Angela Rake, Harpenden based Pilates teacher and co-founder of Zing Wellness, shares her Top 5 Frequently Asked Questions about Diastasis Recti.
If any of this sparks your interest I have specifically created a Core Care & Pelvic Floor Repair course which helps you put all of this into practice. It is accessible in a 6 week group class format, 1-2-1 format and online course format, something for absolutely everyone. My Mums That Move Class is also completely safe if you have diastasis recti so do not fear if your children aren’t babies any more. It is never too late!
Diastasis Recti – Why The Fascination?
With my interest and experience of working with pre and postnatal women I have become fascinated with diastasis recti (sometimes also referred to as DR).
I have completed postnatal training courses with Rachel Rafiefar, Burrell Education, Heather King Smith and Carolyne Anthony. The Center Method for Diastasis Recti Recovery created by Carolyne Anthony has been particulalry instrumental in shaping my practice.
Since I always get asked about this condition, I thought I would address the top 5 most frequently asked questions I get asked.
I love unpicking the story behind every diastasis and the story is never the same.
I have been surprised to find that diastasis recti isn’t just the result of having babies (believe it or not my husband has a diastasis), that sometimes one small change can trigger it to heal and in other cases my clients have to continue to work at it and integrate the work they have been doing into their movement practice for the rest of their life and finally that it is never too late to rehabilitate it.
With every client we work with we learn more and more about this fascial condition and there is never a one size fits all solution. Read on to learn more.
So, What Is Diastasis Recti?
Diastasis recti (DR) is referred to as the separation of the rectus abdominus muscles at the linea alba.
There are lots of different views on how wide a gap is considered a diastasis but generally any distance greater than 2 fingers between the right and left rectus abdominus muscles is considered a DR. 1-2 fingers soon after having a baby is normal whereas 3 or more fingers’ width means steps must be taken to close the gap.
When I am assessing a diastasis recti I am much more interested in how the tissue feels, how much tension I can feel around my fingers and how springy the fascia feels. This and the depth and fascial integrity of the gap is more telling than the width of the gap.
There is recent research by Diane Lee and Paul Hodges that suggests that closing the gap is not as important as being able to generate tension along the linea alba and to functionally improve by reducing symptoms (less back pain, eliminate incontinence, move better)
I would say that although the rectus abdominus muscles are considered the problem when clients come to see me the reality is the separation is more a symptom of lots of other factors at play and therefore a holistic and whole body approach is required to rehabilitate it.
I also ask clients to reconsider the definition of ‘rehabilitation’ as retraining the deep core system along with the synergy of other abdominal muscles and other muscles that are ‘best friends’ with the core so that tension can be generated along the linea alba, and be symptom free rather than closing the gap or being too focused on the aesthetics of the tummy. I choose function and quality of life over aesthetics every time.
So, What Are The Risk Factor For Diastasis Recti?
DR is directly associated with decreased abdominal muscle function so our job is to work with our client to establish what could be affecting their function.
Yes, pregnancy (especially multiples) and childbirth are huge risk factors for developing diastastis recti but so also is abdominal surgery (like a c-section), trauma, posture, poor breathing habits, movement patterns, incorrect body mechanics (especially when exercising), lifting weights with poor form, weight (especially a waist circumference more than 102cm), fascia type and males with abdominal aortic aneurism.
So you can see why we feel it so important to take such a detailed client health history!
How Do I Rehabilitate Diastasis Recti?
As I mentioned before, there is no one size fits all when working with diastasis recti but here are some of the most important areas to look at.
- The first and most important step is self-awareness. I teach movement but most importantly I guide clients on how to connect with their bodies and how to gain a better understanding of what their body is trying to tell them. Healing is a journey and not a destination so often symptoms can reoccur during times when you lose connection with your body often due to being busy or stress.
- We look at posture and observe any gait patterns with regard to how the client holds and moves their body. We then use massage, self-myofascial release, Pilates and corrective exercises to try to correct these patterns. Again, self-awareness here is key.
- We look at the breath and breathing habits and educate clients on how the core works and provide cues to better connect with your pelvic floor and core.
- We look at where the body is holding tension and use massage, movement and lifestyle changes to reduce tension in the body.
- We look at scar tissue that might be hindering core function and use scar tissue therapy to reduce adhesions, break up scar tissue and improve function.
- We look at nutrition, self-care, sleep and stress management as all of these can have a huge impact on the healing process.
- The linea alba regenerates under load so we look to provide a progressive rehab program that starts with simply connecting with the breath, pelvic floor and core, then adding movement and load and finally applying this into functional motherhood movement patterns like squatting, lunging, pushing, pulling, rotating and locomoting because let’s face it, this is real life!
8. And finally, it takes time and patience. As Becky Aston – Pelvic health Physiotherapist says:
” 99% of pregnant women have some separation of rectus abdominus by the end of pregnancy. Achieving the connection between the abdominal wall, the diaphragm and the pelvic floor muscles is crucial to start the rehab process. If this is rushed women can be unhappy with the shape and look of the returning abdominal muscles”
How Do You Check For Diastasis Recti?
You can check for a diastasis by following these steps:
- Lie on your back with your knees bent
- Place 2 fingers horizontally into the midline of stomach
- Support your head, inhale and then exhale and gently curl up looking down the front of the body
- If there is a gap the fingers sink into a cavity in the mid line, indicating laxity in the fascia. If the fascia is healthy it springs back
- Palpate the length of the mid-line taking breaks and engaging the breath again when needed
- I also ask my clients to repeat the curl up really connecting with their pelvic floor and using the visualisations and cues I have taught them on the exhale as they curl up and we compare the difference. This gives us an idea of their ability to manage intra-abdominal pressure both when consciously engaging the core and just exhaling on the effort.
If you would like me to check you for diastasis recti please feel free to book a 1-2-1 with me or I also highly recommend a consultation with a Women’s Health Physio.