Diastasis Recti – the separation of “six pack abs”

Recently, Elements has seen an influx of women and men with diastasis recti, a separation of tissues in the abdomen, resulting in a protrusion or bulge running vertically down the center of the tummy. The two options for treatment are a conservative approach, exercise, and non-conservative approach, surgery. I highly recommend finding a trained physical therapist or personal trainer before considering the surgical option.

Diastasis (a separation of normally joined parts) recti (the “six pack” abs, see picture below) is a condition in which the recti separate by a pathological amount, usually as a result of thinning and stretching of the linea alba, the narrow band of tissue that runs down the midline between recti. This condition happens most frequently with pregnant women. However, it also occurs in men with over-training of the rectus abdominis without the underlying support of the internal obilques, external oblique, transverse abdominis, pelvic floor and diaphragm. People with a history of abdominal or inguinal hernia may develop diastasis recti; also, asthma can cause altered breathing patterns, thus altering the unique stability of “the core.” The core muscles are the transverse abdominis (TrA), internal oblique (IO) and external oblique (EO) muscles, and the diaphragm and pelvic floor muscles; see image below and previous blog [http://elementsjustine.wordpress.com/2014/01/19/stability-with-gyrotonicr-exercise/]

In the picture above the linea alba is the vertical line of connective tissue where the belly button is.

Do you have diastasis recti? If you do a “crunch” (sit up) and see a bump or ridge running up the center of your abdomen, you probably do. This bump is a result of the separation of the rectus abdominis at the linea alba with a protrusion of underlying tissues. When you are relaxed and lying down, the bump recedes and leaves a gap.

Physical therapists measure the gap by the number of fingers we can fit into the separation. The goal is to have no more than a 1-2 finger separation. We also look at the recruitment and timing of the muscle firing and where there is expansion in the body with an inhale. When you inhale, the lungs fill and there is a natural rise of the belly. When you exhale, the belly falls, and that is the optimal time to contract the core muscles to avoid the separation of the linea alba.

When you contract the core muscles on an exhale, the deep core stabilizers help support the abdominal wall. In addition to preventing or resolving diastase recti, this also stabilizes the spine. The action of the rectus abdominis muscle is to flex or bend the spine forward, it is not designed to stabilize the spine. Thus when training the rectus abdominis it is important to engage the, TrA, IO, EO, diaphragm and pelvic floor to protect the spine and avoid excessive sheer on the disks. Keep this in mind when training the six-pack for beautification, it is pretty but not very functional. In people with diastasis recti, the rectus is often overworked without the support of the core muscles underneath.

A wonderful exercise for diastasis recti is to sit upright, either on the floor or on a short stool, with your back against a wall. If you are sitting on the floor, you may cross your legs or put them out in front. Pregnant women usually find it more comfortable to cross their legs. Breathe in and feel the belly expand, then breathe out and feel the belly flatten. As you exhale again, gently draw in the abdomen. If your shoulders rise or you feel tension or your pelvis tucks under you, then you are working too hard. Try again with a little less effort. If it is too difficult to start against a wall, try lying down (see blog on true core [http://elementsjustine.wordpress.com/2013/07/01/the-deep-transverse-abdominal-muscle-just-breath/ ] ). In the supine position, lying flat, gravity is working with you thus it is an easier position. In sitting you have to hold your body upright against gravity so it can be a bit more challenging. Whether you are sitting or lying down for the exercise, it is important to remember that drawing in the abdomen during the exhale is just part of the picture. The exhale also helps recruit the diaphragm and gently draws up the pelvic floor, as if stopping the flow of urine. This exercise can safely be done during pregnancy and after (once cleared by MD). Remember exercise pre and postpartum has been proven to prevent diastasis recti (see reference number 2 below.)

To challenge the pelvic floor, it sometimes helps to feel the contraction by doing the draw-in exercise while in a deep squat position. Stand with your feet wide and squat all the way down, then exhale and draw abdomen in while contracting the pelvic floor. This position stretches the pelvic floor and makes contracting a little more difficult and challenging.

The goal is to be able to recruit the “core” muscles in everyday life. Try doing the draw-in exercise while standing, while reaching for a glass and then try drawing-in walking. Again, as you exhale, draw in the abdomen by contracting the muscles in the front (TrA), the sides (IO and EO), the back (multifidus), the top (diaphragm) and the bottom (pelvic floor picture below). Keep in mind the draw-in should not create tension, just a feeling of support.

Enjoy moving your beautiful body and remember the body does heal!

For more information, contact Elements Fitness and Wellness Center at 202-333-5252 or email frontdesk@elementscenter.com

Warmly,

Dr. Justine Bernard

1) Sharma G, Lobo T, Keller L. Postnatal exercise can reverse diastasis recti. Obstet Gynecol. 2014 May; 123 Suppl 1:171S. doi: 10.1097/01.AOG.0000447180.36758.7a.

“Conclusion: Women who started after delivery an exercise program aimed at reducing diastasis recti achieved the same reduction in diastasis recti as those who started the program during pregnancy. (N=63)”

2) Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014 Mar;100(1):1-8. doi: 10.1016/j.physio.2013.08.005. Epub 2013 Oct 5.

“Results: Eight studies totaling 336 women during the ante- and/or postnatal period were included. The study design ranged from case study to randomized controlled trial. All interventions included some form of exercise, mainly targeted abdominal/core strengthening. The available evidence showed that exercise during the antenatal period reduced the presence of DRAM by 35% (RR 0.65, 95% CI 0.46 to 0.92), and suggested that DRAM width may be reduced by exercising during the ante- and postnatal periods.”

3) pictures from wikipedia commons.