To splint or not to splint? That is the diastasis recti question.
Some experts say you absolutely must splint 24/7 to “heal” the connective tissue, while others suggest splinting will weaken your muscles, aggravate pelvic organ prolapse, or, ironically, leave you unable to shorten the connective tissue.
In typical Motherfigure fashion, I hedge on this question. This doesn’t mean I haven’t thought about it. Oh, have I thought about it. I’ve even tried half a dozen different splints and tracked the progress of my diastasis recti while wearing a splint versus taking it off.
In a nutshell, I’ve come to the conclusion that splinting’s helpfulness depends on how much stability you need. Therefore, it’s probably a useful tool for some women. However, I don’t think a splint will permanently close a damned thing (read more about my specific experience here).
Let’s break down the two sides of the splint debate.
Some DR programs insist on splinting as the foundation of diastasis recti healing. Indeed, the first program I tried had me wearing a splint ALL THE TIME, with the admonition that if I removed it, my progress would revert back to ground zero.
The rationale for constant splinting is the belief a diastasis recti needs to heal and that this healing is accomplished by approximating the two sides of the rectus abdominis. According to this theory, the gap gets smaller as the transverse abdominis and the splint both narrow the waist. Or something like that. (Sidenote: Static transverse abdominis pulses DON’T narrow the inter-recti distance. That’s not how our anatomy works).
Splinting proponents often compare DR to a broken bone or cut skin. They reason, if we compress broken or cut tissue, we should also compress the abdomen as it heals.
These arguments have some logical flaws that I will discuss after explaining the anti-splinting position.
Some other DR programs insist splinting is a horrible idea. They say splinting will cause the muscles to rely on external support. They say splints will push the contents of your belly downward. They also imply splinting will prevent the linea alba from rebuilding connections and, therefore, from shortening. Sometimes the warnings about splints are quite dire: You will lose strength. You will cause prolapse, etc…
What should we believe?
Let’s break down the arguments and try to figure out if splinting is the one true path to DR closure or, conversely, the main obstacle to strength and stability.
First, let’s establish that we don’t have direct evidence for either splinting or “un-splinting.” Therefore, we must analyze the logic behind each camp.
Dissecting the Arguments
The pro-splint argument bothers me because it relies on the assumption that a diastasis recti can be “healed.” The physical therapist Diane Lee rejects this word because it confuses women.
Diastasis recti is caused by stretching of the abdominal muscles and the connective tissue surrounding these muscles. It is not a tear. That would be a hernia. Sure, the tissue has likely experienced some micro-tearing to facilitate stretching, but this is different from an acute injury. Also, DR is neither a sprain nor a break. Consequently, diastasis recti cannot be healed in the traditional sense. It can be narrowed. Muscles can be strengthened. Function can be managed (sometimes without narrowing). But, that’s it. Healers need not apply.
Additionally, I just don’t see how smooshing the two sides of the rectus abdominis together will shorten the linea alba. Both the pro-splinters and the anti-splinters acknowledge the necessity of exercise to PULL on the linea alba. This pull is the best and only chance for the connective tissue to strengthen and possibly shorten.
Admittedly, I’m unclear on the exact mechanisms for shortening, and I have yet to read a good explanation, which makes me think the “experts” are also unclear. Nonetheless, if we agree the muscles need to pull on the connective tissue to strengthen it, then wouldn’t compressing the linea alba take away all the necessary tension? This is the argument many anti-splinters make.
I tend to agree with the anti-splinters that keeping the linea alba artificially and perpetually compressed might inhibit tension through the midline. If you think of the linea alba as an overstretched rubber band and the muscles as two hands pulling on the rubber band from all directions, folding the rubber band on itself will decrease the amount of tension the rubber band can generate.
Muscles and connective tissue work together to transfer force through the body. Some therapists worry folding up this connective tissue like a rubber band will prevent the inner most muscles from stabilizing the body.
One side of the debate believes splinting combined with exercise will shorten the connective tissue, while the other side believes exercise alone is necessary for this shortening. Since the pro-splinters acknowledge the necessity of exercise, I wonder how they address the tension paradox. Muscle contraction pulls, not pushes, on the linea alba. If we need this pull, is splinting inhibiting it?
Does this mean we shouldn’t splint?
Well, maybe, maybe not.
Both sides of the debate assume the connective tissue will shorten over time. And personal experience suggests it very well may. However, we don’t know if a splint actually inhibits this shortening. Theoretically, as stated above, it could. But…
If the muscles and tissue are so stretched that they can’t generate enough tension, perhaps compressing them a little will allow them to work harder, which in turn will allow more pull and thus more eventual strength.
Also, exercise induced pull might not be strong enough to cause changes to tissue structure. Therefore, perhaps the size of the DR shortens because the muscles themselves are getting stronger and more compact, thereby taking some stretch out of the connective tissue. If this is the shortening mechanism, rather than linea alba reconstruction, splinting a large DR might allow the muscles to work more effectively, which in itself might narrow the gap. Or not. I don’t know.
