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Unzipped in the Middle: Understanding Diastasis Recti

Imagine if your abdominal and back muscles formed a tight corset or jacket to support your spine and your pelvis. Now imagine if that jacket was unzipped in the front. It’s not difficult to realize that it would no longer support you as long as it remained unzipped. Diastasis recti is a condition in which the rectus abdominus muscle separates into two halves along the linea alba (the zipper), or the connective tissue that makes up the midline of the body. The rectus abdominus is responsible for abdominal flexion, and abdominal muscles overall are crucial in supporting our backs and organs of the torso.Diastasis recti commonly occur because of pregnancy hormones and the growing baby.Pregnancy hormones soften and thin connective tissue and muscles in the abdomen that are normally thick and sturdy. Simultaneously, the growth of the fetus causes expansion of the abdomen, pushing the uterus against the abdominal wall and further weakening the muscles. Diastasis recti occur when the weakened muscles stretch the body’s midline to at least two centimeters, or about two finger widths apart. Clinically, it has been shown that almost all pregnant women in their 3rd trimesters have a separation and that this is a naturally occurring event.However, approximately 35% of women will continue to have a diastasis after birth and this is where diastasis can become a problem.

When the abdominal muscles are stretched into such a state, the abdomen can no longer effectively provide support and structure for the spine and internal organs. Diastasis recti can also lead to or contribute to pelvic pain, sacroiliac joint pain, pelvic floor dysfunction such as prolapse, fecal and urinary incontinence, lower back pain, intestinal issues, poor core stabilization and decreased center of balance. Women who have struggled with diastasis recti after one pregnancy are very likely to have the problem reoccur in future pregnancies due to re-expansion of the abdominal muscles. However, this condition can also occur in men and children. Anyone with excess visceral fat in the abdomen, poor abdominal muscle tone and poor postural alignment could be at risk for diastasis recti. Often women jump back into boot camps and other rigorous forms of exercises to “tighten up” after giving birth. However, programs such as these can make symptoms worse. Repetitive exercises that push pressure down into the abdomen, such as crunches and other exercises that involve bracing the abdomen, may also put some individuals at risk if they are being performed incorrectly. If you suspect that you may have a diastasis and have started an exercise program with someone who is not familiar with this condition, then it is important for you to be at least evaluated by a knowledgeable physical therapist that knows how to treat this condition. They can work with you and your trainer to modify your exercise program and get you on your way to recovery. In the “exercise of the day”, there will be two simple tests you can do to determine whether you have a diastasis.

There are many misconceptions about diastasis recti. Many people believe that this will cause permanent bulging or distention of the abdomen, that the muscles will remain permanently weak and damaged and that this separation can only be repaired surgically. This is untrue–many patients can completely recover through a physical therapy regimen! A Rebalance therapist will use a hands-on and personal approach to examine your abdomen for diastasis recti.They will recommend lifestyle changes to help you avoid placing excess pressure on your abdomen; for example, avoiding sit-ups, crunches and heavy lifting until you have recovered may be necessary changes for you. They will use various massage techniques in order to guide the soft tissue on either side of the body’s midline back together. They will also teach you exercises to perform on your own that will help you to utilize your breathing to activate and strengthen your core as well as retrain your posture. These exercises will return your abdominal muscles to their original and correct length.

If you are struggling with diastasis recti, contact Rebalance physical therapists to bridge the gap in your abdominal muscles and regain your core strength!

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