Abdominal rehab: Tone your postpartum belly
By Amy Paturel
What is abdominal rehabilitation?
Abdominal rehab is a type of physical therapy to strengthen and tone weak stomach muscles. It's often helpful for postpartum women, whose ab muscles get stretched out during pregnancy. Over the course of pregnancy, your abdominal muscles and the surrounding connective tissue stretch to accommodate your growing baby. Unfortunately, they don't just snap back into shape a few weeks after you give birth. It can take months to recover, and you may need some guidance.
Note: Crunches won't fix the problem and will likely make it worse.
Anyone who needs to strengthen her core or wants to lose her pooch can benefit from ab rehab, but it's especially important for the many postpartum women with a diastasis recti. In this condition, the muscles that make up your rectus abdominis ("six-pack muscles") separate, leaving a vertical gap that allows your belly to sag through.
Why don't crunches help?
Traditional sit-ups and crunches do target the rectus abdominis. But after pregnancy, the connective tissue between these bands of muscle is stretched out, causing each side to pull apart and no longer support your core. Doing regular crunches tends to make the muscles tighter, pushing them further apart and stretching the connective tissue even more so that it grows thinner and weaker.
What happens in ab rehab?
Your physical therapist will teach you how to activate the rectus abdominis safely by doing a series of mini crunches with a sheet wrapped tightly around your waist. This strengthens the connective tissue between them so they function properly again to support your core and keep your stomach from pooching out. Depending on the width of your gap and how conscientious you are about doing the exercises, you could see significant improvement in eight to 12 weeks. You may also learn how to identify and strengthen the transverse abdominis, or TVA, the deepest layer of abdominal muscles, which support your core like a corset. You can feel your TVA contract if you pull your belly button toward your spine or say "shhhh. Your physical therapist will show you how to rely on these muscles to support your core when you get out of bed, pick up toys, and do other everyday activities so you don't make your diastastis recti worse.
How soon after delivery can I begin ab rehab?
Most doctors and physical therapists recommend waiting six weeks before starting a formal exercise program if you had an uncomplicated vaginal delivery, or eight weeks if you had a c-section.
Will diet and aerobic exercise help me lose my belly?
Eating a healthy diet and exercising regularly can help you shed pounds and lose fat. But to flatten and tone your tummy, you need to include targeted abdominal exercises.
Will an abdominal binder or splint shrink my postpartum belly?
Abdominal binders and splints can provide postural support, but they won't change your shape. However, if your core is weak and you feel unstable or have painful joints, your healthcare provider may recommend wearing some type of abdominal support for several weeks after delivery. Similarly, if you have a diastasis recti and are unable to rely on your TVA to support your core, wearing a binder or splint may hold the muscles in your abdominal wall together while the connective tissue heals.
Do home-based ab rehab programs like MuTu and Tupler work?
The MuTu System, Tupler Technique, and other home-based programs use instructional videos to teach you how to close a diastasis recti and strengthen your core. Depending on the program, you may also be advised to wear an abdominal binder to help repair the abdominal muscles and maintain proper alignment.
The caveat: You have to perform the exercises correctly to get results, but there's no trained professional there to tell you if you're doing them right.
How can I find a physical therapist for ab rehab?
To find a physical therapist who's experienced in abdominal rehab, go to the American Physical Therapy Association's website and click on "Find a PT." Get a list of PT's in your area and then choose "Women's Health" from the practice area pulldown to filter the results. Call each practice and ask if the PTs there are trained in abdominal and pelvic floor rehabilitation. (Pregnancy can also damage the pelvic floor muscles that support your bladder, bowel, and uterus.)
In many cases, insurance will cover the cost of evaluation and treatment for a diastasis recti. Check with your insurance provider to see if you need a physician's referral to visit a physical therapist. It may take several sessions to learn the techniques properly so you can continue them on your own.
Will my belly ever shrink back to pre-pregnancy size?
Everyone's body is different. It may take weeks or even months of targeted exercises to get your abdominal and pelvic floor muscles back in shape. (In some cases of severe diastasis recti, surgery may be necessary to close the gap.) And it can also take time and effort to lose the weight gained during pregnancy. Some women are able to regain something close to their pre-pregnancy shape. But for many women, pregnancy results in permanent changes to the body, such as a softer belly, looser skin, wider hips, and a thicker waist.
Note: This article was reviewed by Melinda Fontaine, DPT, pelvic physical therapist at the Pelvic Health and Rehabilitation Center in Berkeley, California, and Alison Ankiewicz, DPT, pelvic health physical therapist at Inner Dynamics Physical Therapy in Ocean, New Jersey.
APTA. Undated. Physical therapist's guide to diastasis rectus abdominis. American Physical Therapy Association. http://www.moveforwardpt.com/symptomsconditionsdetail.aspx?cid=f8a7ad12-eadf-4f42-9537-e00a399c6a03 [Accessed February 2017]
Benjamin DR et al. 2014. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: A systematic review. Physiotherapy 100:1-8. http://www.physiotherapyjournal.com/article/S0031-9406(13)00083-7/pdf [Accessed February 2017]
Hickey F et al. 2011. A systematic review on the outcomes of correction of diastasis of the recti. Hernia 15(6):607-614. https://www.ncbi.nlm.nih.gov/pubmed/21688021 [Accessed February 2017]
Kim E and Lee H. 2013. The effects of deep abdominal muscle strengthening exercises on respiratory function and lumbar stability. Journal of Physical Therapy Science 25(6):663-665. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805012/ [Accessed February 2017]
Lee D and Hodges PW. 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. http://www.jospt.org/doi/abs/10.2519/jospt.2016.6536 [Accessed February 2017]
MedlinePlus. 2015. Diastasis recti. U.S. National Library of Medicine, National Institutes of Health. https://medlineplus.gov/ency/article/001602.htm [Accessed February 2017]
Mota P et al. 2015. The immediate effects on inter-rectus difference of abdominal crunch and drawing-in exercises and during pregnancy and the postpartum period. Journal of Orthopaedic & Sports Physical Therapy 45(10):781-788. http://www.jospt.org/doi/10.2519/jospt.2015.5459?code=jospt-site[Accessed February 2017]
Nahas FX et al. 2004. An efficient way to correct recurrent rectus diastasis. Aesthetic Plastic Surgery 28(4):189-196. https://www.ncbi.nlm.nih.gov/pubmed/15599529 [Accessed February 2017]