Does your client complain of an ‘overall feeling of collapse and weakness’ in their cores? Is your client getting increasingly self-conscious about their rounded, protruding belly ‘pooch’ – and desperate for your help in getting rid of it?
Is your client a recent mother? Then, chances are, she’s dealing with a common postpartum abdominal condition: diastasis recti.
Diastasisrecti can be more than a cosmetic issue, contrary to popular opinion. When left untreated, it can cause several functional problems – including back pain, an overactive pelvic floor, and incredibly tight hips and glutes.
These can make achieving proper form and technique during their workouts near ‘Mission Impossible’. This can increase their chances of injury. This is not ideal.
That’s why this article outlines the basics of what you need to know about working with clients struggling with diastasis recti, so you can help them rebuild their core strength and minimize their degree of ab separation (to the best of your abilities).
What's Diastasis Recti, and how can it help you?
Diastasis recti is also known as abdominal separation.
This condition is typically observed in postpartum women (with a 2015 study suggesting that nearly all women experience at least some degree of ab separation at the end of their pregnancy!)
Due to increased pressure due to an expanding uterus as well as the growing baby underneath, abdominal muscles are stretched, lengthened and weaken throughout pregnancy.
Depending on a mother’s core strength and genetics, the pressure can then cause the 2 sides of the rectus abdominis – what’s commonly known as the ‘six-packs’ – to pull apart from their attachment point, the linea alba.
It creates an area between the sides of the abdominal muscle and may cause visible bulges or gaps after birth.
That said, because diastasis recti's underlying cause is an excessive, built-up pressure behind the abdomen, it's important to note that it can also affect non-postpartum clients (e.g. Men. With these clients, the separation can be a result of the following:
- Undergoing rapid weight changes
- Lifting heavy weights with improper form
- Performing excessive abdominal exercises
Thankfully, you can pretty much use the same approach in addressing a client’s diastasis recti – regardless of whether they’re postpartum or not. We'll get to that in a moment.
How to Know If Your Client Has Diastasis Recti
Checking if your client has diastasis recti is pretty straightforward. Here's a step-by-step guide that'll walk you through the process:
- Have your client lie on their back, legs bent, with their feet on the floor.
- Get them to do a ‘mini abdominal crunch’, where they lift their head slightly off the ground while keeping their shoulders down.
- Gently press down on the midline of your client’s rectus abdominus muscle, just above the belly button.
- Your client may have diastasisrecti when there is a space of between 1 and 2 fingers.
Your client is physically confirmed to have diastasisrecti
Don’t jump right into designing a workout routine for them! Your client should consult with their primary physician for an official diagnosis.
A licensed doctor will be able to do a thorough physical exam (which can sometimes involve imaging with ultrasound or CT scan) to determine if your client indeed has diastasis recti – and, if so, how severe it is.
Make sure your client seeks the all-clear from their doctors before starting them on a workout program.
Coaching a Client Struggling with Diastasis Recti
At this point, your client should be medically cleared to proceed with an exercise routine. It's fantastic. Problem is, however, it's not clear how to help clients navigate the diastasisrecti recovery process.
These are some tips that you should keep in mind.
Focus on Strengthening the Transverse Abdominis
When working with a client struggling with diastasis recti, your primary focus is to help them strengthen their abdominal muscles.
You can’t just rely on the same old core exercises you use for other clients, though.
Instead, you’ll have to select exercises that specifically target the transverse abdominis (TVA). Take this 2018 study published in the Journal of Women’s Health Physical Therapy, for instance.
Workouts that target the TVA may be an effective and non-invasive solution to reduce inter-recti Distance, according to the researchers.
Wondering why that’s so?
Well, it's because, anatomically speaking, the TVA is one of the deepest layers of abdominal muscles; it forms a wall-like sheath to protect the inner organs.
It begins at the bottom of each rib on the spine. Then it wraps around the back of the body and inserts into linea alba.
In other words: you can think of the TVA as something like a ‘corset’.
Strengthening the TVA has the same effect as tightening the laces on a corset; this pulls the entire core region together – essentially reducing the distance between the 2 sides of your client’s abdominal muscles.
Examples of postpartum-friendly exercises that’ll work the TVA include diaphragmatic breathing, posterior pelvic tilts, dead bugs, and side planks.
Core exercises that require spinal flexion, such as crunches or sit-ups (e.g. Sit-ups or crunches are not recommended. This can place excessive pressure on the abdomen and, in turn, exacerbate the condition.
It is easy to determine if the exercise is appropriate for your client by watching how they move their core.
If their belly rises in a dome or mountain-like formation vertically along the midline of their abdomen, get your client to stop – and switch exercises.
Reinforce Proper Breathing Techniques
Does your client hold their breath through all their reps?
