An Introduction to Diastasis Recti in Women's Health
The other day I sat down with a client of mine that was doing fairly well with the other symptoms they were recovering from and we talked about what was bothering her most. She told me that she would like to work on her Diastasis Recti. For those who may be unfamiliar with the term, a Diastasis Recti is the term for the separation of the ‘ab’ muscles (rectus abdominus) most prominently around the belly button and is identified when the gap is greater or equal to 2.7cm. It occurs in both men and women and very commonly occurs during pregnancy due to the straining of the abdominal muscles while also experiencing growth of the abdomen. The strains can be caused by anything from straining through constipation, heavy lifting including of kids, sit to stand motions from deep seated chairs, to certain exercise behaviours such as crunches, front planks and activities on all fours such as downward dog.
Diastasis Recti on its own has not been linked to dysfunction in the body, however the combination of diastasis recti with poor posture and pelvic floor injury/abdominal surgery such as C-Section will result in poor core activation and can lead to a wide variety of symptoms. With this client, I knew that they had given birth vaginally to 2 children (The youngest being 2 years old) but had undergone core rehabilitation and internal pelvic treatment with some talented practitioners in the past. I also knew that her deep core activation was good because I had assessed it myself weeks ago. However, since we had not yet formally assessed the extent of the diastasis still present, and there were some mid low back and neck symptoms still present, we decided to explore.
We began by assessing just how large the diastasis was. In order to see the effects along the entire length of the space between the abdominal muscles, I measured at four places. 10cm above the belly button (umbilicus), 5cm above, at the belly button, and 5cm below. In order to keep things easy I used the widths of my fingers as the patient did a low abdominal crunch to assess the space between the muscles as they engaged and indicated whether the depth of the space was shallow or deep. Now having baseline measures, we treated the imbalances identified earlier in the appointment that we would have addressed anyway.
A deep cross-hand release of the hip flexor muscles on either side were held, as layer upon layer softened and the initial referral into the chest and the difficulty taking a smooth deep inhale subsided. The right leg was externally rotated and the right quadriceps muscle was hard and tender so we addressed that area too with a long twisting stretch. We linked the neck and shoulder discomfort to the pelvis with the use of a ball under her sacrum in crook lying as we pulled through the dural tube and followed up by pressing into the sternum while her head was gently reclined to elicit and soften into the strain that gravity had placed on her in sitting a thousand times before. Before long, the appointment was winding down and it came time to reassess.
Did the patient feel more mobile? Yes. Was the self-reported pain in their hips, neck, and back improved? Yes. Were the legs and hip bones moving as they should with gentle pressure? Absolutely. But the really exciting part was the change in her diastasis:
DIASTASIS RECTI MEASUREMENTS
10cm above umbilicus
5 cm above umbilicus
At umbilicus
5 cm below umbilicus
BEFORE
1, shallow
2, shallow
2, deep
1.5, shallow
AFTER
0
1, shallow
1, deep
0.5, shallow
(Width measured in figure widths before and after the application of 45 minutes of John Barnes Myofascial Release. To learn more about John Barnes Myofascial Release, click here.)
A change of 1 full finger width across the board at all levels without purposefully manipulating the way the patient was breathing or engaging the muscles while testing! How is this possible you ask? Fascia is a densely woven tissue in the body that covers and interpenetrates every aspect of your physical structure and every cell including muscles, bones, nerves, veins and arteries and organs. It is a continuous structure without interruption. It makes up the physical framework of your structure and aids in the communication, support and function of every cell in the body. Essentially, every part of your body is connected to every other part by the fascia like a spider web. Physical and/or emotional trauma (birthing process), scarring (episiotomy/tearing/C-section), inflammation and the cumulative effect of poor posture and repetitive stress alter lines of tension and pull in the fascial system resulting in the production of tensile pressure of up to 2000 pounds per square inch on pain sensitive structures. This is why the core can fail to support the proper activation of the rectus abdominus muscle in spite of creating at least some support for the pelvic floor. While there is definitely a proper way to engage the core, often our symptoms are not solely due to a strength issue. And if strengthening alone will not ‘fix’ the problem, we must look to the resting tension of the surrounding tissues.
What Can I Do To Help My Diastasis Recti and Pelvic Floor?
The body responds to low load, prolonged duration stretching. Self-treatment techniques including stretching or trigger point release over muscles that are hot, hard or tender over a period of 5 minutes creates a significant chemical and mechanical change in resting tissue tension, range of motion, muscle stretch, pain levels and blood flow. Areas of interest are abdominal/C-section scars, the psoas (hip flexor) muscles and the mesenteric root (connective tissue anchoring small intestine to the abdominal wall).
Exercises should focus on proper alignment of the hip/pelvis and breathing that facilitates activation of the core piston. A simple phrase to help remember is to ‘Blow Before You Go!’ meaning time the push/pull or strain of your movement activities with the exhale phase of your breathing.
When abdominal exercise is being performed in the presence of a diastasis recti, the muscles should be supported by using a towel or belt to approximate (bring together) the abdominal muscles whenever possible.
MEDICAL DISCLAIMER: The content of this post is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider with any questions you may have regarding a medical condition.
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