What is diastasis recti or abdominal muscle separation and do I have it?
Have you ever done a crunch, plank, or a pull up and noticed your abdomen bulging, coning, or doming? Have you looked on the internet and seen photos or heard of diastasis recti or abdominal muscle separation? There is a lot of old advice floating around about what you should or shouldn’t do such as never do crunches again, don’t do any core exercises like double leg lifts, and don’t do any heavy lifting. It can be kind of depressing and scary.
What is a diastasis recti? It is a separation in the rectus abdominis muscle which is your six-pack muscle or large front abdominal muscle. Our rectus abdominis muscle has two sides, a left and right side separated by the linea alba which is a band of tissue that runs down the middle. All pregnant women will have a separation of this muscle by the end of pregnancy due to the growing uterus/baby causing the linea alba to get wider. This area is very elastic and typically retracts back after some time. When this gap is larger than normal it is referred to as a diastasis recti. This can make your belly appear to stick out more at, above, or below the belly button or cause a bulge, coning or doming appearance when you do certain exercises. This can also happen if you haven’t had children and in men. For men if this occurs it’s usually over the age of 50 years old and when they have put on some abdominal weight that can stress this area.
This abdominal separation or diastasis recti in the postpartum period usually closes by 8 weeks postpartum but about 40% of those who have a diastasis recti will still have it by six months postpartum. This is typically assessed by lying on your back and doing a crunch motion while feeling above, at, and below the belly button. A positive test is greater than 2 fingers distance of separation or a “sinking” of fingers which tells us the tension of the muscles is not as strong or loading well. It's important to remember there is always a gap here and the goal is not full closure. After having a pregnancy it's normal for this gap to be slightly larger than in women who have not had a pregnancy.
Risk factors include genetics, multiple pregnancies especially if close together, having multiples such as twins or triplets, small petite frame size, pushing during a vaginal birth due to increasing abdominal pressure, and being over 35 years old during pregnancy.
Treatment consists of manual therapy techniques to make sure the abdomen and underlying viscera is moving well and evenly to decrease stress to this area. Checking for postural deviations which may be contributing to the lack of closure or muscle activation such as a rib flare, poor standing posture, weak foot muscles, weak core or back muscles. We want to make sure all the abdominal muscles are working together and not overpowering the deeper core muscles such as the transverse abdominis. For example, we check how the internal obliques, external obliques, rectus abdominis, transverse abdominis, pelvic floor, and diaphragm are coordinating and if they are working optimally together.
I wish it was as easy as just doing exercises but it's not always. We have to look at the whole body to see if other areas are affecting the closure or over stressing the diastasis recti and treat those as well. Poor pressure management, abdominal clenching, and pelvic floor involvement are examples of dysfunctions which can affect this area as well. Other factors include genetics and breast feeding. Physical Therapy and trainers certified in treating this condition can be hugely successful in getting you feeling strong and back to doing your work outs without worrying about your diastasis recti. Sometimes we have to stop focusing on the amount of separation and just make sure everything is optimally firing and you are no longer symptomatic. If all these things have been trialed and it continues to be problematic, surgery is also an option for more severe cases, in combination with hernia repairs, or a tummy tuck procedure. As everything, surgery has its own risks and benefits.
If you have ever wondered “do I have a diastasis recti or not” or “I’m not sure what to do to get my core strong again postpartum” we are here to help you. At dynamic flow physical therapy we offer free diastasis recti screenings where we will assess your musculature and give you tips to treat/modify your program if you do have separation, or give you the confidence to stop worrying about it and start strengthening! I find often both extremes happen where women are so scared to get back to their pilates classes, heavy lifting, crossfit, or work outs since they think they have a diastasis recti or they are doing all their work outs and ignoring the symptoms of a diastasis recti. We are here to help, reach out if you're interested to schedule your free assessment and share this information with your family and friends!