Guest blog post written by Meenakshi Singh, PT pelvic health specialist & owner of Revive Physical Therapy in Issaquah, Washington
What is Diastasis Recti?
Diastasis Recti which is commonly known as mommy tummy is a separation of Rectus Abdominis (6 pack )muscle from the midline connective tissue called linea alba. The Linea alba is connective tissue that connects all of the abdominal muscle in the middle and also connects your ribcage to your pelvis.
What are the symptoms of Diastasis Recti?
Following are the main symptoms of Diastasis Recti:
-Abdominal Separation
-Feeling of a hole in the stomach
-Physical distortion (Appearing six months pregnant without pregnancy )
-Low back Pain
-Pelvic pain
-Wrinkled belly button
-Doming or tenting of the middle of stomach
How is a Diastasis Recti Measured?
It is measured while lying on your back with your head barely lifted. Then you check the width and depth between the two rectus muscle bellies. Anything over 2 finger width is considered diastasis recti and also check for depth with your fingers between two muscle bellies .. Check width and depth above,at and below the belly button. Checking with fingers is somewhat accurate but ultrasound is the gold standard.
Please refer this video to learn more about it.
How prevalent is Diastasis Recti?
60% of women at 6 weeks postpartum and 32% at 12 months postpartum suffer from it.
100% of women at due date and 39% at 6 months postpartum suffer from it. Men and women who have never experienced pregnancy can have this as well. Issues with weight gain or improper lifting and banding techniques, which can place unnecessary strain on the abdominal wall and linea alba can cause Diastatis Recti in nulliparous women as well as men.
What are the common causes of Diastasis Recti and related pain?
Diastasis Recti is a full body issue. When there is a push or pull on linea alba due to the posture, an excess load (with pregnancy and weight gain ) and some front loading exercises/movement patterns, it can cause Diastasis Recti. It all depends on how the abdominal wall handles a load or an increased pressure. Wrong exercises or movement patterns can cause a Diastasis Recti to get worse as it can result in too much force generation. Physical therapy can help fix diastasis recti without surgery.
However, what we need is an optimal force for our body to function optimally; in PT we correct and restore the integrity of the abdominal wall so you don’t need surgery to fix your diastasis recti.
A list of things which can push or pull on your linea alba (connective tissue between pair of rectus abdominis muscle) are the following. If you want to fix your diastasis recti without surgery, you need to address these:
1/ Movement of the Ribcage:
If your ribcage is in thrusted and twisted position. For example, certain sustained posture can lead to a wide infrasternal angle(an angle between two lines extending from just below one side of ribs and the other side of ribs when they join in the center below your breastbone) leading to Diastasis Recti. Physical therapy will help restore ribcage posture and motion so that you can fix your diastasis recti without surgery.
2/ Movement of the Pelvis:
Posture where person stands with forward tilting of their pelvis can also lead to Diastasis Recti. For example, hanging forward into the hips or tilting your pelvis forward strains the front of rectus abdominis muscle. Another example is standing with forward hip thrusting and prolonged sitting down at desk can cause tightness in waist muscles which in turn pulls on your linea alba. Slightly twisted pelvis can also cause damage to the linea alba as well.
3/ Abdominal muscle related pulls:
The internal oblique and transverse rectus abdominis (TRA) muscles are the muscles on the side of the abdominal cavity. As they‘re connected to the rectus abdominis (6 pack muscle ) sheaths, when they contract they can pull two halves of rectus abdominis away from each other and cause Diastasis Recti. Too much tension in the abdominal muscles like TRA and Obliques due to the lifetime of habits or a particular state of tissues like your clothing muscle can stretch to an extent before it splits at its weakest point which is linea alba. The rectus Abdominis (6 pack muscle) bulging or depth in this indicates the whole core system is not firing together.
4/ Shallow Breathing:
When breathing is shallow and focused on belly breathing, it can also lead to Diastasis Recti.
How to fix Diastasis Recti without surgery?
The goal is to improve pressure management while improving strength and learning how to brace properly for exercise. Following are tips to improve:
1) Shoes that support the foot and ankle and keep the heel level can optimize your pelvic and abdominal position. Avoiding shoes with a heel can be helpful because healed shoes will place your pelvis and ribcage in a position that can elongate and strain your abdominal wall and linea alba, making it harder for the linea alba to heal.
2) Promote Body Neutral
- Lower body and pelvis alignment -while standing and walking keep your ankles pelvic width apart and stand with your posture aligned, keeping your ribs on top of your pelvis, on top of your knees, on top of your feet. Avoid hip/pelvis thrust forward when compared to your ribs or knees. Ideally, you want your hips directly above your knee and ankle. This alignment promotes use of your glutes and hamstrings to hold you upright.
- Keep your feet facing straight while standing. Alterations in your foot position will change the forces coming up to your pelvis and abdomen, contributing to ongoing strain through these areaa. In physical therapy to correct a diastasis recti, so you don’t need surgery, we help you correct posture and establish neutral alignment.
- Maintaining a neutral pelvis is also very important. This is hard to figure out on your own. Our patients appreciate the watchful and attentive eyes of our physical therapists to help them position their pelvis and ribs correctly. Often we find people are either standing in a sway back, with pelvis thrusted too far forward. Or a butt tuck, with glutes turned off and pelvis posteriorly rotated. Or in hyperlordosis (excessive arch) of their low back, which elongates the abdominals, worsening the diastasis recti abdominis. Optimal posture maintains a natural curve in your low back, with your pelvis positioned level.
