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Separated Abs Workout

Postpartum women: Address Diastasis Recti Abdominis (DRA), aka “separated abs,” with this core workout.

Separated Abs Workout

This is an article for all the moms out there. As a man, I won’t pretend to know what it’s like to go through a 9-month pregnancy, deliver a baby, and then have to try and get back in shape after the enormous toll on your body.

But as a scientist in the field of exercise, fitness, and physique, I do have knowledge of a common condition faced by many postpartum women: Diastasis Recti Abdominis (DRA), aka “separated abs.”

If you’re a woman experiencing separated abs and looking to improve your midsection both for functional and aesthetic reasons, I’ve got an abdominal and core workout for you, designed specifically for addressing DRA.

You’ll find my Separated Abs Workout at the bottom of this article, so feel free to scroll down and have a look. But before that, I’ll explain the science behind DRA and dive into past research on how to correct it through exercise. 

What is Diastasis Recti Abdominis?

To explain how and why DRA occurs, let’s first talk about the anatomy of the abdominal muscles. The rectus abdominis is the “six-pack” muscle we’re all familiar with. It’s a single, large sheath of muscle, with a strip of connective tissue called the linea alba running down the middle of it and separating the left and right sides of abs.

During pregnancy, as the baby grows, the uterus and stomach expand, causing the abdominal muscles to stretch. When this happens, often times the linea alba widens dramatically, causing a partial or complete separation of the rectus abdominis – the definition of Diastasis Recti Abdominis.

DRA comes in several different forms, depending on what area of the abdominal wall the separation occurs – Around Umbilicus (navel/belly button), Below Umbilicus, Above Umbilicus, or along the full length of the linea alba (aka, Open Diastis).

Here are basic diagrams of the different forms of DRA, with a normal (non-DRA) midsection shown at the upper left:

Image courtesy of PelvicGuru.com. 

In most women, DRA corrects itself in the postpartum period. But for others, the abs remain visibly “separated” long after the baby has arrived. There’s a lot of confusion among women as to what to do about this. Many women with DRA are afraid to do any ab exercises in fear that it will worsen the problem. But that’s the wrong approach to take; if you avoid abdominal and core training, you’ll end up worsening your quality of life due to the negative effects of having a weak midsection (namely, lower back pain). 

(Men can also get DRA, particularly later in life when the “beer belly” grows and the increase in subcutaneous and visceral fat leads to separated abs. But females ask about DRA more commonly because of how often it occurs with pregnancy.)

The good news is, unless it’s an extreme case, there’s no permanent harm done to the body with DRA. The left and right sides of the abs are just separate from each other. In other words, correcting it is not a medical necessity, just cosmetic. The abs will still function just fine.

The Research on Correcting Separated Abs

There’s been a decent number of research studies done on DRA and exercise. Unfortunately, there’s really no definitive conclusion as to what works best for “correcting” separated abs.

For example, one 2019 study did a review of past scientific literature to try and determine the best exercises for DRA “rehabilitation.” The paper concludes that “there is a lack of consensus on the effects of the different types of exercises evaluated on inter-rectus [linea alba] distance.” In other words, the best exercises for correcting DRA are still unknown. 

Another review, this one from 2018, came to basically the same conclusion: that some type of exercise is beneficial, but they’re just not sure which exercises are best. 

One of the reasons researchers are having such a hard time coming to any firm conclusions on the topic could be that their studies tend to look at acute effects of abdominal exercises – meaning, what’s happening during an exercise like the crunch, while you’re actually exercising, not afterward when the muscles have had a chance to recover and grow stronger from the workout. They just look at what happens in the muscles when you either do a crunch or when you suck in your belly button like with a traditional vacuum pose.  

This is a ridiculous way to determine if an exercise is working! You don’t see the positive benefits of an exercise while you’re doing it; you see the results of bigger, stronger muscles over the course of weeks, months, and years of training, after the muscles have had the opportunity to develop through consistent training, rest, recovery, and proper nutrition. As lifters always say, you don’t grow in the gym – you grow at rest!

Two Sides of the DRA Exercise Debate

There are two camps when it comes to how to train the abs for those experiencing DRA.

One camp says those with DRA should never do standard ab exercises like sit-ups and crunches because it could make the condition worse. Many experts on this side of the debate recommend only doing ab “hollowing” exercises and ab bracing moves like planks.

