Crunches for Diastasis Recti Abdominus (DRA): To Crunch Or Not To Crunch?

Are Crunches for Diastasis Recti Abdominus a Good Idea? Let's Discuss.

What does the most recent evidence say about the best exercises to rehab from DRA?

Diastasis recti abdominis, more commonly seen as DRA, is an extremely common condition that occurs in almost 100% of pregnant women, and is still present in about 32% of women 12 months postpartum (Theodorsen et al). 

This article covers:

• The definition of a Diastasis Recti Abdominus (DRA)
• How to know if you have a DRA
• Dispelling myths about abdominal exercises during pregnancy and postpartum

So what exactly is Diastasis Recti Abdominus? 

During pregnancy, a stretching of the abdominal muscles down the midline and the connective tissue between your “6-pack” muscles (or your rectus abdominus muscle) weakens and stretches; this can linger as a palpable and sometimes visible gap in the postpartum period. This appears as either a bulge in the middle of the abdomen (coning or doming), or a visible gap (invagination) during an abdominal contraction.

How do I know if I have this condition?

There is still no consensus for diagnostic criteria (Theodorsen et al, Skoura, Gluppe), however it is common in clinical practice to use a width greater than two finger-widths anywhere along the linea alba (the connective tissue I mentioned earlier) AND having the tension assessed at your deeper abdominal muscles (your transverse abdominus or TA). If you are currently pregnant, you likely have this separation by the last few weeks of the third trimester to make room for the baby – and this is normal (Skoura, theodorsen et al). 

Can I do crunches while I’m pregnant?

Previous advice during pregnancy told women to stay away from crunches, and any concentric (shortening or lifting) contractions of your rectus abdominus muscle. Which if you think about it, this is hard to avoid with daily tasks of life. However, the latest research found the separation of DRA actually shortens the most with crunches and sit-ups compared to pelvic floor exercises and deep core stability exercises (Theodorsen et al, Skoura). This is not to say don’t do pelvic floor and deep core exercise, as they are very important to help with stability during pregnancy and postpartum. It is just to support the principle that crunches aren’t as scary as we’ve previously thought, and in fact, can be beneficial during pregnancy. 

What about if I still have this separation after 6 weeks postpartum?

It has been traditional in rehabilitation of this condition to advise patients to avoid activating the rectus abdominus muscle during exercise, as you would during a crunch or sit-up. Traditionally, the most common exercises to treat DRA have been exercises to target the “deeper core” muscles; transverse abdominus, internal obliques, and the pelvic floor with exercises such as a drawing in maneuver, bridge, head-lift, and bird-dog (Poppe et al). This has been supported especially early on, when the patient cannot perform an abdominal contraction, such as during a sit-up, without coning, doming or invagination ocurring. The literature has reported on a wide-range of type and dosing of exercises, making it difficult to come to a consensus for an agreed upon rehab protocol (Guppe). In the most recent review in 2024, again, there was a wide range in exercises used, but good news- many different forms of abdominal exercises were helpful in reducing the separation and improving function including: deep and superficial abdominal training, pelvic floor muscle training, respiratory maneuvers such as hypopressives, functional exercise (squats, planks, bridges), and yoga (Skoura). 

To summarize, crunches are actually not always contraindicated in the case of DRA as we previously thought, and actually beneficial during pregnancy. Early postpartum should focus more on the deeper core muscles and when it is appropriate to add a crunch or sit-up back into your exercise routine can vary person to person (Skoura, Poppe et al). It is best practice to get evaluated by a physical therapist who can evaluate your strength, coordination, and function and give you an exercise program that is most tailored to you. 

At Femina Physical Therapy, all of our physical therapists have specialized training to address postpartum rehabilitation and will work with your other healthcare providers in a collaborative manner to maximize your function and quality of life. Reach out to our team to get started.

Resources:

Gluppe S, Engh ME, Bø K. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis. Braz J Phys Ther. 2021;25(6):664-675. doi:10.1016/j.bjpt.2021.06.006

Berg-Poppe, Patti PhD; Hauer, Michaela BS; Jones, Cassandra BS; Munger, Mattison BS; Wethor, Cassidy BS. Use of Exercise in the Management of Postpartum Diastasis Recti: A Systematic Review. Journal of Women's Health Physical Therapy 46(1):p 35-47, January/March 2022. | DOI: 10.1097/JWH.0000000000000231 

Skoura A, Billis E, Papanikolaou DT, et al. Diastasis Recti Abdominis Rehabilitation in the Postpartum Period: A Scoping Review of Current Clinical Practice. Int Urogynecol J. 2024;35(3):491-520. doi:10.1007/s00192-024-05727-1

Theodorsen NM, Moe-Nilssen R, Bø K, Haukenes I. Effect of exercise on the inter-rectus distance in pregnant women with diastasis recti abdominis: an experimental longitudinal study. Physiotherapy. 2023;121:13-20. doi:10.1016/j.physio.2023.08.001