- Ribcage alignment: This is very important and usually impaired in our patients who have diastasis recti abdominis. Pregnancy often leaves us with a rib flare, pulling apart the abdominals and linea alba. You often know you have a rib flare because all of your bras are too tight. You used to wear a 34 and now a 36 feels very tight, even though you have returned to prepregnancy weight. We help our patients learn top optimize their ribcage, including breathing and engagement of the abdominal muscles and latissimus and other back muscles around the ribs. Generally, we find people who want to heal their diastasis recti withour surgery may benefit from dropping their ribcage to correct a rib flare. Or, may need to work on ribcage mobility, becuase it is too rounded and slouched. Learning to better align your ribcage is crucial to improving the mechanical loads to your linea alba, because where your ribcage goes, it takes the linea alba with it . To find neutral ribcage rotate your ribcage down and back until the bottom front ribs align vertically with the bones of your pelvis: your ASIS and Pubic Symphysis . Now your torso is like a vertical tube ,taking the tension off the linea alba ,setting all your abdominal muscles up to respond to the daily motions without straining your linea alba .It also decreases compression of your spinal discs and vertebrae ,and decreases the tension on any ligaments in your spine that have become lax due to repetitive hyperextension caused by rib thrusting .
- Don’t hold in your stomach, this impairs your diaphragm, rib cage mobility and also overuses your internal obliques, which can be problematic for your pelvic floor and overall abdominal muscle performance. Holding in your stomch can cause the contents of your abdomen can be pressed up towards the diaphragm. This prevents your diaphragm from moving its full range of motion during breathing and it negatively impacts the use of your abdominal muscles. Instead of sucking in your abs, work on aligning yourself for optimal posture, restoring your abdominal strength and breathing with your diaphragm. Diaphragmatic breathing that moves the back and sides of your ribs, engaging the full circumference of your diaphragm and ribcage, is helpful.
So in nutshell do the following ->Straighten your feet ->back your hips up ->Adjust your pelvis ->Drop your ribs ->Relax your diaphragm by not holding your belly in.
In addition, here are a few exercises that sometimes can help heal a diastasis recti without surgery. Learning to effectively complete these, without overwhelming your linea alba, while coordinating the rest of your muscles effectively helps fix your diastasis recti without surgery. Our PTs evaluate every person’s diastasis recti abdominis while they do these exercisess and others, to ensure they are not straining their linea alba, worsening their diastasis recti. We cannot give a standard set of exercises that are appropriate for every person to heal a diastasis recti, because each person’s abdominal wall’s ability to take the forces that the exercise is creating will vary.
1) Establish 360 degree breathing in seated or standing position .Tie a resistance band around your torso just below breasts at the height of bra strap. Inhale deeply. expanding the ribcage into the band until you feel the resistance from the elastic pushing on your ribs. Follow this by exhale and repeat this for 8-10 repetitions .
2) Side planks -Make sure to not arch your back while doing side planks. Hold this position for as long as you and build up the time of hold. This exercise will work your abdominal muscles especially obliques. We use this exercise often, but only when a person can handle this load through the linea alba. If your body cannot handle it, then this is not advised. Physical therapy can help correct a diastasis recti so you don’t need surgery; getting the expert evaluation and treatment of a PT who specializes in this will set you on the right path forward, so you don’t harm yourself or cause worse problems.
3) Do exercises that supports great alignment with working on glutes, core and pelvic floor. Bridges and squats with focus on gluteal contraction with ball squeeze to get adductors working as it will bring pelvic floor and abdominals to work together.
4) Promote transverse abdominis(TRA) contraction – Start in hook lying position and put your hands on the bony prominence(ASIS) in front of hips with palms of each hand resting on respective ASIS and fingers facing fingers of the other hand. Try to contract the muscle (TRA)between the two ASIS which will bring the two hands close together.
Above exercises are just some of the common exercises that may help some people. Please realize that without a proper evaluation we cannot let you know exactly what is best for you. The exact exercise regimen will depend on different factors like posture, rib flare, abdominal pooching, upper ab gripping, gluteal clenching etc. If you would like to correct your diastasis recti without surgery, reach out to a specialist physical therapist.
Author: Meenakshi Singh, PT
Meenakshi is the owner of Revive Physical Therapy located in Issaquah, Washington
You can learn more about her clinic by visiting https://www.reviveptmfr.com/
Or Call Revive Physical Therapy at (678-429-6435) to learn more.
Purple Mountain Physical Therapy, located in Grand Rapids, Michigan is a specialty pelvic health clinic. We enjoy collaborating with other pelvic health experts, such as Meenakshi Singh, PT, and inviting them to write about their expertise. This helps spread the word about how pelvic health physical therapy can help people. The team at Revive Physical Therapy in Washington is highly trained to help individuals overcome all pelvic problems. Be certain to check out their website here. If you are local to Grand Rapids, Michigan and would like more information about the specialty care offered at Purple Mountain Physical Therapy, you can contact us here or call 616.516.4334 for more information.
Because diastasis recti abdominis typically results in a variety of other impairments, such as pelvic floor dysfunction, pelvic organ prolapse or low back pain, you may be interested in these articles:
What is High Tone Pelvic Floor Dysfunction?
Postpartum Abdominal Help in Grand Rapids, MI