Since the mechanism of DR narrowing is blurry, the solutions are also out of focus, which is why this whole debate even exists.
Overall, I don’t think splinting is always bad, but neither do I think it is always necessary. Even if splinting could theoretically help facilitate muscle contractions for very large DRs, its long term efficacy is dubious. Personally, any shrinking I saw while wearing a splint disappeared a couple weeks after removing it. Thus, a splint’s main benefit might simply be providing stability so you aren’t afraid to move. The moving, not the splinting, is the most important part.
Ah, but what about immediately postpartum?
If a splint isn’t healing anything in the long term, what about right after childbirth? Well, if you are going to splint, this is the best time to do it. In the first 6–12 weeks, a splint may encourage the connective tissue’s natural recoil. I wore a splint after the births of my second and third children, and I noticed a definite improvement in the size of my postpartum gap compared to after my first child.
Again, think of a rubber band. A stretched rubber band will shrink back to size after a force is removed, assuming the initial force wasn’t so hard or so prolonged that the rubber band became permanently stretched out.
Obviously, biological tissue is more dynamic than a rubber band, which is why connective tissue can probably shorten. Nonetheless, the general visual is similar. Immediately after childbirth when the force of pregnancy is removed, the tissue starts to recoil. Perhaps splinting can help with this. However, if the tissue has been stretched past its recoil point, no amount of splinting will close it. At that point, you’re just crinkling up the saggy rubber band, kinda like wrapping your face really tightly to restore collagen and erase wrinkles. Once you remove the wrap, the wrinkles will come back.
This is all conjecture by the way. Maybe splinting isn’t doing any of that.
If you decide to splint, make sure you choose wisely. A too tight splint or one that shifts around can push your abdominal viscera downward to your pelvic floor. This is bad. Really really bad.
A good post-pregnancy splint will create some stability for the abdomen, while also allowing you to breathe naturally and without putting pressure on your pelvic floor. Not all splints are created equal and creating this balance is tricky (see the resources page for ones I like).
Where I fall on the splint spectrum
Overall, I think splinting’s benefits are drastically overstated. I don’t think a splint will close a diastasis recti. I don’t think splints will help “heal” connective tissue that has been stretched, and I don’t think splints are permanent solutions to the gap.
However, neither do I think splints are all bad. When I was pregnant and experienced severe back pain, a splint was my best friend. It single-handedly removed the pain. That’s no small feat.
Similarly, post c-section, a splint made me feel like I could function again. It didn’t make my muscles atrophy. If anything, the splint encouraged movement, which kept me active.
I also believe a splint could benefit women with large gaps or very unstable cores, whether they are immediately postpartum or not. Again, the splint by itself won’t rebuild the tissue, but it might encourage stronger, more stable abdominal contractions, and those contractions are key. Whether this encouragement is psychological or physical doesn’t matter. Anything that helps women move smartly is a-okay in my book…as long as it doesn’t become a crutch or isn’t worn for months on end.
The Bigger Picture
Ultimately, a splint might “remind” your muscles how to function closer together. It might help alleviate back pain in the short term. But I’m unconvinced it single handedly restores connective tissue. Prolonged use might even prevent adequate pull on the linea alba, pull that is necessary for sustained stability and function.
Oh, and you’ll notice that one splinted program talks about the need to periodically re-splint if the DR “opens” again. What the what?! This completely invalidates their entire argument for splinting. If the splint had helped “heal” the DR, why would it reopen? Therefore, even this program unintentionally acknowledges that the splint is just superficially moving the rectus abdominis closer together. If the connective tissue had permanently shortened, re-splinting wouldn’t be necessary. In my experience, progressively harder exercise permanently changed my tissue structure, not any of the splints I tried.
Frankly, if your tissue can’t transfer force between the muscles, you might need surgery. A splint won’t change that. Whether you can avoid surgery will depend on your particular anatomy and your ability to strengthen and retrain your abdominals in the long term (which, again, is related to your particular anatomy).
I’d be skeptical of any program that says a splint is absolutely necessary for the program to “work.” I’d also be skeptical of anyone who says you should never ever splint (my midwife tried to warn me against my pregnancy splint because she worried my muscles would weaken. I ignored her because I had to take care of my toddler, and I preferred to do so without back pain. I’m glad I listened to my body’s cries).
The debate between the pro-splinters and anti-splinters points to a larger problem with diastasis recti advice: We aren’t going on a lot of information.
This absence of evidence leads practitioners to swoop into the cracks. Internet banter might give the illusion of robust research, but the online experts (that includes me) are just fiddling with limited evidence to come up with a possible solution. Mostly, we don’t know what we are talking about. Some of the guesses are pretty good. And some seem to be falling down the wrong rabbit hole.
So, to splint or not to splint? If you want stability, go for it, but if you think it will heal your belly, proceed with caution.
Want to know more about diastasis recti? Check out the essay “Why Diastasis Recti Experts Disagree.”