I touched on this a bit earlier. It’s terrible advice to say people with DRA shouldn’t do exercises like crunches and sit-ups. These exercises involve trunk flexion, a basic human movement required in countless everyday activities, not to mention a ton of foundational gym exercises. Avoid these types of movements altogether and you’re going to have a lower quality of life due to a weak core and most likely lower back pain.

The other camp says you should in fact be doing exercises like crunches, reverse crunches, and leg raises. The rationale here comes from research confirming that the linea alba shortens (and thus the space between the left and right sides of the abdominal wall decreases) during the crunch, and it does the opposite (lengthens) during ab hollowing and “drawing-in” movements. The conclusion, then, is that you do crunching exercises and not hollowing moves.

But as I just mentioned, these are acute studies, so take it with a grain of salt.

If you’re getting confused by all these studies, don't worry – you’re right to be dumbfounded! Most of the studies on this topic are contradictory, inconclusive, or both, which adds up to a lot of confusion.

Case in point: One 2014 study showed that isometric contractions on crunches shortened the distance between the two sides of the rectus abdominis during the contraction. And yet another study suggested that while shortening the linea alba is the long-term goal, shortening it during the workout may not be effective, and, believe it or not, lengthening it during workouts might lead to better long-term results.

There are a lot of studies out there looking at exercise and DRA, but most of them don’t amount to much.

The Winning Formula for Separated Abs

Fortunately, not all of the research on DRA and ab training is useless. A couple studies in particular have used more logical methods than the aforementioned reviews and have come to more legitimate conclusions. Let’s take a look at that research…

One study, which lasted eight weeks, compared two types of ab/core workouts: one with only typical ab exercises (crunches, reverse crunches, Russian twists, etc.), and the other with those same exercises performed but preceded with deep core exercises like planks, side planks, and “cat” and “cow” poses like you see in yoga. The latter workout also consisted of abdominal hollowing exercises to hit the transverse abdominis; pelvic floor strengthening in the form of Kegels; and isometric abdominal contractions.

So basically, subjects in the second group did deep core exercises and then followed that with a typical ab workout of crunches, reverse crunches, and twists.

The researchers found that, over the course of eight weeks, both workouts shortened the linea alba distance between the two sides of the rectus abdominis to decrease the ab separation. However, they found that the reduction was greater when subjects did the core stability program before the traditional ab exercises.

Another study found that adding electrical muscle stimulation to an otherwise typical abdominal training program resulted in a greater reduction in the linea alba space than doing ab exercises minus the electric stim. Like the other study, doing ab exercises without the electric stim still worked, but adding the stim to the routine was even more effective.

The take-home from these two studies is pretty clear: For those with DRA, you want to do some form of deep, stabilizing core training like planks and hollow moves in addition to standard ab exercises like crunches and leg raises. Core stabilization followed by standard ab exercises from all angles – that’s the winning ab-training formula.

4 Exercise Tips for Separated Abs

So, what’s a woman to do with all this information? My recommended Separated Abs Workout is below, but here are some general guidelines to follow:

  1. First and foremost, don’t be afraid to do ab exercises. The last thing you want to do is shy away from ab and core training in the gym (or wherever you train). You want the muscles in that region to be strong. Don’t let them get weak!
  2. If DRA is a major issue for you, I recommend working with a licensed physical therapist who has experience dealing with clients with DRA and has seen good outcomes. You should also look for a therapist who’s not going to be afraid to put you through a real workout.
  3. If you want to address DRA on your own before working with a physical therapist, make sure your workouts consist of core stabilizing moves like planks, cat/cow, and isometric contractions (5-second holds per rep); Kegels for strengthening the pelvic floor; and traditional abdominal exercises like crunches, reverse crunches, leg raises, and twisting movements. Based on the aforementioned research, I highly recommend doing the core stabilizing moves before the ab exercises within each workout.
  4. Focus your ab training on which form of DRA you have: Around Umbilicus, Below Umbilicus, Above Umbilicus, or Diastasis along the full length of the linea alba. As a general rule of thumb, if the DRA is above the belly button, focus slightly more on upper ab exercises like crunches (any and all variations); if it’s below, focus more on lower ab moves like leg raises and reverse crunches. If it’s around the belly button or along the full length of the linea alba, a general ab-training routine that hits all areas of the midsection should be performed.

Separated Abs Workout

Although I recommend working with a therapist who can customize a training program for your specific DRA, this general routine (based on the above 8-week research studies) can be helpful for most women. 

