Happy Diastisis Recti Awareness Month!
Let’s talk about Diastisis Recti (DR). What is it exactly?
DR is defined as a separation of the linea alba (LA), the connective tissue between the two muscle bellies of the rectus abdominus.
During pregnancy, this connective tissue will become more lax to help accommodate your growing uterus and fetus. It is important to recognize that DR is a normal part of pregnancy. In fact, studies suggest greater than 60% of women will have some form of diastisis in pregnancy and postpartum. Have you noticed that when you perform a sit up, get out of bed, pick up your baby, etc, you experience bulging or doming along your midline? This gives us a clue as to how you are managing intra-abdominal pressure. The fascial tension is unable to counteract the abdominal pressure being forced on it.
How is it measured?
To measure a diastisis, you want to roll to your side and over to your back. You want to be sure you roll to your side vs. going straight up/down to put less pressure on your diastisis and pelvic floor.
Halfway between belly button and rib cage - Find your belly button and rib cage. Pick your head up. If you feel a gap, how wide is it? Is it squishy?
Right above belly button - pick up your head. Any gapping here? How far do your fingers go down? How many fingers wide? If its greater than 2 fingers, then it is considered a diastisis
Halfway between your belly button and pubic bone - same thing here. Lift your head. Palpate. How wide? How deep? Is it firm or squishy? You want it to feel firm, like a trampoline.
Image from Girls Gone Strong
Now, even though I've explained how to measure a diastisis, I don’t want you to get bogged down by how wide or deep the gap is. Recent studies on diastisis and clinical rehab has been shifting to “it’s not all about closing the gap, but restoring the fascial tension." The ability to create tension, helps the two side of the abdomen communicate with one another to control the trunk and pelvic during functional activities and exercise.
So, what exercises are safe and not safe if I find that I do have a diastisis?
This is a loaded question! The bottom line is that we can’t dump each individual who has DR in the same bucket. Some people with diastisis will be able to perform these so called “safe exercises” and then there are some who can't depending on how they are performing them. The important thing is the ability to maintain connection and control over your core muscles in various positions. Exercises can be made harder or easier depending on how well you are able to load the system. Signs that may indicate the need to modify would be: pain, heaviness, leaking, excessive doming and bulging. So “unsafe” exercises now, may be “safe" later on as you progress!
The most important thing to do is build a strong foundation before loading so you can return to activities you love without pain, leaking, bulging, heaviness, etc.
The diaphragm, core (transverse abdominus, internal obliques, and multifidi) and PF provide central stability for your spine and pelvis. They create and regulate pressure. They all complement each other and interact with each other in a dynamic way.
Steps to Build a good foundation:
Engage Pelvic Floor
Engage transverse abdominus (TA’s)
Coordinate both with proper breathing
Fix Posture
Fix Rib Angle/Positioning
Then add Strength and progressively load it up!!