WHAT IS DIASTASIS RECTI?

Diastasis Recti, also referred to as ‘Divarication of the Recti’, DRA or ‘Rectus Divarification’, is the widening of the gap between the 2 sections of the Rectus Abdominis (or 6 pack) abdominal muscle. The split occurs at the Linea Alba, the mid-line collagen structures of connective tissue at the front of the abdomen.

100% of women have some level of diastasis of the rectus abdominis in the third trimester.(Gilliard and Brown 1996, Diane Lee 2013)

Importantly, for many women the gap remains widened at 8 weeks, and left untreated, this distance at 8 weeks remains unchanged at 1 year postpartum. (Coldron et al 2008, Liaw et al 2011)

66% of women with diastasis recti have some level of pelvic floor dysfunction (Spitznagle et al 2007). Diastasis recti and pelvic floor problems tend to go together.

The Linea Alba (seam of tissue structures that form the meeting point of the 2 sides of all the core musculature) no longer provides tension and stability. ALL the muscles of the abdomen- Transversalis, internal and external obliques, as well as Rectus Abdominis – meet at this centre midline. So all are compromised. This lack of protection and stability affects the whole body both aesthetically and functionally.

WHAT DOES A DIASTASIS LOOK LIKE?

You may see a ‘pooching’ or ‘doming’ of your stomach, especially when coming up from a lying position on your back. Sometimes you appear still a few months pregnant. As well as the aesthetic concerns, diastasis recti is associated with a weak core (and pelvic floor). This can lead to a lack of strength and stability in the entire pelvic region and midsection.

WHAT CAUSES DIASTASIS RECTI?

Diastasis Recti is the result of excessive intra-abdominal pressure or loading. It is common in the later stages of pregnancy, particularly second or subsequent pregnancies. It is important to note though, that pregnancy does not cause a diastasis. The increased load and further shifts in alignment of pregnancy exacerbate the root problem: excessive, ‘un-contained’ intra abdominal pressure.

The Rectus Abdominis is only 1 of 4 layers of abdominal muscles: the Transverse Abdominis (deepest muscle layer) the Interior and Exterior Obliques (next 2 layers) that form your waist, and then the Rectus Abdominis is on the outside.

Unfortunately when the 2 parts of the muscle separate or come apart, the connective mid-line is stretched and weakened as it takes all other muscular and fascial support structures along with it. This leaves the front of the abdomen unsupported and unstable. This seam of connective tissue is designed to be taut, at full length and aligned in a vertical (breastbone to pubic bone) plane. But it cannot perform or function optimally when alignment is ‘out’. So it’s alignment we need to address to address a diastasis!

Diastasis Recti is a symptom of excessive and unsupported intra abdominal pressure. This is the same issue that creates other pelvic and abdominal problems including hernia and prolapse. DR should therefore be treated as part of an integrated program designed to re-align, re-connect and then strengthen the entire core musculature, rather than be addressed in isolation. The focus should not be only on ‘closing the gap’).

HOW TO TEST FOR DIASTASIS RECTI

Lie on your back with your knees bent and your feet flat on the floor. Relax your head and shoulders and place your fingers (palm facing you) just above your belly button.

Lift your head and neck very slightly off the floor and press down with your fingertips. If you feel a gap, that’s the diastasis. You will feel the muscles close in around your fingers as you lift your head and neck. Don’t lift your shoulders. Repeat the test in two other place: directly over the belly button, and a couple of inches below.

A diastasis recti gap is measured in finger width’s. You are aiming for a 1-2 finger gap or less, but don’t panic if it’s much bigger at first.

Even more important than the width of the gap though, is the tension (or lack of tension) in the midline – the linea alba. Contracting the muscles should create tension and resistance when you apply gentle pressure with your fingers to the midline. If it doesn’t – you have some re-connecting to do…

SHOULD YOU USE A SPLINT, BELLY BINDER OR ABDOMINAL WRAP TO BRING A DIASTASIS TOGETHER?

Postpartum abdominal binding has been traditional practice in many parts of the world for generations.In my experience, supporting the abdomen during and immediately after pregnancy may be helpful in some cases, and, used correctly, can help with awareness of the abs and for lower back support.

However, wrapping it up tight, pulling the two sides together… won’t make them heal or stay there. Don’t use a wrap or splint as a substitute for actually engaging the right muscles… otherwise you’re going to wearing that splint for a very long time.

Remember the diastasis is caused by excess loading and pressure within the abdominal and pelvic ‘canister’. A pressure that your body can’t withstand as it should. Wrapping it up in itself won’t fix it, it will just squidge your abdominal mass in a different direction (think of a tube of toothpaste squeezed in the middle…) You need to correct alignment and re-engage an entire SYSTEM of muscles and fascia to put your tummy back where you want it for the long term

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WHICH MOVEMENTS OR EXERCISES SHOULD I AVOID?

Crunches, sit-ups, oblique (twists) combined with crunches; anything that  ‘jack-knifes’ the body, by pivoting at the hip and placing strain on the abdominals – such as straight leg lifts or holds from lying on your back and similar Pilates moves.

MY YOUNGEST IS AT SCHOOL…! CAN I REDUCE MY DIASTASIS OR AM I TOO LATE?

Activating and engaging your core transverse abdominis muscle and learning to re-align and and strengthen your core and pelvis can be done at any stage postpartum and will improve the gap. If you did a lot of crunches and/or oblique crunches post baby, then you may have developed a ‘cone’ shape on your abdomen. This is where you have worked the muscles hard, but in the wrong direction. You may not bring the muscles back together completely, but you can definitely make improvements to strength, stability AND the way your tummy looks!

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WHAT EXERCISES WILL HELP CLOSE A DIASTASIS?

First, you need to FIND and connect with your deep core muscles. Here’s how: Without raising or tensing your chest or shoulders, GENTLY draw your belly button back towards your spine as you slowly exhale. That’s the right muscle! You’re not ‘sucking in’ or making any forceful or exaggerated movement. Your pelvis shouldn’t tuck under as you do this – in fact nothing should be happening in your shoulders, chest or pelvis! It is just a subtle drawing in at the lower abs.

You are not… sucking in your stomach, holding your breath, moving your ribs or your shoulders. You’re not tucking your butt / tailbone under you or thrusting your hips. These movements indicate instead that the Transverse is not fully engaged. You need to find this this muscle first and re-connect with it, if it is going to play its vital role in your core and pelvic floor system.

You need to correct your ALIGNMENT – the cause of that excessive pressure and loading.

Then you have to learn to ENGAGE  your transverse abdominis and pelvic floor muscles effectively and correctly, not only when  you exercise, but also during every-day movements like lifting, sneezing or twisting. This is a natural, reactive movement which you won’t always have to do consciously! But to re-connect, to realign and to restore, we isolate at first.

Then you need to STRENGTHEN your transverse abdominis muscle in a way that will draw your rectus abdominis muscle (the six pack, outermost one, the one that has separated) back in together, pulling your belly back in… flatter and stronger.

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