Diastasis Recti

Diastasis recti, also known as a separation of the abdominal wall, often happens during pregnancy. So what is a diastasis? A separation of the abdominal wall. The linea alba connects the two rectus muscles “6 pack ab” muscles. During pregnancy, this can become thinned, and stretched, and, in some cases, can become ruptured, that would be a hernia, and then it will come back together. […]

There is some research that states that no matter what, you’re going to get some degree of separation. However, you can minimize this with proper knowledge. A lot of women, after they have babies, express,”I just wanna close the hole in my stomach. I want to decrease my diastasis or decrease my abdominal separation.” Although I like to talk about decreasing that separation, it is really important to know that, clinically, it has not been shown that you actually decrease the separation w,hat shows is that you actually improve the tension of the tissue between the two six-pack ab muscles. The goal is to improve the tension that’s generated between the gap, and, therefore, then you won’t feel a gap as much.
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The other really important part of the puzzle is, it’s not really about, how it looks, really, we want to generate a good amount of tension so there is good tension between the tissue so you have good force absorption and pressure management. If there is a big hole in your stomach, and there is no tension in the linea alba, then what can happen is you actually have a pressure issue. You have abdominal pressure in your belly. If you don’t have good integrity of the wall on the front of the abdomin, then you could have a lot of bloating, or pressure, and then the other muscles aren’t working as well. If you think about your core as a pop can, and the pop can has pressure in it, once you open it, that pressure is gone so then you can squish the can. In this case, we’re looking at that “can” as the core. This is an example by Dr. Mary Massery, PT, DPT, DSc she uses this pop can analogy. The front of the belly is the front wall of your pop can. If there’s a hole in that, then, all of a sudden, you can squish the can. You want your core to be so strong that there’s not a hole in any piece of it. I am going to go on to tell you what the rest of this pop can looks like just so you have the awareness of what a good, strong functioning core is.The top of the pop can is your diaphragm, and the diaphragm is a muscle. When you breathe in and inhale you are contracting your diaphragm. So, on the inhale, the diaphragm contracts and actually pushes down into your belly. The diaphragm lives under your ribs. During pregnancy, your ribs will flare. With that rib flare, the diaphragm actually gets a little weaker. When the diaphragm is all stretched out, then you have a hole at the top of the pop can because that muscle isn’t as strong as it used to be. Now if you have a hole in the front wall, and the top of the can isn’t as effective as it used to be, you have a weakened core.

You have to retrain your diaphragm and retrain the front of the belly. The bottom of the pop can is your pelvic floor.That’s where you have your vagina, your anus, and your urethra, so pee, poop, and sex, and vaginal deliveries.Those all come out of the pelvic floor. If you have any scar tissue in that area, or if that muscle isn’t able to contract, and relax, and bulge, then you have a problem at the bottom of the can. The back of the can is your multifidi muscles. These are your low back muscles, and then I also throw in that these are your glute muscles. These help maintain integrity there. If you have low-back pain, these might not be working for you. And so, you could have a hole in the back of your can. It is really important to know that all of these muscles must coordinate and work together. When we’re talking about diastasis, we can’t just look at the belly. And, that’s why I’m telling you all of this. We can’t just look at the belly and say, “Oh, you have a diastasis. Let’s just focus on your core through your belly and that’s it.” That’s not how this works. If you have a diastasis, you need to know what’s happening in the pelvic floor, what’s happening in the diaphragm, and what’s happening with the low-back muscles so you can make sure you have a strong core and force absorber. Clinical diastasis is considered two finger-widths or more of separation. You need to make sure that you are activating the right muscles, and everything is coordinated so your core can be this awesome force absorber.

What happens if a diastasis goes untreated? Say you have a two-finger width separation diastasis, and you go 5, 10 years without getting treatment for this? What that ends up looking like is you just don’t have your core working for you. What happens is people end up with shoulder problems or hip problems, so your joints have to take up a lot more of the force. Because that means that there was a hole in the soda can, and so it was a lot easier to crush the soda can than to actually be a force absorber.We want that pressure within the can, and we want that pressure and tension to be normal so nothing is wearing out more than it should. If you have questions on this, definitely get help from a Pelvic Floor Physical Therapist so they can help make sure that you are doing everything accurately and appropriately.