That’s a no-no for most clients (unless you’ve specifically asked them to perform the Valsalva maneuver) – but especially for those struggling with diastasis recti.
Breath-holding during a lift has been shown to significantly drive up intra-abdominal pressure, which, obviously, isn’t ideal for a client trying to coax their ab muscles back together.
It’s not just all about avoiding excessive intra-abdominal pressure, too.
Your client's deep core muscles can be strengthened by proper breathing techniques, such as a lift. You will experience more power and stability.
Your client should inhale while on the eccentric section of the lift and exhale when they reach the concentric portion.
Of course, when you cue it as such, you can almost certainly expect some clients to look at you with a puzzled expression … and ask, “How would I know which portion of the lift is concentric, and which is eccentric?”
Don’t worry: a helpful and less confusing way to cue proper breathing technique is to ask your clients to exhale on exertion (i.e. The hard stuff.
This is why it's important to keep in contact with your client regarding how they feel about the various weights and exercise. You can make them forget how to breathe if you push too hard.
You can use a scale called the Rating of Perceived Exertion (RPE); this is a subjective scale where clients rate how exerted they are during an exercise.
One is very easy and ten is difficult.
Ratings between 6 to 8 are typically considered the 'sweet spot' for when a client is challenged – but not to the point they have to use the Valsalva maneuver to complete their reps.
Help Your Client Get into Good Alignment in Their Daily Life
Chances are, your client, like so many in the world right now, is navigating a new home office lifestyle. It is simply a matter of spending more time at the home. Especially so for a postpartum client – who’s adjusting to the 24/7 demands of caring for a newborn.
It’s all too easy for them to slump over their computers, phones, and even babies in their daily life. This brings about 2 undesirable results:
- A weakening of muscles (e.g. abs and the glutes) that's supposed to be active, and
- An overactivation of muscles (e.g. the hip flexors and erector spinae) that aren’t supposed to be
In turn, pulling your client's posture into a chronic 'rib thrust' position (aka the anterior pelvic tilt). The consequences of being in a perpetual anterior pelvic tilt are well-documented. These include tight hamstrings, lower back pain and low activation of the glute muscles.
For clients with diastasisrecti, this posture can place additional stress on the linea algar (i.e. Attachment point of therectus abdominis.
To help your client get his/her body back into good alignment, you can use the following cues:
- Stand with the feet positioned directly under the hip bones and pointing straight ahead.
- The rib cage should be placed over the pelvis.
- The lower back should be slightly arched to avoid the tailbone from getting under your torso.
- Maintain a high thoracic spine and keep the ears aligned with the shoulders. You can allow a slight forward curve at the top of the spine.
This alignment should be used in daily activities and all other exercises. When they are carrying their baby. You may also want to program in exercises that’ll help stretch the hip flexor muscles – and those that’ll strengthen the glutes.
Set the Right Expectations from the Very Beginning
It is important to manage client expectations right from the start. Make sure they know that their abdominal muscles can never completely come together even with targeted exercises.
The unfortunate truth is that there’s still no international consensus – amongst medical experts and researchers alike – on the treatment of diastasis recti. Research consistently shows that all available, effective treatment options such as physical therapy and surgery (e.g. Physical therapy and surgery are controversial options for improving overall condition.
This may cause your client to be (understandably) upset. Especially if they’d hired you specifically to help ‘fix’ their diastasis recti.
That’s why you’ll have to(*You can find out more here. demonstrate empathy as you educate your clientYou can say something like, “I can see how learning about this would be difficult for you. While targeted exercises may not close the gap completely, they can help you build a strong, functional core.”
Drive home the point that core work shouldn't be viewed only as an 'aesthetic' solution – but also a functional one that'll help your client in their fitness journey.
Functional benefits to mention during your talk with your client include:
Reduced back pain:
- consistently shows that core strength training (and training the deep trunk muscles, specifically) can help alleviate lower back pain. ResearchAthletic performance:
- The core is involved in almost every sports action. With a strong core, your client will lift heavier, run faster, and jump higher (amongst other athletic pursuits). likely be able toFuture pregnancies:
- Core-strengthening is exceptionally crucial if your client is planning to get pregnant again. A found that abdominal strengthening programs provided to pregnant women can help decrease the severity of diastasis recti. 2019 studyMain Takeaways
Ultimately, it’s worth remembering that helping your client tackle diastasis recti is so much more than just working on strengthening the transverse abdominis, improving breathing techniques, and reinforcing good alignment in everyday life.
It also involves working closely with your client to understand what they’re facing – and what they should expect during their diastasis recti recovery journey (e.g.
). Empathize with your clients and try to find the best approach. providing recommendations for post-partum nutritional needs