A recent research study on diastasis recti has been making headlines over the last few weeks. The Norwegian study focuses on the efficacy of physical therapy as a treatment for diastasis. Some of the sensationalized headlines it has provoked include:

“Researchers have no idea how to fix your ‘mummy tummy’”

Is this really true? Is physical therapy not as helpful for treatment of diastasis recti as we initially thought? Let's look into what exactly the research was about and decide for ourselves. But first...

What is a Diastasis Recti?

In the third trimester of pregnancy the connective tissue between the abdominal muscles stretches to allow the baby room to grow and expand in the belly. Instead of a tightly knit "six-pack" configuration, the muscles begin to shift to each side, forming two separate groups with a "gap" in-between. This is known as diastasis recti, which can be shortened to diastasis or DRA.

While this happens in almost 100% of women during their third trimester, the connective tissue can regain its tension and return the rectus abdominis back to it's original configuration. However, studies show that 50-60% of women are still experiencing a diastasis recti six weeks after delivery

Comparing the Research

So how do we reconcile this new research with previous studies that have shown that physical therapy can absolutely improve or eliminate a diastasis recti? Study results have shown:

• A targeted abdominal and pelvic strengthening program was capable of a 50% reduction in the size of a diastasis in just 8 weeks

• Diastasis size can be reduced with isometric contraction of the abdominal muscle

• Abdominal exercises affect the inter-rectus distance

• Education and abdominal exercise immediately after delivery can reduce the size of diastasis recti within 24 hours of delivery

• Abdominal exercises in addition to standard pelvic floor exercises were more effective than pelvic floor contractions alone

As pelvic floor physical therapists, we've also seen repeated (though anecdotal) success in improving both the appearance and functional limitations of a diastasis recti. To reconcile this new research with our previous knowledge, we need to take a deeper dive into the study protocol.

Study Limitations

Contrary to the provocative titles of the articles written about this study, it did not feature physical therapy. Instead, a physical therapist led a group exercise class once a week for 45 minutes. They were also given a series of pelvic floor muscle contractions – Kegel exercises – to do daily at home

“The main focus on the exercise protocol was to strengthen the PFM (Pelvic Floor Muscles), but the program also contained strengthening exercises for the abdominal, back, arm, and thigh muscles, stretching, and relaxation. All exercises, except the PFM exercises, were performed to music.”

So these exercise classes weren’t even focused on the core and abdominal muscles, but on the pelvic floor! And after they finished doing Kegel exercises in 5 different positions, whatever time was left over was split between exercising every major muscle group in the body to music. The new mothers weren’t instructed to do any home exercises other than the daily Kegels.

What the Research Really Shows

This research confirmed many things that we already know clinically. A generic, formulaic approach will not benefit the majority of patients. 'Just Kegel' isn't the answer to post-natal recovery. And a treatment session of just 45 minutes once a week isn't enough if the patient is not participating in a well-designed, individualized home program.

So some better headlines for articles about this study might be:

• Kegel exercises can't heal a diastasis recti

• Non-specific exercise routines performed to music are ineffective.

• Spending less than 20 minutes a week on core strength doesn't result in diastasis recti improvements

Treating a Diastasis Recti

From clinical experience and clinical studies, we know that resolving a diastasis is not a simple case of following a few stock exercises to "close the gap". It is about retraining and rehabilitating the body to use all of the "core" muscles efficiently. A pelvic floor physical therapist who is experienced in treating a diastasis can determine the underlying issue, use hands-on treatment methods to facilitate recovery, and prescribe an individualized exercise regimen to help new mothers meet their goals.

We certainly need more research in this field, including controlled clinical trials like this one. However, the treatment protocols need to test what has been shown to be successful in clinical settings, not test an arbitrary, non-specific, and formulaic weekly workout.

Additional Resources

• Common, but Not Normal - Post-Natal Pelvic Symptoms

• What is Pelvic Physical Therapy?

• Pelvic Health Stretching Regimen

Dr. Nicole Cozean is the founder of PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic. One of only 270 PTs to be board-certified in the pelvic floor, and the first PT to serve on the ICA Board of Directors, Nicole is the author of the acclaimed and best-selling book The Interstitial Cystitis Solution (2016). She is an adjunct professor at her alma mater, Chapman University. The PelvicSanity blog focuses on presenting practical, positive information to help patients beyond the walls of Nicole's clinic.

Dr. Sharon Thompson is a physical therapist at PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic. Sharon combines a strong orthopedic background with her skill as a pelvic floor physical therapist. She is vocal advocate for those who suffer from pelvic floor dysfunction or pain, and is especially passionate about spreading hope and awareness about these conditions.