What the heck is diastasis recti?
What is diastasis recti? It’s a common diagnosis in the pelvic floor world but what does it mean to you? Is it a problem? What can be done about it? Can it be avoided? Who develops it? These are all common questions surrounding diastasis, and things I hope to shed some light on this week.
Diastasis recti is commonly seen in pregnant people as they reach full term, as well as after a baby is born; in fact, nearly 60-70% of pregnancies will see diastasis develop. Even so, we can see diastasis in anyone who has a rapid change in the size of their abdomen, pregnancies, weight gain, or even toddlers with their cute little bellies. It is more common in women just because of the pregnancy and childbirth factor, but men can develop diastasis because all you need is that rapid change in shape. Ultimately it is a stretch and thinning of the connective tissue that connects our left and right ‘6 pack abs’. These abs, more specifically named rectus abdominus, run vertically from our pelvis to ribs and help to curl our trunk toward our legs and legs toward trunk. Between the two vertical muscle bellies, there is connective tissue that also runs vertically in line with our belly button – this is called the linea alba. Its job is to transfer load between the muscle bellies when we need stability at the center. Like when we lift, jump, brace, or transfer load from our arms or legs.
When we have a sudden increase in size that surpasses the tissue’s ability to adapt, this connective tissue can become less elastic, and less effective at transferring that load. This often shows up as a gap between the muscle bellies that can either dent inward or protrude out with an increase in abdominal pressure. This process in and of itself is typically not painful, and doesn’t appear to create direct problems; however, with this decreased ability to effectively spread load throughout our core, it can become harder to manage pressure within the abdomen and pelvis with exertion. This can potentially lead to other pelvic floor symptoms including pelvic pain, hip/low back pain, as well as incontinence.
To identify a diastasis recti, a practitioner may press along the midline of the belly (on the linea alba), feeling for an indentation or gap between muscle bellies. This can be further examined by asking the person to engage through the abdominal muscles and assess for changes in that gap – does it widen even further, can I sink my fingers deeper between the bellies, or does it become taught, making it harder for my fingers to sink down? The latter is a normal response, and what we want to see; the former are responses we would expect with a diastasis.
Natural healing of this connective tissue occurs once the stretch placed on it is reduced, which in most instances is after delivery. We also see the extent of this natural healing complete within a few months. However, even with this natural healing, the tissue is never quite the same and one can continue to have difficulty with pressure management; especially for someone who enjoys higher level physical activity, or things that require lifting and bracing. Fortunately, there is so much to do to help despite the changes in tissue!
So what can you do about it? The large focus here is to re-train one’s ability to manage the pressure created throughout the abdomen by improving coordination and strength throughout additional core musculature, including transverse abdominus, obliques, and rectus. A focus is also placed on breathing and bracing strategies during functional activities to promote support to that connective tissue and improve the ability to transfer load throughout the core. As this strength and coordination is improved, as well as integration of appropriate strategies during activity, we see an improved ability to transfer load through the core which can reduce any current symptoms but can also prevent others from coming along down the road! The cool part is that the already changed tissue doesn’t have to change back for this to happen! So, even when someone is months or years out from pregnancy and feels like there’s nothing to be done – there definitely is!
These strategies are also put in place as someone progresses through pregnancy or is trying to avoid a significant diastasis from developing! Check out this table for helpful tips surrounding both prevention and treatment:
I want to prevent a significant diastasis!
Diaphragmatic breathing w/ abdominal squeeze on exhale
Plank / modified plank
Side plank / modified side plank
I want to help my current diastasis!
Diaphragmatic breathing w/ abdominal squeeze on exhale
Deep abdominal squeeze with curl up
Bent knee fall out
It’s important to note that the appropriateness of these exercises is largely dependent on the individual, and their circumstances; therefore, an individual assessment is so important! You can find videos by clicking on the bold print above.
As always, hit the "Talk with a PT" button above to dive into your specific case and see how we can best help!
This week we’re talking all about RED-S. Something many of you may have never heard of. If you’ve spent time in the world of sport and athletics, you may be familiar with the female athlete triad – a combination of disordered eating, lack of menstruation, and osteoporosis. This combination is typically developed through over training with inadequate intake (FOOD!) which results in poor calcium maintenance in bone and altered hormones affecting reproductive cycles. It’s important to clarify that inadequate food intake can be both intentional and non-intentional; both because of poor eating habits and too intense exercise. RED-S has come about more recently to capture all the bodily functions affected by over-training and under-fueling; and to address the fact that males can fall into these patterns just as commonly.
Really, any active person is at risk for developing RED-S – relative energy deficiency in sport. You don’t have to be involved in competitive athletics, training, or sport; however, competitive athletes may be at a greater risk due to more rigorous training schedules. Those who participate in endurance sports, or aesthetic sports like gymnastics or dance are also at a greater risk. RED-S captures both males and females and in its most simple form occurs when an athlete consumes too few calories for their activity level.
RED-S can be difficult to diagnose because it can present in a variety of ways. A large indicator for this in females is a cease in menstruation; especially if the cycle had been regular previously. Decreased caloric intake doesn’t allow for the energy required to maintain appropriate hormone levels and conduct these functions throughout the month. This can have a long-term effect on bone health as proper estrogen levels are essential for affective calcium storage. RED-S is often seen in younger females who are not typically concerned with something like osteoporosis; however, bone density peaks between ages 25-30 so this is a crucial period to assure strong bones are being developed! Bone loss can occur in just a few months of having an irregular or absent period. Other symptoms – for both males and females - can include repetitive stress injuries, decreased performance or difficulty training at a high level, dehydration, GI problems, cold intolerance, low heart rate and blood pressure, cramps, fatigue, and brain fog.
