Diastasis Recti: Self-Treat, Surgery, or…Something Else?
From the moment I signed up to specialize in women’s pelvic health, I was interested in Diastasis Recti Abdominis (DRA).
I knew from the get-go that pregnancy and postpartum was my passion in the realm of pelvic floor PT, and I gathered right away in my first postpartum training that diastasis recti was this side-car that no one seemed to care much about, EXCEPT the women who were struggling with it. There was little to no research on the condition, and the few protocols I could find to actually heal DRA seemed oversimplified and archaic.
(**Not sure what DRA is? Download my free informational PDF here.)
When I saw my first patient with DRA (probably around 2012), I remember phoning a provider thousands of miles away to ask how she treats it, because she was the only specialist I could find who seemed to actually know anything. That was over 10 years ago. Since that time the online culture and market around DRA has literally exploded. You cannot search for “postpartum exercise” without finding 20+ articles or online programs touting the ability to “Fix your Diastasis” or “Loose the Mummy Pooch” in 6 weeks, or 10 minutes per day, or 3 simple exercises etc. etc.
Everyone out there seems to be screaming that THEY have the secret sauce, and all you have to do is buy their program and your worries are gone.
Often when clients come in for DRA, the say “I started doing research online … but there is so much conflicting information – I freaked out and froze. I didn’t know what to do, so I stopped exercising all together. But it’s not getting better, so finally I decided to see a specialist.” This is a great decision, because there truly is SO MUCH online – lots of great quality advice that is simply outdated, some poor advice that is based solely on personal experience and no research or clinical evidence, and a lot of well-meaning and good advice that is just not the FULL STORY. Every body is unique, so that blanket quick fix that works for a lot of people just doesn’t work for everyone. A one-size-fits-all program is not tailored to your body or your history, so for YOUR DRA it may be incomplete or ineffective. This is where many women can get frustrated and just give up.
As a DRA specialist, I am thrilled that so many more women are aware of the condition and that something CAN be done. I am also a bit frustrated at the amount of misinformation out there, the unwillingness of physicians to refer to postnatal physical therapy (PT) immediately, the persistent myth that surgery is the only answer, and the general hesitancy of women themselves to actually go see a specialized PT.
It seems like most women are trying all the “cheap and easy” DIY methods, and when those fail both women and their doctors are assuming they must now need surgery, completely skipping the option of skilled rehab. With other musculoskeletal conditions (knee pain, shoulder pain, back pain etc.) the pattern is always complain, self-treat (with Dr. Google), see your actual doctor, your doctor refers you to a REAL physical therapist for actual hands-on, individualized treatment. They usually don’t immediately sign you up for a knee replacement, a rotator cuff repair, or a spinal fusion! They send you to 8-16 weeks of physical therapy before even considering that recommendation.
So why is everyone SKIPPING PT when it comes to core rehab??
If you’ve read this far, I’m guessing you have some interest in DRA – most likely you know you have it or suspect you have it, and you’re struggling with why it won’t get better even with all the things you’ve tried.
(If you don’t know what DRA is, you can grab the free cheat-sheet here.)
So let’s dive in to WHAT to do with DRA.
The first step is to do a thorough self-test. You can find a very detailed walk-through here on my YouTube or Facebook channels.
Once you take your measurements, you can decide your next step based on how severe your DRA seems to be.
For our purposes, let’s describe mild as less than 3cm wide at its widest point and less than 2cm deep at its deepest point. (Researchers vary in what they qualify as mild vs. severe, so this is just a clinical “estimate of thumb” I use in my practice.)
If you determine that your DRA is MILD, I would say you are safe to start with good PT-designed online program for DRA. Some of my favorites include the Bloom Method (use code BLOOMSHEFITPT for 10% off), and The InCore Method. (There are also some I DON’T prefer because they may contribute to pelvic floor dysfunction, but you’ll have to email me for those 😉 .)
