Diastasis Recti (DR) is a separation of the abdominal wall, specifically the separation of the abdominal muscle’s tendons layers. The separation occurs along tissue in the middle of the belly where several layers of abdominal muscle cross over each other. This meeting, also known as an aponeurosis, is called the linea alba.
Linea Alba Anatomy Lesson
Biomechanist Katy Bowman defines the linea alba as not “where the stomach muscles connect” but rather where the fibers of the abdominal muscles’ aponeurosis (think of flat, bi-layered tendons) cross over each other and then resume on the other side of the abdomen. Interestingly enough, the aponeurosis of the three waist muscles all come in obliquely (at angles) — even the transversalis abdominis, the deepest abdominal muscle layer. This means the rectus abdominals (the most surface-layer abdominal muscles running top to bottom) are really under the pull of three oblique angles at the linea alba.
Diastasis Recti Explained
DR is more easily understood when we think about what happens in a person who is pregnant. The cause behind DR is similar to a person with increased abdominal and visceral weight gain. During pregnancy, the linea alba tissue thins in the midline from the force of the uterus pushing against the wall of the abdomen. Hormonal changes contribute to this thinning because pregnancy hormones cause tissue to soften and further thin. Diastasis Recti can occur at any time during pregnancy but it often happens in the later weeks as the belly contents become larger and hormone levels rise. DR occurs in roughly 30% of all pregnancies. A small amount of widening of the line alba occurs in all pregnancies and is normal and many women’s midlines spontaneously close to less than a 2 finger-width after labor. However, for others, the midline tissue remains too wide. A midline separation of more than 2-2.5 finger-widths, or 2 centimeters, is considered problematic. You might think that the only way to correct this problem is through surgery, but DR is often treatable without it!
Diastasis Recti Doesn’t Discriminate
DR is thought to happen only in women who are pregnant, but it is actually a common dysfunction in men and even children. Just as a pregnant person can experience this change with increased belly mass, so too can men, women, and children who experience increased weight gain over time or with excessive straining of the abdominal wall through certain activities.
How Does a Diastasis Happen?
Excessive abdominal and visceral (internal organ) fat can put additional pressure on the abdominal muscles and cause a separation. Abdominal surgery can also create the separation in both men and women, especially in a surgery when an incision is made through the midline. Even individuals we would consider to be in good shape can have a diastasis. Years of intense abdominal work, or “ab exercises”, can cause a diastasis because of the increased pressure some exercises place on the abdominal wall. It is said that even Joseph Pilates, the creator of Pilates, had a diastasis.
Do You Have a Diastasis?
Diastasis recti can change the appearance of the abdomen. The skin may droop, and some patients may even develop an actual hernia through the midline. Postpartum people may complain of continuing to look pregnant. To find out if you have a diastasis, check the space between your two rectus abdominis muscles (better known as your six-pack muscles, these muscles run lengthwise up and down your abdomen). Now check the depth of the gap. The wider and deeper the gap, the more serious the thinning of the tissues. Remember, the linea alba is not simply one large tissue, but rather a crossroads of sorts. To do a more formal check, try this test:
Test Yourself
Here’s how:
1Lie on your back with your knees bent and your feet on the floor.
2Place your fingertips of one hand at your belly button as shown in the image below and, while your abdomen is relaxed, gently press your fingertips into your abdomen at the midline area.
3Lift the top of your shoulders off the floor into a “crunch” position.
4Feel for the right and left sides of your abs and take note the number of fingers that fit into the gap.
5Repeat this test again approximately 1-2 inches above and below your belly button to determine the length of the gap. You may also see a bulge but you don’t have to feel a bulge. You may just feel the gap.
Who Can Help?
There are specialized physical therapists who understand how the abdominal muscles interact with other muscles of the trunk and pelvis. Often, the abdominals are only one part of the problem. Other muscles may also need to be evaluated to determine if they are contributing to the problem or if they could help with the solution. Rebalance physical therapists have specialized training to help treat and manage diastasis. Your physical therapy evaluation includes a complete assessment of the abdominal muscles, fascia, and other connective tissue that could be contributing to the problem.
Check back next week if you or someone you know has a diastasis and wants to start healing. We’ll be sharing some tips to treat Diastasis Recti and where to get further help!
Written by Stephanie Muntzer, MPT, CPI, SFMA, FMSc, PTYc
