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
Anti-rotation press 

I want to help my current diastasis! 
(Early stages) 
Diaphragmatic breathing w/ abdominal squeeze on exhale
Pelvic tilting   
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! 

Cheers! 

​Elle Carlson