What is Diastasis Recti and How to Treat it with Physiotherapy
Are you a mother who has just given birth? Then you may be familiar with what’s referred to as "mummy tummy" or "mommy pooch", or what is known as Diastasis Recti in medical terms.
Imagine that your abdominal muscles have a 'zipper' that (just like a track top) pulls both sides of your core together. When this 'zipper' for the muscles along the midline of your abdomen separates, that’s Diastasis Recti.
The actual name of this ‘zipper’ is the linea alba; it is a long, thin band of connective tissue that divides the rectus abdominis muscles (the abs or "six-pack" muscles) into left and right halves and plays a crucial role holding all the abdominal muscles together.
Besides having a lower belly pooch, individuals with Diastasis Recti may also have issues like lower back pain, pelvic floor issues, hernia, and poor core strength.
Every pregnant mother is likely to experience some degree of abdominal separation by their due date as the abdominal fascia must stretch to accommodate the growing baby. In most cases, the separation naturally and spontaneously recovers without any treatment. The chances of Diastasis Recti Abdominis (DRA) go down from about 60% at six weeks to around 45.5% at six months after giving birth.1
While Diastasis Recti is most commonly associated with pregnancy and postpartum, it's not exclusive to mothers; babies, individuals who are obese, and chronically ill patients can also experience it.
So how can physiotherapy be a game-changer for your recovery?
How do you know if you have Diastasis Recti?
Diagnosing Diastasis Recti involves a series of assessments conducted by your physiotherapist to determine the extent of muscle separation and its impact on functional movements and exercise.
One common evaluation method is to have you curl up and do a crunch to engage your core muscles. While holding the crunch, your physiotherapist will place their fingers gently on your abdomen, typically above, below and at the belly button. As you lift your head, they will assess the width and depth between the two rectus muscles. If the width is more than 2 fingers, and you’re able to sink your fingers in between your abdominal muscles instead of feeling a firm bounce like a trampoline, then you might have Diastasis Recti.
Doming or bulging of the middle abdominal area is also an indication of Diastasis Recti and that the soft tissue around the area lacks tensile strength. Sometimes, the doming doesn’t show up unless you perform strenuous activities like planking, push-ups or double leg lifts. To identify this, your physiotherapist will assess you in various positions as you might look great while lying on your back but worse in a plank position, or vice versa.
Understanding the specific characteristics of your condition is vital for tailoring an effective treatment plan. It's especially important for those who plan to engage in intensive postpartum workouts to seek professional guidance and support in managing their Diastasis Recti.
So how Is Diastasis Recti treated?
The normal treatments for Diastasis Recti typically encompass a range of conservative and non-surgical approaches, with surgery considered only in more severe cases.
The primary and most effective treatment options are guided by a physiotherapist who specialises in postpartum issues.
Your physiotherapist will design a personalised exercise program aimed at strengthening the core muscles and pelvic floor to help to improve muscle coordination, alignment, and overall stability.
In addition to exercise, learning proper breathing techniques can often be an essential part of treatment to help in core activation and provide healing support along with maintaining a healthy weight and proper nutrition, as they can help reduce pressure on the abdominal muscles.
Don’t do these things!
Due to persistent societal expectations to quickly regain their pre-pregnancy appearance and achieve a fit body, some postpartum mothers use abdominal binders or support garments to provide additional support to the abdomen and core muscles.
However, binders, if over-tightened, can create more pressure and force the organs down towards the pelvic floor. Excessive use of binders does not allow the fascia to heal and too much pressure on the pelvic floor can lead to other complications and discomfort including pelvic floor dysfunction.
A safer option is to use bottom-up support in the form of shorts or self-taping instead of abdominal binding while getting your strength back.
Quick fix procedures
Many postpartum mothers also turn to quick fix procedures offered by aesthetics clinics to address Diastasis Recti. While some of these treatments may focus on improving the appearance of the abdomen and strengthen the core, you may not be taught how to coordinate your core and move safely through higher levels of physical activity like executing burpees, planks, squats and so on.
Before opting for any such treatments, it is recommended that you consult a qualified healthcare professional (such as a physiotherapist or medical doctor) for a thorough assessment and recommendation that is evidence-based and tailored to your specific needs.
It's important to choose solutions that target the root cause of Diastasis Recti rather than solely focusing on cosmetic outcomes.
Treating Diastasis Recti with Physiotherapy
At Performance Wellness, we target your holistic well-being. Our experienced team of physiotherapists takes a comprehensive approach to treating Diastasis Recti. We don’t just focus on the problem, we look at your entire body and assess how different aspects are impacting one another.
To resolve Diastasis Recti, our physiotherapist will teach you how to properly activate your deep core muscles which act as stabilisers. We can also use ultrasound for biofeedback training to provide you with a visual guide to your core muscles and teach you how to activate them.
We also recommend pilates classes to gently strengthen the core by engaging your muscles without excessive strain, allowing for the gradual recovery of abdominal separation. With controlled and modified movements on the reformer, you’ll rebuild core strength safely.
We will also work on improving how your abdomen manages pressure to prevent unwanted bulging and doming. Furthermore, we will guide you in coordinating your deep core muscles with exercises and everyday activities to speed up your functional recovery.
Advantages of seeing a pelvic health physiotherapist
When you choose to work with a pelvic health physiotherapist, you're tapping into a wealth of specialised expertise that is related to the pelvic region.
Dr. Esther Lim, our experienced Senior Physiotherapist at Performance Wellness is equipped with in-depth knowledge to resolve pelvic floor issues. She will ensure that you receive a programme tailored for you to strengthen your core and improve pelvic floor function.
The specialised focus on pelvic health can make a world of difference in the effective recovery and rehabilitation of Diastasis Recti.
More importantly, the conversations at Performance Wellness revolve around health, strength, and functionality, rather than aesthetics. With your well-being as our primary concern, we do our best to ensure that you achieve a healthy strong body that supports you in all aspects of your life.
- Sperstad JB, Tennfjord MK, Hilde G, et al. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine 2016; 50:1092-1096. https://bjsm.bmj.com/content/50/17/1092