Recently I have been treating a few women who are post-partum and who are struggling with aches and pains that come with being a new mom. These range from neck aches from marathon feeding sessions, mid back aches from holding positions so still so that their new bundle of joy doesn't wake. Now, muscle aches and pains aside, some of these women are also dealing with a condition called Diastasis Recti (also known as Rectus Diastasis)
What is it?
Lets start with some anatomy, and since not everyone shares my love of anatomy, we can make it quick and painless.
Our abdomen is made up of layers of muscle that all work together to allow us to have control as we perform both simple and complex moments. The 4 layers of the abdominal wall:
- Transverse abdominis (deepest layer)
- Internal & Exernal Oblique (middle two layers)
- Rectus Abominus (outer layer)
The rectus abdominis muscle runs up the front our abdomen from our pelvis to our ribs. The connective tissue that connects the left and right muscles is called the linea alba, pictured above.
Diastasis recti is defined as the separation of the right and left rectus abdominis muscle bellies as a result of the separating at the linea alba. This separation occurs with there is increased pressure inside the abdomen, pushing outwards on the abdominal wall.
Separation most often occurs at the level of the belly button and can range in width. The length of the separation also varies depending on if the separation is above the belly button, below, or both.
I would like to be clear that this is not a condition that solely occurs secondary to pregnancy. This condition is not gender specific and is also associated with:
- Increasing age
- Regularly lift heavy weights
- Performing full range sit ups
- After major weight loss
- Congenital/born with separation
Self Test:
Find a comfortable space on the floor where you can lay flat on your back.Slide your ankles towards your body to the point that your knees are bent into a comfortable position. From here, rest your hands on your abdomen with your finger tips close to your belly button. Gently lift your head and shoulder blades up off of the floor.
Feel for any separation of your rectus abdominis muscles and the connective tissue in between. Note how many finger width distances between the left and right rectus abdominis muscles. Note any separation above or below the belly button.
Why is it a problem?
The abdominal wall plays an important role in many of our day to day activities. It stabilizes our trunk in bending, turning, and flexing. It plays a large role in posture and breathing, as well as being very important for delivering the baby as well.
It is not uncommon for this to go unnoticed by the patient and doctors, so these patients can present to chiropractic offices for secondary complaints due to altered movement patterns.
With altered movement patterns of the trunk, complications can occur. Diastasis Recti can contribute to low back pain, pelvic pain, abdominal hernias, urinary incontinence, and fecal incontinence.
So what can we do about it?
Once Diastasis Recti is diagnosed your health care provider will develop an individualized home exercise program designed specifically for your needs. The goal of the program is to decrease the width and length of your separation. It will start with specific exercises that activate the transverse abdominis muscle, the deepest layer of abdominal wall.
The exercise program will be progressed as needed to continue to challenge your body in order to maintain the benefits you have achieved. Abdominal bracing and taping may also be used as part of your treatment plan.
All of this is done while concurrently treating any secondary complaints that may be caused by resultant changes in your movement patterns.
Exercises to avoid:
Since the goal is to activate and re-train the abdominal muscles to support the core and spine, it is important to avoid activities that increase intra-abdominal pressure.
Avoid aggressive and high intensity movements of the core such as
- Crunches of any kind
- Sit ups of any variation, including twists
- Lifting or moving heavy objects
- Any exercise or activity that causes your abdomen to bulge out when performed
Also avoid any exercise or movement with you expand or stretch the mid-line of your abdomen. Examples include the yoga poses:
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References:
Keeler, J., Albrecht, M. et al. (2012). Diastasis recti abdominis: a survey of women's health specialists for current physical therapy clinical practice for postpartum women, Journal of Women's Health Physical Therapy. 36(3): 131-142.
Rett.M.T., Braga, M.D. et al. (2009). Prevalence of diastasis of the rectus abdominis muscles immediately postpartum: comparison between primiparae and multiparae, Rev Bras Fisioter. 13(4): 275-280.
Labels: Diastasis Recti, exercise, post-partum pain, Rectus Diastasis, transverse abdominis