine Corrector to provide a safe and effective way to challenge

the back extensors, which are so important after pregnancy. Strengthening the multifidus, a

deep core muscle that supports the spine, as well as the quadratus lumborum and the erector

spinae muscles are very important to restore good posture after pregnancy.

Roll Down to complete session

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Pregnancy comes with many changes of a woman’s body and life. Diastasis Recti is

one of the most common conditions, and with that comes many challenges. Women can

unknowingly worsen their abdominal separation doing traditional exercises like ab crunches

and planks. With the proper selection and modifications of exercises from the BASI

repertoire Diastasis Recti can be healed over time. I love the fact that I am well equipped to

help women heal their bodies through Pilates as I really enjoy being a source of information

and support for my pregnant and post-natal clients. Motherhood is full of so much anxiety

and stress, the last thing women want to worry about is if they will have a permanent bulge in

their tummy, or worse. The BASI Pilates repertoire is suitable for women throughout the

various stages of pregnancy as well as post-partum, providing many options to help heal the

most common ailments that come with pregnancy, diastasis recti.

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Bibliography

“Diastasis Recti, What Is It, and How Is It Treated?” Healthline.com, Jane Chertoff,

Medically Reviewed by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT.

Web, 20 Nov 2017

“Diastasis Recti: The 3 Keys to Healing Your Separated Abdominals”

Progressivemotion.com.au Stacey Pine, 7 Aug 2015

“The Truth About Diastasis Recti & Healing Your Core” www.theworkoutmama.com,

Tamara Buschel, 24 February 2014

"Understanding Diastasis Recti: Part 1” www.bodyandbirthphysio.com,

Samantha Cattach PT, 5 May 2016

Pilates for Pregnancy, 2015 Manual, Studio Pilates

BASI Comprehensive Course Study Guide, Rael Isacowitz, 2017