If your DRA is severe (let’s say >3cm wide and >2cm deep, you notice a lot of “doming” with daily activities and especially ab exercises, you may have other symptoms like back pain or bladder issues), your first step should be to consult with a women’s health physical therapist specializing in postpartum care and specifically diastasis recti. Women’s health/pelvic PTs are the most educated and qualified professionals to assess and treat these issues. Your PT can thoroughly assess the status of your entire core and help you decide IF you really need intensive one-on-one therapy, or if an online program will be just fine to start with. She may even recommend you follow an online program and just check in 1/month to make sure things are progressing smoothly. Please bear in mind however, PTs who are not specializing in diastasis may not have any better information than what you found on the internet, so if you really want to tackle a stubborn DRA, it is important to find someone to “does DRA” as their bread and butter.
(You may be thinking, “why wouldn’t I go to my physician or midwife?” It’s pretty simple. Those professionals are expertly trained to take care of you and baby through pregnancy, but they are by and large not trained in addressing specific musculoskeletal conditions via rehabilitative exercise. They may recommend you do something generic like exercise, pilates, or surgery, but they are not trained to help you actually “close the gap” or get your strength back. It is completely fine to go see them for a diagnosis or to get a referral, but if they don’t suggest PT, I strongly encourage you to go anyway!)
If you don’t have access to a specialized PT, I would really start researching how you can get yourself in for at least one visit to get a thorough hands-on assessment and detailed training on reactivating your core. In the meantime you may want to see a different type of professional who has specialized training in postpartum and diastasis recti. This will most likely be a fitness professional like a personal trainer, but could also be chiropractor, pilates instructor, or other type of provider.
When choosing a professional for your team, here are a few things to keep in mind.
1) What level of education and training does this person have?
Do they have any formal education or certification in anatomy, muscle function, pregnancy/postpartum complications and healing, pelvic floor dysfunction, ligament healing principles, exercise physiology or biomechanics? Reading a few articles and blogs on the internet does not make you an expert.
2) Is their primary claim to expertise based on personal experience?
Is the main pitch a glossy photo of their own 6-pack? The fact that they “got their abs back” after their own baby? Diastasis is a complex condition that can involve a lot of factors besides just the abdominal muscles. It’s great that she was able to find a strategy that worked for her – but that does not make her an expert on postpartum or core dysfunction, nor does it mean their strategy will work for other bodies completely different from her own.
3) Are they promising you the moon?
Any professional who has studied diastasis and worked with a lot of DRA clients is aware that conservative methods cannot fix everyone. Healing DRA in terms of getting it to close completely is not always possible; a small % of women do need surgical repair. If someone says they have “the key” and can absolutely fix you in “X” weeks, they are likely overstating their abilities.
If your DRA is mild and acute (you haven’t had it for long), and you don’t have complicating factors or longstanding muscle imbalances, you may do very well with these programs/professionals. If, however, you have had DRA for a long time, if it is quite severe, if you have other complicating factors like urinary incontinence, prolapse or pain, or if you have tried other programs to no avail, I strongly recommend you see a pelvic physical therapist who specializes in postpartum care and diastasis recti.
If you have easy access to a specialist (for example, if you live in San Diego and can come see me at SHEFit Physical Therapy) you should strongly consider starting with a pelvic PT in the first place! There is never any harm is getting that thorough assessment and setting your mind at ease.
You can book your evaluation with a SHEFit PT here 🙂
Lastly, I would like to say that the treatment of Diastasis Recti is a rapidly developing field. We don’t have a lot of research on DRA, but we do have a lot more than we had 10 or even 5 years ago. Some of what we do have is inconclusive or conflicting – this may be related to the high variability in the causes and presentation of the condition. This can be a complex condition to treat, especially if you are not up to date on the current, ever-changing theory and evidence surrounding this condition.
If you’d like to read a bit more about what specific exercises or exercise principles we use in actually treating someone with DRA, I invite you to download my free PDF on this topic, or watch the YouTube Video here.
I will also be posting some more detailed blogs on specific exercises for mild AND severe DRA in the future, and you can follow me for tips on IG @SHEFitPT.
Happy healing,
Dr. Sheri DeSchaaf, DPT