Wednesday 24 February 2016

Diastasis Recti: Do I Have It & What Can I Do About It?


Written by Lindsay Nealon, DC  
Diastasis Recti. Perhaps you’ve heard of it, perhaps you haven’t. Most of us are first introduced to Diastasis Recti during pregnancy, but it doesn’t only affect pregnant or postpartum women, it can also affect men and children too. As many as 30% of newborns have this split at birth which closes once they gain head control and their core takes on more of an important role, interesting yes?  However, postpartum women have a higher risk because of the increased intra-abdominal pressure created by the growing uterus in pregnancy which pushes the abdominal muscles apart. But let’s get one thing straight, all pregnant women will experience some degree of stretch or separation. We have to or our bodies would not be able to carry a child. See it’s not all bad!
 
But what exactly is it?
Essentially Diastasis Recti is when those core muscles, specifically your rectus abdominus (you know, the ones that make up your six pack?), split apart. It sounds uncomfortable! But you’ve got some connective tissue (the linea alba) holding the 2 sides of muscle together. It can stretch and thin out causing the abdominal separation. The more dysfunctional your core is, the more likely something like this can happen.

Image of Diastasis Recti before and after. Credit.

Do I have a split? 
You may still have a ‘mommy tummy’ or your abs may pop up when you get out of bed. But do you have a split? The most common test performed to evaluate diastasis recti is, of course, the diastasis recti test, otherwise known as, the curl-up test, the crunch test, abdominal separation test, etc. You get the picture.  Here is how to do it. Diastasis Recti Test
  • Lie on your back with your knees bent, feet on the floor, shoulder width apart.
  • Place your dominate hand on the top of your abdomen, just below your ribs, with your fingertips across your midline-parallel with your waistline.
  • With your abdominal wall relaxed, gently press your fingertips into your abdomen. Get a feel for it.
  • Roll your upper body off the floor into a "crunch" making sure that your ribcage moves closer to your pelvis.
  • Move your fingertips back and forth across your midline, feeling for the right and left sides of your rectus abdominis muscle.
  • Relax.
  • Move your fingers down and assess the area below. It’s important to test for separation at, above, and below your belly button. 
The diastasis or split is measured by the number of finger spaces that fit in between the two rectus abdominis muscle bellies (the left and the right side).  Normal: 1 finger space or less.  Diastasis Recti: 2 or more finger spaces or a distance of 25 mm (just less than 1 inch). But again, this is just a clinical observation! This test gives us no information regarding the function of your core and that is what truly matters. You must first regain proper core function and then address the gap. Diastasis Recti Curl Up Test Demo  

The Research (Or at least some of it)  
In the last decade many studies regarding pregnancy and diastasis recti have been published. Of note, in postpartum moms, the ‘inter-recti’ distance (the space between the left and right sides) of the rectus abdominus muscle decreases markedly on its own from day 1 to week 8 after pregnancy. Great! However, if there is a gap after 8 weeks and no interventions are done to help it, the gap will remain unchanged at 1 year postpartum. Keep in mind that many times diastasis recti doesn’t just hang out on its own, other core dysfunctions tag along like stress urinary incontinence, fecal incontinence and/or pelvic organ prolapse, again letting us know that the split is just a split and we have a dysfunctional core.
 
Is my core is dysfunctional?  
First we have to become aware of our core and what it’s doing (or not doing) as we get through our day.  Core is a part of all of our movement and the fifteen minutes of core exercises we complete every few days isn’t going to make a dent in our overall core stability and strength. And while it seems like more and more postpartum women are dealing with Diastasis Recti, a sedentary, unhealthy lifestyle doesn’t help either; certain muscles are overworked and others are never worked at all. My guess is that even before pregnancy your core could have used some work. Why? Because we simply don’t move right! Think about what your body is doing all day long. How is your posture? Are you sitting upright engaging your core throughout the day? What about your breath—do you breathe deep into your diaphragm or shallow only breathing into the top part of your chest? Do you find you have back problems or experience incontinence? Does it hurt to do everyday functional tasks like squatting or lifting? Are you answering ‘yes’ to any of these? Then yes, your core is probably dysfunctional and could use some love and attention.

Ways to Help
Let’s look at a few known ways that may or may not help heal diastasis recti so you know what to invest your time and energy into.

Should I brace?
I see why some may think a brace or splinting would help. It is my understanding that the intent of the brace focuses on healing the connective tissue. “It holds everything in place, eliminating any chance of connective tissue (linea alba) stretch due to intra-abdominal pressure,” says Julie Tupler of the Tupler Technique. However, the brace itself adds abdominal pressure so while the pressure isn’t creating the gap it will create some other dysfunction in another part of your core.  And most likely it will be your pelvic floor or the bottom of your core that fails.  It is my opinion that bracing has nothing to do about regaining proper function and will leave you with superficial, temporary results. So my answer is no you should not brace. What should you do? Well that’s coming next.

Is surgery an option?
I’ve spoken to many moms who believe surgery is the only option. It is not and it shouldn’t even be on your radar until you have been accessed and followed a treatment plan provided to you by an expert! Besides that, there are many things to do before you go under the knife. Some women, in the end, still opt for surgery, aka a ‘tummy tuck’ but by this point of this blog post you know that the gap isn’t necessarily the issue and by just fixing the gap other dysfunctions may pop up in the future. You must ensure proper core function is restored.