Behavioral indicators can also be spotted, including anxiety or depression, body dysmorphia, exercising beyond what’s required, difficulty concentrating, and avoidance of eating or certain eating situations.
RED-S can impair health and sport performance as an under-fueled human is slower and weaker, regardless of the activity being performed! As activity levels remain high despite inadequate fuel, we can see fatigue progress to a loss of strength and muscle size as the body uses this tissue to fuel essential functions. Inadequate fuel can also affect the brain, leading to difficulty concentrating or remaining on task. With these changes in strength, energy, concentration, and coordination, there can also be an increased risk of injury. Along with the potential implications of bone health, stress fractures – and repeated stress fractures – can be a sign of RED-S and inadequate bone density. With that, repeated stress fractures, or unexplained injuries should always be a red flag for further investigating one’s exercise and fueling routine!
So, what can be done to prevent RED-S; to make sure our young athletes and active adults are setting themselves up for success; or to allow you to recognize if you’re trending toward some of these patterns and how to move the dial in the appropriate direction?
As always, consult with a physician if you are concerned about anything discussed above.
In a world where we have people and things to compare ourselves to literally in our palm, it can be easy to constantly ask more of yourself or to continue to push despite signs that you need the opposite. It’s common to think that we’re not doing enough exercise, or the right exercise; or that we need to follow this diet, or that other one you heard about last week. In a lot of instances, we need to fuel ourselves MORE, and more appropriately for what we’re asking our bodies to do. Rest and recovery needs to be recognized and encouraged in order to have the most success… and far more importantly, to take care of our health for the long haul!
How does breathing affect leaking?
This week we’re bouncing back to the pelvic floor and diving more specifically into some of the topics within this realm. If this is a topic that interests you, or you feel you’re in need of some work here, we’d love to see you at one of our upcoming workshops! We unpack the pelvic floor, its function, and its potential dysfunction; as well as what we can do about it. As these evolve, we’ll dive deeper into specific aspects; so, if you’ve been to one already, keep your eyes peeled for something fresh!
At a pelvic floor workshop last week, we talked a lot about incontinence. Particularly stress incontinence (leakage with things like coughing, sneezing, lifting, jumping, etc.). Something that is SO relevant to many! This one can be a tricky thing to manage because we need to know exactly what is going on in YOUR body, not that of the person next to you. HOWEVER, there are some general concepts surrounding breathing and pressure management that can go a long way; so that’s what we’ll talk about today!
Incontinence, as well as many other symptoms of pelvic floor dysfunction, is impacted greatly by the pressure we create – and manage – through the abdomen and pelvic floor. Think of the area from your ribs to pelvis like a cylinder, or a pop can… do you say pop? Anyway, this cylinder is formed by the diaphragm on the top, pelvic floor muscles on bottom, and abdominal muscles/spinal muscles all around the outside. When we do things with exertion – sneeze, jump, run, cough, etc. – we create increased pressure through this cylinder. This in and of itself is not a bad thing – it helps us to move STRONGER and brace better. The problem comes when an aspect of that pop can can’t withstand the pressure created. This is often the pelvic floor, and this can result in leakage during activity.
Strength can be an issue here, but it seems to more commonly be increased tension or over-activity through the pelvic floor. One thing we can work on to address this is breathing. Through our breath, our pelvic floor is meant to stretch upon inhalation, and return from this stretch on exhalation. This is caused by a synchronistic movement with the diaphragm; when we breath in, the diaphragm and pelvic floor both lower, when we breathe out, they raise. If we don’t utilize the diaphragm as we should, this synchronistic lowering doesn’t happen, and the pelvic floor remains tense. This is fairly common because many of us breathe primarily through our chest for a variety of reasons. This can be because of anxiety or feeling stressed; but also, because we try to keep our abdomen tight and belly sucked in. Regardless of the reason, when we don’t get adequate belly movement during breathing, we have inadequate diaphragm and pelvic floor movement.
The first step in this is to work on breathing more into your belly and toward your pelvic floor. You can start by simply lying on your back when you’re hanging out in the evening or getting into bed. Place a hand on your belly, and as you breathe, send your breath toward your hand so that it raises as you breathe in, and lowers as you breath out. At the same time, you can think about sending that breath lower toward the pelvic floor, and feeling a gentle flare of your sit bones as you breathe in.
This is a super simple movement, but it can go a long way in the journey of addressing incontinence! It’s important to note that this alone will not likely have a large effect on leakage during activity – laying down on your back is much different than jumping rope after all! These breathing and bracing strategies need to be progressed to functional movements for ultimate success; and need to be part of a plan that tackles mobility, strength, and coordination! That being said, it is a great place to start, and to assess what your natural breathing pattern is.
Try it out, reach out with questions, and keep your eyes open for next week’s newsletter!
If you’re interested in learning more about the pelvic floor, or how to help yours, hit ''Talk with a PT' up top for to register for a free discovery call!
Dr. Elle Carlson, PT, DPT
Elle Morgan, PT, DPT