Diastasis Recti - What is it & What can we do
Diastasis Recti – also known as DR, DRA, Rectus Diastasis or abdominal separation. Is a separation of the Rectus Abdominis, the outermost abdominal muscles (the ‘6-pack’ muscles). The separation occurs at the Linea Alba, the midline connective tissue in the front of the belly. As the abdominal muscles separate, the Linea Alba becomes stretched and loses its firmness and supportive function causing weakness. Although the main muscles seen in the separation are the Rectus Abdominis. All of the muscles of the abdomen meet at this point and are therefore compromised by the DR.
Why is a Diastasis a problem?
The muscles of the abdomen – the deep Transverse Abdominis, the obliques and the uppermost Rectus Abdominis. All work in conjunction with the muscles of the pelvic floor and back. They play a supportive role to the back and when these muscles are weakened. As they are in Diastasis Recti – as a result of the separation and weakness of the Linea Alba. They cannot support the back or pelvic floor sufficiently. So a gap in the abdominals can lead to issues such as back pain, pelvic floor problems such as stress incontinence, umbilical hernias and gastrointestinal issues.
What causes Diastasis Recti?
Diastasis Recti is caused by excessive and uncontrolled intra-abdominal pressure. Commonly a DR is seen during and post-pregnancy. As the increased load and changes in bodily alignment that occur with pregnancy cause an increase in pressure on the abdominal wall. However, pregnancy is far from the only culprit and there are many other causes. All of which increase intra-abdominal pressure and encourage alignment issues such as rib-flaring. These include weight gain, abdominal surgery, exercises such as crunches, oblique twists etc, gymnastics, tennis and even swimming and golf.
Who can get a Diastasis Recti?
It is possible for anyone to have a DR, because of the reasons listed above. Women, whether they’ve had a baby or not, men and even children can all have diastasis recti. It is very rarely checked for amongst non-pregnancy/postnatal populations so it is hard to estimate how many people are affected.
During pregnancy estimates of women with DR range from 70-100%. Postnatally it has been found that around 35-40% of women will still have a Diastasis 8 weeks post birth. A gap measuring 2-3 fingers width and with little firmness in the Linea Alba. There will be some unconscious healing up to around 6 months post birth.
If I have Diastasis Recti will I need surgery?
In severe cases surgery may be needed to treat abdominal separation, but it is far from inevitable. With the correct intervention and help many women can heal their Diastasis without the need for surgery.
How do I know if I have a Diastasis?
You can self check for Diastasis Recti. You are checking for two different elements. Firstly the width of the gap between the abdominal muscles. You can do this by seeing how many fingers fit between the abdominal muscles at different points – more than a 2 finger gap points to the possibility of DR.
The second is the firmness of the connective tissue. The deeper your fingers go down, the weaker the connective tissue is.
If you are unsure by checking yourself, whether you have a Diastasis, then ask a professional – a physio or pre/postnatal qualified personal trainer – to check for you.
It’s not all about the gap
A healed DR does not necessarily mean there is no longer a gap. We are more concerned with the quality of the connective tissue, the Linea Alba. If this is firm and can create good tension when needed then a gap between the abdominals becomes less of an issue. If the Linea Alba remains soft and ‘squishy’ then this may indicate that further healing is needed.
How to self check for Diastasis Recti
1: Lie on your back with your knees bent and feet about hip distance apart. Do the assessment on your naked belly as it will be easier to feel than through clothing.
2: Place your fingers on your belly and walk them down on your midline from under the ribs to just above the pubic bone, gently pushing down to feel the firmness of the tissue. Note if there are areas where you feel the tissue is squishier than others, can you easily press far down or does there feel like there is some tension?
3: Place the three fingers of your hand onto the midline just above the belly button. Push down firmly and then lift your head off the mat. You should feel the muscles of the abdomen closing together and be able to measure how many finger widths the gap is. Make a note of this distance. Repeat the push down and head lift a few times to be sure you have the right the measurements. Ensure you are just lifting the head from the mat, not the shoulders – you aren’t performing a crunch. If you don’t feel the muscle bellies closing then you may need to add another finger and perform the head lift again.
4: Repeat the above step just below the belly button and make note of the distance between the ab muscles and how firm, or squishy the connective tissue feels.
5: Repeat again a few inches above the belly button.
6: Re-test all three areas, but this time before the head lift use your activation breath to gently lift the pelvic floor and activate the core. This is a gentle activation – around 20-25% of your maximum effort. Note if there is any difference in the measurement of the gap or, importantly, the firmness of the connective tissue between the abdominals.
I think I have Diastasis Recti, what do I do?
Firstly, don’t panic, DR is certainly an issue that you want to deal with but there’s a lot that you can do to help heal the gap without drastic measures. Post Natal training with me will teach you to reconnect with your core and pelvic floor and teach you the gentle movements that will reach the deep core muscles and get everything functioning well again.