Do this workout three times a week, with 1-2 days rest between workouts (ie, Monday, Wednesday, Friday or Tues/Thur/Sat). 

Part 1: Core Stabilizing

Exercise Reps/Time
Plank To failure1
Side Plank To failure1
Woodchopper 5-202
Cat to Cow 5-203
Kegels 5-204
Isometric Crunch 5-204

Start with one round (one set of each of the above exercises), then increase to two rounds once you’ve gotten stronger. Eventually, work up three rounds in circuit fashion – one set of each exercise in order – resting 1-3 minutes between each circuit.

After doing the Core Stabilizing portion of the workout, move onto Part 2…

Part 2: Abdominal Strengthening

Exercise Reps/Time
Windshield Wipers To failure
Reverse Crunch To failure
Crunch To failure
Russian Twist To failure

Start with one round (one set of each of the above exercises), then increase to two rounds once you’ve gotten stronger. Eventually, work up three rounds in circuit fashion – one set of each exercise in order – resting 1-3 minutes between each circuit.

Download This Workout

Exercise Notes:

1Start by doing 5-second plank holds, with 10 seconds of rest between holds. Try to do as many 5-second holds as you can until you can do at least 12 in this fashion – that would be considered one set. Once that’s no longer challenging enough, switch to holding the plank for as long as possible without any breaks. See if you can pass 3 minutes. Each longer-held plank is considered one set; for side planks, holds for both sides is one set.

2Use a light weight/resistance that allows you to complete 5 reps per side fairly easily. Increase reps gradually over time until you can do 20 per side, then increase weight. Woodchoppers can be performed with a dumbbell (or other comparable weighted object you have at home), a cable station, or bands.

3Hold the cat pose with abdominal hollowing for 5 seconds, then move into cow pose with abdominal bracing for 5 seconds. Rest for around 10 seconds after completing both, and repeat. Start by doing 5 of these holds per round and work up to 20.  

4Hold for 5 seconds and rest for 10 seconds. Start with 5 holds per round and work up to 20.

Tips for Abdominal Bracing, Hollowing, and Kegels

It’s important that you understand how to perform abdominal bracing and hollowing, as well as Kegels (pelvic floor strengthening). These are often difficult exercises to master, as they mainly rely on deeper core muscles in the deep abdomen and back. 

Abdominal Bracing: To properly perform abdominal bracing, pretend that someone is about to punch you in the stomach. Now, hold those muscle contractions to brace. You’ll need to brace like this for exercises such as planks, side planks, and cat to cow. 

Abdominal Hollowing: To do abdominal hollowing, try to pull your belly button back toward your spine and hold for 5 seconds. This will work the transverse abdominis muscle that runs across your midsection below the rectus abdominis. It may help to do this lying on your back or standing in front of a mirror to help visualize.

Kegels: To do Kegels correctly, go to the bathroom. Literally. Urinate, and try to stop the flow of urine. That muscle is the one you want to contract for 5 seconds when doing Kegels.

 

References

Carrera, C. P., Da, I. C. C., & González, Y. G. (2019). What is the best exercise for rehabilitation of abdominal diastasis rehabilitation?. Rehabilitacion, 53(3), 198-210.

Kamel, D. M., & Yousif, A. M. (2017). Neuromuscular electrical stimulation and strength recovery of postnatal diastasis recti abdominis muscles. Annals of rehabilitation medicine, 41(3), 465.

Lee, D., & Hodges, P. W. (2016). Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study. journal of orthopaedic & sports physical therapy, 46(7), 580-589.

Michalska, A., Rokita, W., Wolder, D., Pogorzelska, J., & Kaczmarczyk, K. (2018). Diastasis recti abdominis—a review of treatment methods. Ginekologia polska, 89(2), 97-101.

Mota, P., Pascoal, A. G., Carita, A. I., & Bø, K. (2015). The immediate effects on inter-rectus distance of abdominal crunch and drawing-in exercises during pregnancy and the postpartum period. journal of orthopaedic & sports physical therapy, 45(10), 781-788.

Pascoal, A. G., Dionisio, S., Cordeiro, F., & Mota, P. (2014). Inter-rectus distance in postpartum women can be reduced by isometric contraction of the abdominal muscles: a preliminary case–control study. Physiotherapy, 100(4), 344-348.

Thabet, A. A., & Alshehri, M. A. (2019). Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial. Journal of musculoskeletal & neuronal interactions, 19(1), 62.

 




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