Diastasis recti, or abdominal separation, is something that we see a lot when working with Moms. So often, that it serves as a great teaching tool for physiotherapy students! Read below, for what my lovely PT student Danielle learned about this condition over the summer.
Diastasis. Recti. These are two words that strike fear into the hearts of women pre-natally and post-natally all over the world. This fear typically begins as you start to notice changes within the abdominal wall that are associated with pregnancy. If this is the first time you have heard these two words strung together, excellent. It’s time to set the facts straight on what an abdominal diastasis is and begin to understand what to monitor for and how it can be treated.
To begin, it’s important to understand the anatomy that is commonly associated with a diastasis recti. If we start on the outside, the first muscle that we will encounter is the rectus abdominis, more commonly known as our six pack muscles. 1 The rectus abdominis starts at the bottom of the rib cage and spans down to the pubic bone in the front. 1 This muscle has a separation down the middle of your abdomen that is joined with a connective tissue called the linea alba. 1
The second group of muscles that needs to be recognized is what we call the Core.2 The core consists of 4 deep muscles that work in synergy to transfer loads and aid with stability.2 The four muscles that are incorporated in the core include the diaphragm – which sits on the top at the level of the lower ribs and is involved in respiration.3 The second muscle is the erector spinae which follows up the spine and has a large role in stabilization of the spine.2 The bottom of the core is the pelvic floor.2 And the fourth muscle, which lies beneath the rectus abdominis, is the transverse abdominis.2
Now that you have a better understanding of the muscles that are involved, it’s time to discuss what a diastasis is. A diastasis recti, in simple terms, is a separation that can occur between the rectus abdominis (your 6-pack muscles) during pregnancy. 3 This occurs as the linea alba (the connective tissue between the rectus abdominis muscle) stretches to accommodate for the growing baby. 3
Great! Now you know a whole lot about the anatomy of the body, and what exactly happens to the muscles and tissues when you’re pregnant. Why do we care? Research supports the idea that connective tissue within the low back, abdominal and pelvic region plays significant roles in the typical functioning of our muscles, our ability to control when we urinate or have a bowel movement, as well as how we breathe. 4
To understand this better, it’s easiest to picture the deep core and the outer core as systems that work together to control pressures within the abdomen, ultimately leading to better stability. 4 When a weakness develops in one of these systems, we begin to notice potentially harmful effects. 4 These can include anything from pelvic pain, incontinence (leaking urine), or dissatisfaction with the appearance of our abdominal muscles. 4
Now that you understand a diastasis recti, the next logical step is to assess whether or not you have a one! A quick test for the lay person, is to lay down on your back and bend your knees with your feet on the floor in a comfortable position. Now, bring your chin to your chest by lifting your head off the ground. Did you notice your stomach creating a little dome? These changes to your abdomen might indicate you have diastasis recti.
Take a deep breath! This isn’t the end of the world and doesn’t need to be something that elicits fear or hopelessness. With the proper knowledge and the right coordination of your deep core, you can actually control the appearance and function of this area in your body. Fortunately, there are many things that can be done to help improve this condition without surgery. This doesn’t have to be a lifelong issue. It would probably be a good idea to get checked out by a pro, like a pelvic floor physiotherapist, who can safely work with you to improve the strength, function and possibly appearance of your abdomen.
Danielle Savoie, PT Student
References:
1. Hickey F, Finch JG, Khanna A. A systematic review on the outcomes of correction of diastasis of the recti. Hernia. 2011 Dec 1;15(6):607-14.
2. Nelson N. Diaphragmatic breathing: The foundation of core stability. Strength & Conditioning Journal. 2012 Oct 1;34(5):34-40
3. Benjamin DR, Van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014 Mar 1;100(1):1-8.
4. Lee DG, Lee LJ, McLaughlin L. Stability, continence and breathing: the role of fascia following pregnancy and delivery. Journal of bodywork and movement therapies. 2008 Oct 1;12(4):333-48.
