Diastasis recti is defined as a separation of the two sides of the rectus abdominis muscle (the six pack muscle) at the linea alba or midline at the belly button. The separation can be noted during a physical examination by palpation at the belly button while asking the patient to lift her head. During this motion a gap is noted and measured above and/or below the belly button.
While the actual cause may vary from person to person, DR is more commonly seen in pregnant women and particularly in those who have had multiple pregnancies, gave birth to larger babies (> 9 lbs), and/or are over the age of 35. It is important to note that excessive abdominal exercises that involve the rectus abdominal muscles (crunches, sit ups, leg lowering, etc.) during the first trimester of pregnancy can increase the risk of DR.
Avoid excessive abdominal exercises involving the six pack muscle (sit up muscle) both during pregnancy and during postpartum recovery. This includes sit ups, roll ups, V ups, and leg lowering as some examples. Additionally, it is helpful to perform transversus abdominal exercises in order to help close the potential gap in the muscles. Work with a physical therapist or personal trainer to help learn how to access these muscles.
Abdominal exercises in neutral spine as well as proper pelvic floor activation assist the closure of the gap. Example: In a seated position, place both hands on abdominal muscles just inside front hip bones. Slowly contract the abdominal muscles as if pulling the front two hip bones closer together. Hold the contraction for 1-2 normal breaths. Relax and repeat. Complete 10 repetitions.
Avoid positions that stress the rectus abdominal muscles. These include excessive bending forward, slumped sitting, and lifting the head when lying on the back. Notice these postures during the day and avoid them as much as possible. For example, when getting out of bed, roll over onto the side and sit rather than lifting the head and sitting straight up. Or when breastfeeding, support the back and sit upright rather than slumping forward.
When in doubt, seek care with a women’s health physical therapist who can diagnose and provide personalized treatment.
Dr. Holly Durney is an APTA Orthopedic Certified Specialist and has pelvic floor rehabilitation training from the Herman and Wallace Pelvic Rehabilitation Institute. Her pelvic health training focuses on treating pelvic floor dysfunction and related issues in the pelvis, hip, and spine. Her pelvic floor treatments involve assessment including movement patterns, ligament structure, current activity level, and pregnancy history. She believes that treating the whole person is the key to complete health and wellness and to help her patients achieve their goals. Dr. Durney sees patients at Smart Athlete Physical Therapy
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