What is Diastasis Recti? Perspective on the Split
I always thought that ‘Diastasis rectus abdominus’ sounded like a fancy term that could be an inscription towering above on a wall of ancient Rome. (After all, there are many minimally clothed and abdominal-chiseled works of art bathed in Latin in that area of the world). However, this is the term we use to describe a separation in the outermost abdominal muscle, the rectus abdominus, and its connective tissue dividing the muscle into its right and left halves, called the linea alba (commonly known as the ‘six pack’). Separation of this muscle and tissues most commonly occurs during the second and third trimesters of pregnancy, when most of the stretching and abdominal changes take place.
Pregnancy remarkably changes a woman’s abdominal wall, requiring a healthy stretch of the abdominal muscles and tissues, along with numerous other bodily changes to accommodate the growing fetus inside the uterus. Internal real estate becomes increasingly valuable and this stretch is imperative and normal! After delivery, a woman may feel that they have a ‘gap’ along the midline of their abdomen and research tells us instance of diastasis recti (DRA) increases with age, being pregnant with multiples and/or many pregnancies. Feeling a DRA is normal immediately postpartum and can vary in both width and depth, as can be measured by your hand while lying down.
While appropriate to begin certain movements and exercises during pregnancy and soon after delivery, we begin to suspect more specialized attention is needed if DRA and other related symptoms persists roughly beyond 8-12 weeks (ish) postpartum. Commonly associated postpartum symptoms including pelvic girdle and low back pain, urinary incontinence, muscular weakness and ligament laxity, pelvic organ prolapse, not to mention other issues which can amplify postpartum including painful intercourse, constipation, fecal incontinence, immense hormonal shifts, poor sleep patterns and mental health changes, to name a few.
If you follow any women’s health topics on social media, chances are you’ve come across the pervasive promise of ‘fixing’ diastasis recti by subscribing to a 30-day fitness challenge or an influencer’s exercise program subscription in promotion of her washboard-y abs. And the message is often coated in fearful to-dos and not to-dos. PT Spoiler Alert: it’s not merely fixable with a speedy, one-size-fits-all program, nor do six-pack-y abs suggest good health of one’s postpartum abdominal wall. While my inner optimist hails the greater spotlight on women’s health and postpartum issues, my outer realist and clinical specialist knows that DRA and related symptoms speak to a greater, misbehaving system that can affect a woman’s long term health. And as a PT, this compels me to advocate for skilled, thorough evaluation by Pelvic Health Physical Therapist for those with this distinct split down the middle. Even a couple of these issues will fundamentally change how we as women live in our bodies and move through our daily routine. So, a mere few exercises to ‘fix the gap’ is deficient treatment in addressing the greater scope of postpartum health. Physical Therapy has been shown to be a safe and highly effective treatment for DRA and these related postpartum issues.
The appearance of a woman’s belly postpartum, though initially perfectly soft and normal after 9 months of remarkable work, is often what most patients say motivates them to seek our PT help. Our society glorifies washboard abs and a sprinting return to ‘a normal body’ postpartum, despite unrealistic tissue healing timelines and expectations. As PTs and mothers, we certainly understand the postpartum mental dance of longing for even semblance of one’s pre-pregnancy attributes. However, a secret, dear reader: As PTs, we’re really not as concerned about the ‘gap’ itself: Why yes, we can and do make positive changes in narrowing this separation, we’re more focused on a bird’s eye perspective of a woman’s postpartum heath and finding strategies for optimal return to function, whether daily tasks, exercise or other goals. Postpartum is, well, for the rest of our lives.
I’ve had patients over the years with more significant DRAs who perform exercises and tasks with great control of their core muscles and breathing, a sign of a healthy and functional diastasis. And I’ve had patients with minor DRAs with much greater difficulty during day-to-day tasks. While the gap is a symptom, DRA has little significance until we have a thorough history and context of how you are moving during daily tasks or exercise. With PT, after a comprehensive patient history, we prioritize a thorough musculoskeletal evaluation (hips, low back, pelvic girdle including pelvic floor muscles, abdomen, mid-back and ribs, neck) combined with watching a patient’s movement patterns (How does she move through her day? What strategies does she use to pick up her baby, carry a car seat, push a stroller and breastfeed for hours on end?) to build the best plan of action for her goals and recovery going forward.
Diastasis recti is remarkably common and nothing to fear. And the good news is that working with a Pelvic Health Physical Therapist is highly effective and safe treatment for ‘minding the gap,’ addressing any associated issues (voiding issues, pain, weakness, etc) improving the strength and control of our bodies and most critically, return to an active and healthy routine postpartum. As PTs, we know that woman’s optimal postpartum recovery is a critical insurance policy and resilience strategy for her longer term health and wellness.
Dr. Gina Yeager and the Pelvic Health Team