Diastasis Recti & Coning - What you need to know

Someone commented on a post I made earlier this week on Instagram asking about coning and why it was such a big deal. Honestly, it's a good question because I think there's a lot of messaging out there to avoid coning, but explanations are not really given. Just giving it a quick Google, I see lots of articles on preventing and treating a diastasis - but no explanation as to what's going on. I've had a draft of this blog post in the works for months but never had the time/motivation to finish it until now.

First off- a diastasis rectis is pretty much guaranteed to occur with every pregnancy that makes it full-term. It's the body's natural response to the growing baby and keeping it from smushing all your organs.

I had never heard of a diastasis until I was in physical therapy school, and I think it was only brought up because one of my classmates was pregnant, so our instructor assessed her for one. Because of my lack of knowledge up until shortly before I became pregnant, I expect many other individuals are quite unfamiliar with this naturally occurring process and it as a dysfunction.

Diastasis refers to "separation". Recti refers to the rectus abdominus muscle. Diastasis recti is the separation of the recus abdominus. 

Image from the Baby Center.

Image from the Baby Center.

This separation occurs along the linea alba, as pictured above. The linea alba is the line of fascia that divides the sides of the "six pack". 

For pregnant women, as the fetus is growing inside of them, space is needed so that baby doesn't smush all the vital organs in the abdominal cavity- so the abdominals stretch and eventually split. THIS IS NORMAL AND OCCURS IN 99.9% OF WOMEN WHO MAKE IT TO THE END OF THEIR 3RD TRIMESTER. Read that again. The reason why I don't say 100% is because there could be some insane outlier out there, but it is completely normal for a woman to have a diastasis at the end of her pregnancy. This is the body's way of dealing with that growing baby.

So ladies, don't freak out about a diastasis. However, it is important to avoid activities and movements that cause "coning". For those that are unfamiliar with coning or "doming", here's a picture of it occurring during my pregnancy.

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Coning

Source: TheMovementMinistry on Instagram

Coning is pressure not being managed by our body. Intra-abdominal pressure or IAP is normal and many lifters use it to lift heavy, utilizing breath holding or valsalva techniques (post to come on that). However now there's a fetus growing in your uterus, taking up space and causing your belly to grow outward- completely normal. If you try to do something that requires too much abdominal contraction and they can't contract well because there's something growing inside, coning can occur. Sometimes coning can be managed with breath and strategy. Sometimes not. If you experience coning that you cannot make go away, please stop that movement.

After giving birth, some women's diastasis may heal in a few days or weeks. Others may take months. I'm personally in the months group. It is important after giving birth to give our body time to rest, heal and adapt to the new lifestyle as a mother. Many women want to get back to working out, however that healing time/"4th trimester" is so critically important. Giving birth, whether vaginal or cesarean, whether it went well or not as good as one would've hoped, is traumatic. We give people weeks and months to heal from orthopedic surgeries and injuries, but for some reason social media likes to pressure moms to "bounce back".

Unfortunately we don't just "bounce back". Our bodies underwent massive changes over 9 months, muscles were overstretched and it all doesn't magically resolved in a few days (though it would be wonderful if it did). Hormones are going crazy, which certainly doesn't help. After allowing time to heal, we have to consciously work to get everything working together again- and by that I mean the core: rectus abdominus, transverse abdominus, obliques, pelvic floor, diaphragm, multifidi and erector spinae. Most of the time, this conscious effort is necessary, just slowly easing back into things isn't enough if the system is not functioning quite right. 

As a physical therapist and Pregnancy & Postpartum Athleticism coach, I highly recommend going to see a pelvic floor physical therapist upon being cleared by a physician to return to working out/activity. They can formally assess and accurately measure a diastasis, in addition to checking pelvic floor function. They can then give exercise recommendations and strengthening/stretching to do to address any dysfunctions.

Coaches and trainers, it is important for you to be looking for and monitoring this in pregnant and postpartum clients. A majority of women cannot feel coning, myself included. The only way I know if I cone is if I watch my abdominals, or have someone else watch. This should go without saying, but I'm going to say it just in case- you should not be working with a client who has not received the all-clear from her physician to begin exercise.


Coning & Postpartum - is it still a big deal?

So we know that coning during pregnancy is something we want to avoid, as we don't want to further stress an already stressed & stretched system of tissue. But what about postpartum? Is coning still something we need to monitor? Yes and no.

It does take time for a diastasis to heal- everyone is different in the amount of time needed. As I stated above, mine has taken months (10.5 months postpartum currently) & it's pretty closed. It'll probably close a little bit more once I'm no longer nursing. As the tissue was healing & the linea alba was rebuilding, I didn't want to do things that consistently caused coning. This would have delayed the healing and/or prevented healing from occurring. 

If there's some coning with movement, BUT it can be decreased or go away completely with adjusting posture, breath, activating deep core muscles, then it can be okay to do. Stressing the system in a small, controlled amount is ok- that's what we do every time we workout. 

But why do we need to watch out for coning postpartum?

  • Coning can be a sign of decreased trunk/core strength. Decreased strength of the core can be linked to impairments such as low back pain, pelvic pain.

  • The stress that coning puts on the abs can cause/continue to have weakness in the core noted. Consider this, if there's a separation of abdominal muscles, they're not able to generate as much force as if they were able to contract together with minimal to no abdominal separation.

  • Due to the stress that coning puts on the linea alba, an umbilical hernia can develop.

  • Coning can cause a distorted pull on the fascia. Take a look at the pictures below from "Anatomy Trains". You can see how the rectus abdominus ties into the hip flexors and even the pecs- it can affect both the shoulders and lower body.

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Diastasis can persist into postpartum with no symptoms. However for many of you reading this, you're probably CrossFitters or other high level recreational athletes - powerlifting, body building, running, Olympic lifting, etc. Because of the significant demands we place on our bodies with our activities, having a diastasis should not be taken lightly. Meeting with a PFPT and getting the pelvic floor assessed in addition to checking for a diastasis can give direction with training. If there is a diastasis, trying to minimize or "close" it is something that can be done. I strongly caution you to avoid programs that guarantee to fix or close a diastasis- because everyone is different. What might be appropriate and good rehab for one individual to close a diastasis, won't work for someone else.

Hopefully this helps provide some clarity on what coning is, what a diastasis & what this means during pregnancy & postpartum. A diastasis and coning is certainly not a death sentence & doesn't mean that we can't do ab work or the things we want to do again. Instead, we need to learn to reconnect with our body- which is a bit different now after growing and bringing a human into the world.