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Strength Training with a Diastasis Recti

I published this article on the amazing Maternal Goddess website in March.

Strength Training With a Diastasis Recti


A diastasis recti (DR) is created by intra-abdominal pressure. In most cases it will occur from pregnancy, but there are other possible causes such as abdominal loading with poor technique (“pushing out” while weight training for example), obesity, constipation, and chronic cough. If you have been assessed with a DR it is imperative that you work with a core restorative trainer to rehabilitate the dysfunctional core.

MaternalGoddess-Strength Training with a DRMany women become apprehensive to strength train with a DR. It can be difficult to know what exercises are safe and effective to use to refrain from making the DR worse (which is possible) and/or undermining the rehab work.
Any movements that cause intra-abdominal pressure are contraindicated. These include forward flexion movements from a supine position such as crunches, v-sits and sit-ups. Supine leg lifts should also be avoided.

Until a DR is closed or becomes “functional”, restricted activities include front loaded positions such as plank, push up, downward dog, cat & cow, etc. A DR is functional when the connective tissue (CT) is able to generate enough tension to support the abdominal wall when the core is engaged, despite a separation between the recti. With displaced recti unable to support the weight of the internal organs, they press on the already weakened CT which can exacerbate a DR and undermine the work to close the separation. These exercises can be reintroduced post core rehab.

A DR is a core dysfunction resulting in poor pelvic stability control. Despite a compromised core, the body can achieve amazing feats of strength with compensatory strategies. We must train to offset adjacent strengths and strengthen the body functionally and comprehensively. A person can seem to become very fit with a weak foundation, but ironically the more fit they appear to become, the more unstable the system and the increased risk of injury.
 
Optimal function of the pelvic girdle requires stability of the two joints at the back of the pelvis (sacroiliac joints or SIJ) and the joint at the front of the pelvic girdle (pubic symphysis or PS) When load is transferred through the pelvis, this motion must be controlled. It is imperative to monitor for pelvic discomfort during and after each workout. If a lateral load transfer exceeds control, the PS may be strained resulting in soreness or discomfort in the front of the pelvis (this is very common). If the SIJ is overloaded, the piriformis and psoas may become contracted causing discomfort and possibly inflammation at the hip joints (ASIS/PSIS).  Targeted piriformis and psoas release work are typically built into a core rehab and pelvic stability control strength program.

The job of the pelvis is to stabilize with weight load and transfer. Lower body strength programs should focus on compound body weight exercises which involve weight load transfer with functional movements. Focusing on hip abductor movements is a great investment in pelvic stability control. The best hip abductor exercises involve single leg standing positions, and lifting the leg to the side with medial rotation of the hip. Each time the opposite leg/hip moves it challenges the ability of the standing leg to stabilize itself. If side-lying position is preferred, resistance bands can be utilized for added difficulty.
 
In consideration of the contraindications and restrictions for DR, the core is a challenging area to train safely and effectively. When we eliminate the traditional ab exercises, how do we strengthen the core? Side, supine and standing positions are favoured for core strengthening. Side plank variations, bridging and knee raises are all safe and effective. These exercises will also serve to strengthen the upper body to support full planking once the DR is closed or “functional”.

Training the upper body with a DR is not overly problematic as long as the weight restrictions are adhered to (see below) and the pelvic stability component is taken into consideration. Shoulder press, bicep curls, chest press, flys and pull downs are not restricted. Bent over row is an example of an exercise that may be problematic with a DR, due to the more front loaded position. A seated row would be a better exercise.

Always engage the core with exertion. An abdominal splint or binder is always effective to support a weakened core during exercise.

Weight load restrictions for DR:

  • Lower body weights should not exceed 40 lbs total.
  • Upper body weights should not exceed 12 lbs/side.
  • Weights should be held at chest in unilateral movements such as lunges. This will center the weight and avoid placing too much strain on the pelvic stability control aspect of the movement.
  • LR weights can be held at the sides in bilateral positions such as squats. The pelvic stability control is minimized.
Don’t be scared!
Often if you are assessed with a DR you may become apprehensive to exercise for fear of worsening the condition- which is possible. The purpose of this article is to establish some guidelines for training with a Diastasis Recti and the confidence to safely train in a way that will achieve the desired results.

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