As we discussed at the end of our last blogpost, there are a lot of problem that crop after a woman has delivered her baby. These can include incontinence and pelvic pain (read our previous blogpost here for more information on that) and diastasis recti. These are signficant issues that need to be addressed as soon as possible since they signal a complete failure of at least one part of our core and can lead to severe pain problems and dysfunction. As we've already addressed the pelvic part of this dysfunction, today's blogpost will focus on diastasis recti.
First of all, let's discuss what it is. One of our abdominal muscles is our rectus abdominis (aka the "six pack muscle") which flexes or curls our trunk. The left and right side of this muscle is held together by some connective tissue called the linea alba. The diastasis recti occurs when the linea alba is over stretched or breaks. This most commonly occurs during pregnancy where the abdomin grows very large in a relatively quick amount of time. It can also occur with excessive abdominal circumference or adipose tissue or possibly with the overuse of the Valsalva maneuver (read our blogpost on that here.)
This is most commonly diagnosed by a healthcare professional. The patient will lie on their back with their knees bent and feet flat on the floor. They will then lift their head off of the ground to activate the rectus abdominis muscle. Once, activated the left and right side of this muscle should be easily palpated. If the space between these sides is wider than 2 fingertips, it's generally considered that they have a diastasis recti.
Why is this important? This finding suggests that at least a quarter of your core muscles do not function as they should. Think of a closed can of coke. You can squeeze it as hard as you want and you will not be able to pop the can. However, prick a hole in the can with a needle, and you'll be able to crush the can with enough pressure from your hand. The rectis abdominis is the pinprick in the soda can. Now that your core is damaged, you will not have the intrinsic core stability needed to do more normal activities in a biomechanically correct way. This will lead to compensations and further breakdown of your body until you're left with a loss of function or development of significant pain.
Physical therapy is the leading intervention for a diastasis recti. Typically, therapists try to work out the abdominals in a "safe" manner to restore our core strength. In our therapist's experience,t this is a bandaid on the problem and although it can ease pain in the short term, it does not correct the problem as much as possible.
At Integrate 360 Physical Therapy, we treat this issue is a very holistic manner. We look at the position and function of the entire body to see what is feeding in to the dysfunction. Typically, we find that the lumbar spine is too arched or overextended which places the pelvis in a tipped forward position. The rectis abdominis attaches to your lower ribs and the front of your pelvis. When your pelvis is tipped forward, the muscle is elongated and subject to "stretch" weakness which means it cannot work very well. We utilize repositioning activities to help restore normal spinal position. From there, we not only activate the rectis abdominis, but we restore true core strength through utilization of the transverse abdominis and obliques to support the rectis abdominis and take additional strain off of this tissue. We also focus a lot on proper breathing patterns so that the diaphragm can be appropriately utilized. This will help to reduce pressure on the diastasis recti and support proper posture. Assessing and intervening on all of these areas is what allows us to "heal" our patients more completely than in traditional settings.