Okay, so what can I do to make my core more functional?
We need to look at ‘exercises’ that address all aspects of core and retrain our body’s proper movement.  Here are a few of my favourites! Dynamic Stretching

Most of the tightness in our extremities stems from a sloppy core and poor posture.  Our bodies are smart. If I have taught my core to be sloppy or unstable then the tightness in my extremities is there for a reason. It is serving a purpose. It is creating ‘fake’ stability. So I must loosen up my hips and my shoulders so that I can regain my core. The dynamic stretching videos are designed to loosen up your hips and shoulders so that they core exercises below are more effective.  
Lower Dynamic Stretching Demo Upper Dynamic Stretching Demo  

Crocodile Breathing  
Breathing can help a slew of problems, including regaining proper core function, so don’t underestimate it! First off, do you breathe correctly? The inhale should be initiated at the lower abdomen with the belly expanding with the inhale and contracting with the exhale. The pelvic floor muscles (a group of muscles contained in the pelvis) should drop down with our inhale. The reverse happens with the exhale, the pelvic floor muscles lift up and the belly flattens, allowing air to move out of the rib cage. For our pelvic floor to function properly, proper motion must happen during each breath cycle. Crocodile breathing is a great way to add function to your diaphragm and pelvic floor.
  • Begin by lying on your tummy, rest your head on your hands.
  • Breathe in through your nose pushing your belly into the floor, out to the side and up to the ceiling.
  • Release the air and relax into the floor.
  • Complete 10 times at least 2 times per day. 
Why crocodile? Because when our back goes up and down we look like a crocodile lying on its belly breathing.

Heel Drops
  • Begin on your back with your knees bent and feet on the ground. Relax neck and shoulders and lay arms by your side.
  • Find your pelvic neutral position. Move your pelvis through its full range of motion (anterior pelvic tilt/posterior pelvic tilt) and find pelvic neutral which is the position half way in between.
  • Raise both legs, one at a time, to ‘table top’ position (hips at 90 degrees, knees at 90 degrees) while maintaining pelvic neutral.
  • Slowly lower legs, one at a time, to the ground while maintaining pelvic neutral.
  • If you begin to arch, don’t reach your legs out as far or bend your knees more.
  • Perform 15 perfect reps on each side x 2.



Resisted Bridge
  • Begin sitting, tie a piece of tubing around your legs and place just above your knees. Keep your hips in line with knees, knees in line with feet. The tighter the tubing the more difficult it will be to maintain this position. Your butt must fire to keep your legs in line. 
  • Lower onto your back, keep your knees bent and feet on the ground. Relax your neck and shoulders and flip hands to palms up so you don’t cheat with your arms.
  • Bridge up and down while maintaining pelvic neutral.
  • Complete 25 x 2.

How Can Chiropractic Help?
The basics: our nervous system controls and regulates every cell, tissue, organ, system and muscle of our body. It’s our power supply. When our nervous system isn’t functioning properly we don’t function properly. This includes the core.  Our core is built like a cylinder. It is synergistic in nature, meaning that all the parts must work together in order to serve its purpose. From a muscular standpoint it looks like this; 
  • Front: Abdominal muscles (specifically transverse abdominus)
  • Back: Intrinsic back muscles (multifidus), psoas & lateral glute muscles
  • Top: Diaphragm
  • Bottom: Pelvic floor & obturator internus muscle
Here’s what we know about muscles. They are dumb! All of them! They are told what to do from your nervous system. They don't contract unless your nervous system tells them to. The nerve supply to your core includes: 
  • Transverse abdominus: Lower intercostal nerves (T7-T11), iliohypogastric nerve (L1) and ilioinguinal nerve (L1).
  • Multifidus: Posterior nerve root T10-S5.  Psoas: (L1, L2, L3), Gluteus medius and minimus: L4, 5, S1. 
  • Diaphragm: C3-5, intercostal (T5-T11) and subcostal nerves (T12).
  • Pelvic floor: Sacral nerve roots S3-S5.  Obturator internus: L5, S1, S2.

Credit.

Does your nervous system play a role in a functional core? Absolutely. If these spinal levels are not moving correctly will they play a role in a dysfunctional core?  Most definitely. Throughout your pregnancy and delivery, your pelvis has experienced a ton of stress. So while functional exercises are important, your spine must be moving properly. The nerve supply to these muscles must be free of interference or the program will be ineffective. I have worked with hundreds of women regain their core function. If you have any questions I am here to help. You can reach me at drlindsay@thewellnessstudio.ca.

Xx
Dr. Lindsay

 
Sources:
Carey, Elea. Heal Diastasis Recti: Exercises for New Moms. Healthline. Aug. 2014.  http://www.healthline.com/health/pregnancy/disastis-recti-exercises
Lee, Diane PT. Diastasis Rectus Abdominis & Postpartum Health. July 2015. http://dianelee.ca/article-diastasis-rectus-abdominis.php
Lee, Diane PT. Understand Your Back & Pelvic Girdle Pain. Jan. 2011. http://dianelee.ca/articles/1-Understanding-Your-Back-&-PGP-2011-opt.pdf
Lee, Diane PT and Linda-Joy Lee. The Pelvic Girdle: An Integration of Expertise and Research. Churchill Livingstone, 2010. Print.
Powell, Wendy PT. Why You Should Stop Measuring Your Diastasis, Or Anything Else For that Matter. MuTu System. Apr. 2014. https://mutusystem.com/why-you-should-stop-measuring-your-diastasis-or-anything-else-for-that-matter.html
Scapens, Lorraine. Does Your Diastasis Need to Close for Optimal Function? Pregnancy Exercise. Jan. 2015. http://www.pregnancyexercise.co.nz/does-your-diastasis-need-to-close-for-optimal-function/

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