Should You REALLY Avoid Crunches If You Have A Diastasis Recti?
Did you know that up to 100% of people will develop a diastasis recti during pregnancy? 60% of those will have a diastasis recti at 6 weeks postpartum, 45% will have one at 6 months postpartum and 33% will have a persistent diastasis recti at one year or greater after childbirth.
If you have a diastasis recti as ~45% of people at 6 months postpartum do, you may have come across the advice to avoid crunches. Traditionally, people who have a diastasis recti are taught to avoid using their rectus abdominis, or 6 pack muscles. These same people are also taught to avoid going into full extension or deep rotation. But does the research really support that?
In this blog post we’re going to dive into what a diastasis recti is, why it happens, what it means for your strength and health long term as well as what you should and shouldn’t do about it! Then we’ll do a quick dive into whether the data really supports that you shouldn’t be doing crunches.
What is a diastasis recti?
A diastasis recti is a separation of the rectus abdominis, or 6-pack muscles, along the linea alba in the midline of the abdomen. The linea alba is a thick band of fascia that spans the distance between your right and left rectus abdominis, also known as the inter-rectus distance. Different studies have proposed a number of different metrics for defining a mild, moderate and severe diastasis recti, but a widely accepted rule of thumb amongst pelvic floor physical therapists is that an inter-rectus distance of greater than 2 centimeter or two finger widths at any point along midline is considered a clinically diagnosable diastasis recti.
Note: It is normal for folks to feel a ridge between their right and left rectus abdominis! Before ever becoming pregnant, I had a .75 centimeter or so separation between my rectus abdominis. Remember, these are two separate muscles coming together along a fascial line. It’s totally normal to be able to feel their borders.
Why does a diastasis recti occur?
A separation of the right and left rectus abdominis occurs because of sustained strain. In pregnancy, this is typically from sustained increases in intra-abdominal pressure as the belly grows. Despite popular beliefs that a diastasis recti (DRA) only occurs amongst pregnant and postpartum people, it’s actually totally normal for young children to have a DRA as well as older men, Children may have a DRA as a result of a lack of muscle coordination and this is common amongst older men with larger abdomens or a chronic cough.
During pregnancy, your abdominal wall undergoes months of sustained and progressive stretch, contributing to a thinning and widening of the linea alba. The baby has to go somewhere and this is your body’s totally normal and healthy way of morphing to accommodate these changes!
What does a diastasis recti mean for your strength and long term health?
In some folks, a diastasis recti is associated with back pain, pelvic pain, abdominal weakness, urinary incontinence or various other symptoms. But in others, it’s not! I’ve seen folks with large a large diastasis recti who have absolutely no associated pain or weakness. I’ve seen folks with a tiny diastasis recti with a ton of back pain, pelvic pain and core weakness.
Your diastasis recti is certainly part of your clinical picture, but it does not define you, your strength, your symptoms or abilities.
Here are some of the factors that I consider as a pelvic floor PT when I work towards determining if your DRA is impacting your overall health and clinical picture:
Do you have tenderness along the abdominal wall?
Are you able to engage your abdominal muscles when moving functionally or during exercise?
Do you have doming or coning along the abdominal wall with movement, and if so, is that doming or coning hard or soft?
Do you have pain associated with certain movements or positions?
What’s your overall activity level?
What are your goals? What do you want to get back to doing?
Are you experiencing prolapse symptoms? Urinary symptoms? Pelvic or back pain?
The answers to these questions along with a physical therapy exam help me determine what your diastasis recti means for you, right now.
The good news? Long term, your DRA will not define your health or strength. There’s nothing that someone with a DRA should never do. We may just need to build strength over time to help you get wherever you want to go.
What should you and shouldn’t you do about a diastasis recti?
Traditionally, people with a diastasis recti are told not to crunch, twist or extend their backs fully. Earlier in my career, I was guilty of guiding people the same way. This is how diastasis recti has been treated for way more years than I’ve been a physical therapist.
But as with all things in healthcare, research changes and treatment must change to keep up with the new information we have! This evolution is a blessing. It allows us to merge the years of clinical exprience we have watching various treatment approaches work for people PLUS hard evidence in science to incorporate into our process. I had a mentor early on in my career that said they day she’d quit PT was the day she treated the same way for 6 months straight. In healthcare, we always need to strive keep up with the evidence.
What the most recent evidence has shown us about DRA tells us that we need to treat it just like we treat every other musculoskeletal injury - on a one on one basis with fewer hard and fast rules. So here are some new guidelines that I propose, based off of years of clinical experience plus a recent deep dive into new data:
Some people should add crunches into their rehab while others probably shouldn’t.
We need to work the rectus abdominis and inner and outer obliques, not just the transverse abdominis.
We absolutely need to stop telling people they shouldn’t be working their core if they have a DRA. Strength training is key.
We need to begin encouraging pregnant and postpartum people to move their bodies without fear.
We need to start treating diastasis recti as any other musculoskeletal injury, and strengthening all of the muscles in and surrounding the abdominal wall.
So, should you really avoid crunches if you have a diastasis recti?
Last year, a randomized controlled trial by Gluppe et. al. was published. This study looked at the impact of curl-ups on people with a diastasis recti of 2.8cm or greater at 6-12 months postpartum. They gave their experimental group a 12-week, standardized exercise program that included exercises like head lifts, curl ups and curl ups with rotation.
And you know what they found!?
Those who participated in this 12 week program had no change in the width of their diastasis recti or the severity of pelvic floor dysfunction, but they did have stronger abs.
Another 2023 study by Theodoresen, et. al. looked at the impact of various abdominal engagement cues in pregnant people between the weeks of 27 and 37 weeks of gestation and found that the only cues that brought the inter-rectus distance together were a headlift, curl up and diagonal curl up.
So, should you REALLY avoid crunches if you have a diastasis recti? Maybe there is a reason you should, but the data doesn't support a hard and fast rule that everyone should.
Want to work with a pelvic floor PT for personalized care through pregnancy and postpartum recovery? Contact us here!
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.