Diastasis Recti 101

Diastasis Recti, oh the questions I get about this topic! I hope to go over the most frequently asked questions about this very common, but highly misunderstood topic. Here is a video I made back in the day about how to check yourself for DR.

***It’s always a good idea to see a pelvic floor physiotherapist, and the content of this blog is not medical advice.

This is a picture of a DR. Notice the separation of the muscles and the white fascia in between.

**Note: a separation can occur along any point of the linea alba (see how it goes from the sternum to the pubic bone!) but its usually the deepest around the belly button, because that’s where most people stick out the farthest when pregnant.

Photo credit GirlsGoneStrong: google images

First of all, a very quick anatomy lesson.

Let’s start at the top. You have a muscle underneath the lungs that’s called the diaphragm. It helps the lungs move air in and out by moving up and down. The diaphragm works with the pelvic floor, so when the diaphragm is contracting and flattening and making room for the air, its moving the pelvic floor down. When the air moves out and the diaphragm is relaxed, that’s when the pelvic floor lifts back into place. Who thought there was so much to breathing! This is why we always start with the breathing when looking at a DR. People can also get into different breathing patterns, which can also affect things down the chain.

Now lets move to the stomach. The deepest muscle, the one that lies closest to your organs, is called the Transverse Abdominus. It’s called the corset muscle because it wraps around your torso! It’s job is to flatten the abdominal wall, help expel air, and provide some stabilization for the spine. It works with the pelvic floor to make sure your organs are supported and to help control the inter-abdominal pressure.

Next we have the internal oblique muscles, and then the external oblique muscles. These oblique muscles make up different layers, but run diagonally across your torso from the ribs to the linea alba. The IO runs up, and the EO runs down. Their job is to help bend and rotate your torso.

In the front we have the linea alba, which is that white connective tissue that runs from the sternum to the pubic bone. That’s what what we access when doing the typical crunch and check around the belly button DR test.

And then we have the rectus abdominus muscle, which is the very top layer! This guy is the 6 pack muscle and is in charge of flexion of the torso, so bending forward like you would then you do a crunch or pick something off the ground. Still important, but maybe not as much as you initially thought. And here’s a fun fact for you, if your Diastasis is wide, you may need to work on your rectus abdominus. If the Diastasis is deep, that usually means that the transverse abdominus needs some more practice.

So there’s a quick overview of what is going on every time you breathe or move! Let’s move on to the next part!

I want you to answer true or false for each of the following statements.

  • DR only happens to pregnant people
  • All pregnant people get some degree of DR
  • There are different “kinds” of DR
  • Having a DR means that you need to avoid certain types of exercise like planks and sit-ups
  • DR only affects your tummy
  • You’ll for sure need surgery to fix it
  • Just check for the depth of the separation

Ready for the answers? Here they are folks! Were you surprised?

  • False
  • True (well, if were talking about full term pregnancies)
  • True
  • It depends 😉
  • False
  • False
  • False

Let’s break down each point a bit more. I will try to be brief, and then elaborate more on these topics in upcoming blog posts.

DR can happen to anyone. Two of my babies were born with it, men can develop it. Maybe we should start to think of it as a “pressure management thing” instead of a “mommy problem thing” How you breathe MATTERS. Your posture matters! Your body will create imbalances and compensations and weaknesses, and that is what DR is.

DR is needed at the end stages of pregnancy. You try growing a human and all its accessories without a bit of help from your connective tissue. Sometimes it resolves after birth, other times you need to rehab it a bit more.

Which nicely brings me to my next point, where we’re going to discuss the different types of DR. Specifically, injury based vs natural causes. Pregnancy is a natural cause. Injury based could include things like improper breathing during heavy lifting, or doing core work that is too advanced for where your body currently is. Don’t forget that pregnancy adds hormones and a growing belly that you have to balance against gravity!

Certain exercises to avoid? It depends if you can keep good form throughout. A few markers of “your body is handling this exercise” that I look for I

  • your belly is flat (not bulging along the midline)
  • you can engage the lower abs and pelvic floor
  • your DR isn’t squishy. A firm feeling linea alba is a great sign that the exercise you’re doing isn’t too much. More on this in a bit…
  • you’re breathing in and out, talking, and maintaining this throughout the exercise

This will vary from person to person, and even from day to day and exercise to exercise.

Does DR only affect your stomach? Well, think about the body as one unit. Everything is so connected and we are really good at compensating. I look at the body as a whole when helping someone rebab their diastasis. Is their back so tight they are only breathing in the front? That’s a factor. Are they pushing their ribs forward when they lift something? That’s a factor. We need to make sure the body is functioning well as a whole unit, which is why strength training is so important. Being able to release and relax your muscles is also important, and overlooked. How are muscles supposed to work properly if they can hardly move? My first few sessions with postpartum clients are usually more about releasing and activating than actually “working out.”

Will you need surgery to fix it? Maybe in some extreme cases. But consider this: if everyone had surgery but didn’t correct the imbalances that caused the DR to begin with, are they solving anything? Or would those imbalances eventually take over again?

If you watched the self check video you’ll know the answer to this next one. We want to check the width as well as depth. Width is important, but that shows how developed the Rectus Abdominus muscle is. The Transverse Abdominus is the deepest core muscle and that is what determines depth. We want the DR gap to be as shallow as possible, because then we’re generating enough inter abdominal pressure to do an activity. Too much pressure and you get the doming along the midline. So, finding the balance and slowly building strength is key to healing and being able to do the exercises you really want to do!

Do you see the bulging just above her belly button? That is what a DR can look like, and what I was referring to in the points above. Remember, having a DR is not bad. It can be natural and necessary. But it’s also your body’s way of saying stop and readjust, or stop and wait on that activity.

photo credit: the Movement Ministry: google photos

This blog just touches the tip of the iceberg. Please let me know if you have any questions, (maybe you have more questions now than you did when you started reading!)

Stay tuned for next month’s blog, where I plan to go over planks, and planking with a DR.

Until next time,

Steph

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