Diastasis Recti: Diagnosis & Healing



What is Diastasis Recti?

A Diastasis recti or (DR) is a separation of the two sides of the rectus abdominis (RA) muscles that run vertically down the middle of your belly. The two sides of your RA are connected in the middle by connective tissue, the linea alba, which sits behind your belly button and runs from the bottom of your rib cage down to the top of your pubic bone. This connective tissue is made of collagen and connect the two sides of RA together. During pregnancy as your baby and uterus grows larger the muscles of your abdomen must stretch and shift position slightly to accommodate its growing size. In the first instance your linea alba stretches vertically from top to bottom and when that capacity is reached it then begins to stretch horizontally form left to right. This causes the linea alba to stretch wider than its normal size and the two sides of muscle to sit further apart. This is known as a DR. It is worth noting that though a DR is mainly concerned with the linea alba, all muscles of your abdomen will have stretched including the transverse abdominis that wraps around your waist like a corset and the obliques which sit at the sides of your torso and connect your rib cage to your pelvis.

This results in a weakened core and associated problems.


Diagnosing a DR

A DR is measured in finger widths. When a gap of 2 fingers width or more exists either above, below or at the bellybutton a DR is diagnosed. If a gap of one finger or less exists then it is not classified as a DR but rather a natural sized gap. This can be diagnosed by a doctor, trained Fitness professional, physiotherapist or trained tissue therapist.

You can also self-diagnose using the technique outlined below.


Self-diagnosis:

  1. Position yourself safely into a position on the floor lying on your back:

  2. Bend your knees and place your feet flat on the floor

  3. Ensure that your knees and feet are hip width apart

  4. Starting at your bellybutton place two fingers on the mid-line of your abdominal

  5. Now exhale as you lift your head and shoulders off of the floor in a mini crunch and hold that position whilst you feel for the gap.

  6. Press your fingers down and wiggle gentle from side to side to feel the edges of your RA muscles.

  7. If there is room for another finger place it there as well and wiggle to check the fit.

  8. Lower yourself back gently to the ground.

  9. Repeat above and below your belly button to assess the gap as it may differ in width.

If you find you can fit 2 or more fingers in the gap then you may wish to seek the help of a trained professional to help you heal your DR and rehabilitate your core.


Common problems associated with DR

The cores muscles perform important functions such as protecting and holding in your vital internal organs, stabilising your spine, managing increases in pressure when you lift or move your body weight or external load. They also have effects on the function of other vital core muscles that they connect to such as your diaphragm and breathing, pelvic floor and incontinence. Hence the following problems can develop and persist if the core is not rehabilitated and the whole body not treated.

  • Poor breathing technique

  • Increased risk of umbilical hernia

  • Poor posture

  • Weakened core

  • Back pain

  • Stress incontinence

It's also worth noting that a DR can exist whilst not causing any of the above problems and in such cases the only real problem would be the unwanted aesthetics of the DR causing a protruding belly or mummy tummy.


What makes a DR worse?

DR can be worsened by engaging in any exercises or activities that place too much strain on your core by adding too much rotation of the torso, external load (weights), impact (jumping/running) or bodyweight activities that increase internal pressure e.g.:

  • Twisting core or oblique exercises as they pull the muscles further apart

  • Crunches, sit-ups or planks as they increase pressure and distend the belly

  • Heavy weight lifting as it increases pressure

  • Activities that promote poor posture and muscular imbalances e.g. one side baby wearing or carrying etc.

Once a DR is healed and/or load can be managed effectively then these activities can be gradually added back into a progressed exercise programme.


Healing a DR

In most cases a postpartum DR will naturally heal itself as the linea alba heals and contracts and the two sides of RA muscle are knitted back together. All that is required is rest, adequate nutrition & hydration, correct postural realignment, proper breathing techniques and not doing activities that can make the problem worse or delay healing.

This natural healing can take anywhere from 6 weeks to 6 months until the gap is closed.


However for some women a Dr will persist and a dedicated holistic approach is required to heal the gap including addressing:

  • Breathing strategies

  • Posture and ligament from head to toe

  • Specific Nutrition & hydration for healing

  • Altering lift and managing load/weight awareness

  • Ceasing movements and exercises that make DR worse or delay healing

  • Commencing a specialised rehabilitation programme that is not loaded

  • Progressing to an exercise programme that is loaded

The aim of healing the DR will be to address any problems that it may be causing or contributing to such as weakened core, poor posture, incontinence, reduced body image etc. But it is mainly to ensure that the core muscles can now manage increase in pressure effectively, stabilize the core and spine safely and cope with carrying increased load and weight. If this can be achieved with or without the gap closing then a huge achievement has been made.


Sometimes we can be so focused on closing the gap and losing the look of the mummy tummy that we jump into doing the wrong exercise or try to take shortcuts. It is important to remember that a DR requires a holistic approach and it's worth taking the time to seek out a professional with specialist training who can help you to manage, heal and rehabilitate your DR and associated core issues by providing the following:

  • Thorough health, history and lifestyle

  • DR diagnosis

  • Identification of any factors contributing to your DR and address these

  • Prescription of a safe and effective exercise programme

  • A holistic support plan to increase success and prevent a return of DR

A specially trained fitness professional or women’s health physio will be able to do these things for you.

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