Can exercise in pregnancy help prevent the tummy muscle gap?

also known as “rectus abdominis diastasis”

What is diastasis of rectus abdominis?

If you have found your way here, you probably already know a little something about diastasis of rectus abdominis (DRA), so I’m not going to describe it in too much detail.

In a nutshell, it is a widening of the linea alba, which is the connective tissue connecting the two sides of your six-pack muscles.

It is something that often occurs during pregnancy as a result of the combination of hormonal influences on the connective tissue as well as the biomechanical changes that occur as the tummy expands to accommodate the little person inside. It can occur outside of pregnancy too (in fact, men can have a DRA!), but we’ll talk about that another time.

Photo Credit: Mutu System

Don’t Panic

Now depending on what articles you have read, you may be feeling a little freaked out by this whole concept of DRA. I certainly have many pregnant women telling me how worried they are about DRA having read so many articles in the media.

They worry about doing too much exercise, not enough exercise or maybe even moving incorrectly.

While I think it is fantastic that we have the opportunity to talk about these topics and educate people via online forums and blogs, sometimes the message becomes one of fear and I think we need to bring a more balanced view.

Yes, there is research to show that somewhere between 66-100% have a DRA at the end of the pregnancy. But of course you have to ask, what constitutes a DRA? How wide or deep does the gap have to be to be considered “abnormal?” If 100% of women in a study had a DRA at the end of the pregnancy, then couldn’t it be considered a normal response of the body to pregnancy? Or was their cut-off measurement for DRA way too narrow (1.6cm…)? These are all important questions to ask when we are considering the relevance of these measurements.

So for now, let’s just take from this the fact that most women have changes to the connective tissue in their abdomen during pregnancy and to some degree it is considered normal.

And on the good news front, the majority of women have resolution of their DRA after birth anyway. A large study of 300 women in Norway showed that at one year postnatal only 31% had a mild DRA (2-3 fingerwidths) and 1.1% had a moderate DRA (3-4 fingerwidths). None had a severe diastasis. Interestingly, there was also no correlation between the incidence of DRA and low back pain, which surprised me. I see a higher percentage of new clients postnatally with DRA than that, but that might be because they specifically seek out a physiotherapist for that reason.

If you are postnatal and have a DRA, be reassured that most women do very well with a customised exercise and education program. We’ll address that in another post, but for now let’s stick to talking about pregnancy.

Can appropriate exercise during pregnancy help?

Anecdotally I can say that the ladies who regularly attend my pregnancy classes do very well postnatally. I haven’t done clinical research (hmmm…maybe I should!), but I have noticed that those that I follow through with into the postnatal classes seem to recover very well and nearly all have DRA less than 2 fingers within the first 12 weeks.

But do they do well because of those specific exercises in pregnancy or just because they were probably pretty fit and active prior to pregnancy (with good muscle strength)? Or is it because they are attending regular postnatal exercise classes conducted by a physiotherapist who can adapt the exercises to suit their capabilities?

Tough to answer.

So what does the research tell us?

Ok, let’s get a little nerdy now and look at the research. Well, as with most medical research, the results are inconclusive as to whether or not exercise in pregnancy helps reduce the incidence of DRA.

However, there are a couple of interesting studies that I think are worth mentioning.

A study by Candido et al (2005) of 208 women looked at the risk factors associated with DRA.

They found that:

  • women that did not exercise regularly had a 2-fold increased risk of DRA
  • women who had no/mild diastasis postnatally were more often engaged in vigorous exercise (3x/week or more) or regular walking/exercise (2x/week or less) compared to those with moderate/severe diastasis.

Another study of interest was performed in 2005 by Chiarello et al, that looked at the effect of exercise on the incidence of DRA in 18 women.

The exercise group performed a 90-minute weekly exercise program for a duration of 6 weeks. The exercises consisted of

  • deep abdominal static contractions
  • theraband arm exercises
  • theraband leg exercises
  • pelvic tilts in supine and standing

The results were impressive:

  • of the 8 women in the exercise group, only 12.5% (ie one) had a DRA
  • of the 10 women in the non-exercise group, 90% had a DRA

Although these results are very impressive, I can see at least 4 limitations with this study:

  1. they didn’t take measurements of the DRA before initiating the exercise program
  2. the non-exercise group had a higher number of previous pregnancies (which is a risk factor for DRA)
  3. the group sizes were small
  4. the recruitment for the exercise group was done via a prenatal exercise class, so that group may have already been very physically active prior to the program (there was no investigation as to the previous fitness level of either group)

However, despite these limitations, it looks very promising that exercise during pregnancy may help reduce the incidence of significant DRA.

Interestingly, the exercises in this particular program are very similar to that shown within Pregnancy Club. 

And as always…more research is needed, but if I were a betting woman, I’d continue exercising in pregnancy to improve my odds of not having a large diastasis postnatally.

You’ll notice that the list of exercises doesn’t include planks, crunches and other more hard-core abdominal exercises. I’ll write more on that soon.

Let us know your thoughts in the comments below

References:

Candido GLo T and Janssen PA. Risk factors for diastasis of the recti abdominis. J Assoc Chart Physiother Womens Health 2005;97:4954

Chiarello CMFalzone LA, McCaslin KE, et al . The effects of an exercise program on diastasis recti abdominis in pregnant women. J Womens Health Phys Ther 2005;29:1116

Sperstad JB, Tennfjord MK, Hilde G, Ellstrom-Engh M and Bo K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbo-pelvic pain. Br J Sports Med 2016

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