The Do’s and Don’t of Diastasis Recti

Posted on Posted in All Posts, Let's Get Technical, Women's Health
 

Hello all,

As a physical therapist, I have had a number of patients coming in with questions about their diastasis recti. As you may remember from my previous post, I recently had a baby and since then, the question of how to treat a diastasis recti has been on my mind. This seems to be an issue shrouded in concern and fear for many women, so let’s talk about it.

WHAT IS A DIASTASIS RECTI? Well, the rectus abdominus is a muscle that runs vertically along your abdomen from your lower sternum to the pubic area. It’s the muscle that creates the “six pack” aesthetic, if toned, in those with low amounts of abdominal body fat. It also functions to forward bend your trunk, and participates a bit in the stabilization of your spine (although it’s not the main player). A DIASTASIS RECTI IS WHEN THE CONNECTIVE TISSUE BETWEEN BOTH HALVES OF THE RECTUS ABDOMINUS STRETCHES OR SPLITS.  This happens commonly in pregnant women as their abdomens grow, with some studies suggesting that it occurs in up to 66% of women in their third trimester of pregnancy (Lee, 2011). It can also arise in people that exercise incorrectly or in men with large bellies.

diastasis recti
Typical abdomen vs a Diastasis Recti abdomen

Having a diastasis recti can contribute to lower back pain, pelvic pain, and incontinence. Therefore, treating it and correcting the loss of abdominal stabilization is important. In order to know if you have this issue, the test is pretty simple:

Lie on your back with your knees bent and place your fingers in the center of the rectus. Gently lift your head and shoulders off the ground and see how many fingers you can fit in the space between your abdominal muscles. You can test at the belly button, slightly above, and slightly below. If you can fit 2 or more FINGERS, you may have a diastasis recti.

If the test is positive, it’s time to go to your OBGYN or MD and get a referral to PT, or if you live in a direct-access state like New York, call your physical therapist office directly and make an appointment. We can help!

Now, if you have a diastasis recti, THIS IS NOT A CAUSE TO PANIC.  For women, a natural reversal of the separation will be seen at about 4 weeks post-delivery (Gilleard and Brown, 1996).   After that, the diastasis will typically not close further unless you do targeted activities to address it. So, if you have a diastasis recti and have delivered over 4 weeks ago, it would be a good idea to figure out some strategies to help improve generalized muscle activation and closure of the muscle. There are ways to diminish the size of the diastasis recti while also improving abdominal control. First things first: speak to a pro! Find a physical therapist or educator in your community who specializes in working with diastasis recti. For women, especially those who are pregnant or were pregnant, this might mean finding a PT that focuses on women’s health or works with women postpartum. At THRIVE, although we are not specifically a women’s health practice, all the therapists on staff are qualified to work with women pre-delivery and postpartum with this condition. We help our clients to work on abdominal activation, pelvic floor activation and relaxation, and movement re-education so that they can feel confident and strong with all movement and exercise tasks. We can also educate you on whether or not you might use a supportive brace to help with spinal support or prevention of increased separation.

YOU CAN ALSO START TO WORK ON THE PROBLEM AT HOME. Often times, the issue is not just the rectus abdominus muscle but a generalized abdominal activation problem. Specifically, you want to be sure that when rolling in bed, sitting from a reclining position, lifting, etc. that you are not bearing down on the abdominals for support but rather are gently drawing them in. A way to practice this at home is as follows:

• Lie on your side or back with your knees bent

• Start by working on breathing into your lower rib cage.  Put your hands on the sides of your lower ribs, and think about filling up that part of your ribs on the inhale, and then letting them gently descend towards mid-line on the exhale.  Don’t squeeze or push on the exhale, just check that movement is occurring as your ribs relax down.  Focus on your breathing for 3-5 minutes.

• Now, work on gently engaging your lower core. This action should be very subtle, and should not involve pushing out the abs.  Instead, it is a gentle drawing in of your pelvic floor by lifting up and in on the area between your anus and pubic bone, and widening across the front hip bones.  Less is more, don’t overdo it!  Try this over 10 cycles of breaths, coordinating this action with the exhales.

You want to gently draw in your abs when rolling in bed, standing from a lying down position, and when lifting. Again, diastasis recti is made worse with a bearing down or pushing out action, so really tune into whether you notice that happening. There are also some positions to avoid while you await treatment. Don’t do sit-ups, planks, major lifting, or things that stretch out your front body like upward dog.

Diastasis recti is a common problem but one not often addressed with immediacy or correct techniques. EVIDENCE SUGGESTS THAT STRENGTH AND CONTROL CAN BE RESTORED ACROSS THE MIDSECTION WHEN APPROACHED WITH CARE AND GOOD INSTRUCTION. And for many, the closure can be reduced. Ultimately, the goal is being able to safely return to full activity without pain and without limits!

Cheers,
Elizabeth Shah, PT, DPT, OCS


References:
1) Mombod Fitness: Fit Moms to the Core. Viewed 14 December 2015, http://www.mombodfitness.com
2) Lee, Diane. (2011). The Pelvic Girdle. Churchill Livingstone, Elsevier.
3) Gilleard, W, Brown M. (1996) Structure and function of the abdominal muscle in primigravid subjects during pregnancy and the immediate postpartum period. Physical Therapy, vol 76 (7), 750-762.
4) The Physiotherapy Clinic: Diastasis of the rectus abdominus muscles. Viewed 14 December 2015, http://www.physiotherapyclinic.com.au/attachments/diastasis_abdo.pdf

image via mombodfitness.com


Elizabeth D'Annunzio Shah Physical Therapist New York CityElizabeth D’Annunzio Shah, PT, DPT, OCS, MTC works with patients of all ages and abilities including recreational athletes, professional dancers and performing artists. She has a special interest in vestibular and balance disorders, movement theory and creative solutions for both neurologically and musculoskeletally impaired persons. Elizabeth is passionate about exercise as a means to maintain health, manage stress and enjoy life! She practices yoga in the Iyengar tradition, is an avid surfer, and participates in distance running events whenever possible. (more)