• Dr. Kelly Sammis, PT, CLT

Diastasis Recti...The Gap Isn't The Problem

As women, especially in the postpartum phase, we are plagued with societal pressures and advertisements to get our pre-baby body back. A number of these plugs come from movement platforms promising women that by engaging in a specific set of exercises they will get rid of their “mommy pooch” or “mommy tummy”, referencing the visual appearance of the belly when there is a presence of diastasis recti (DR). The goal of these platforms is often obsessed with closing the gap when, realistically, the gap isn’t the problem. The heavily centered focus around the aesthetics of the dysfunction shows little regard to day to day function. While many of those affected by DR worry about the look of the separation, they are often improperly educated that closing the gap is the key to mind and body healing. I am going to take this opportunity to change the conversation about DR to make it about optimal function rather than aesthetics.


Diastasis recti is a hot topic in the world of postpartum health and exercise, as it occurs naturally during the pregnancy phase, especially in the third trimester. The stretch/strain that a growing fetus puts on the abdominal muscles and fascia can cause a natural separation of the connective tissue along the linea alba. This, by definition, is DR. While the demand that pregnancy puts on the body is one variable of DR, it is certainly not the only contributor.



Copyright © 2019 Shelby Hoge @sahogeart. Image produced for use by KL Therapies, LLC. All rights reserved.


How does Diastasis Recti happen?


DR is heavily influenced by the inability to regulate intra-abdominal pressure (IAP) during activity. The abnormal regulation of IAP is the main contributor to DR. For this reason, men, women who have not been pregnant, athletes and children can also be affected by DR.


Poor regulation of IAP stems from non-optimal movement strategies and strength deficits that cause abnormal loading of the connective tissue of the linea alba. Preventing and/or healing DR isn’t necessarily about avoiding certain movements or exercises, more-so it’s about understanding that your current movement strategies, strength and connective tissue health are non-optimal. If you are demonstrating signs of tissue failure and poor regulation of IAP with your current movement strategies, continuing to move in the same way will only reinforce the dysfunction. The ability to properly regulate IAP and recruit the deep core to tension the linea alba is called forced closure. Without forced closure clients are at risk for non-healing or worsening DR, pelvic floor dysfunction, pain associated with activity, pelvic organ prolapse and/or incontinence.


Furthermore, some individuals can achieve temporary narrowing of the separation by engaging their abdominals utilizing non-optimal recruitment, meaning they could use the more superficial abdominals (obliques most often) to make the gap come together, but the deep core muscles (transverse abdominis and co-activation of the pelvic floor) responsible for forced closure may not be recruited at all. This causes a more global issue because true trunk stability will not be restored with this band-aid type recruitment pattern. This can lead to continual poor regulation of IAP bringing us right back to the main component that contributes to DR. Not the revolving door we want to be stuck in.


If you aren’t aware of the movement strategies that are contributing to the stresses and strains that abnormally load the linea alba, then how could you possibly prevent or heal a DR? If improper regulation of IAP is decreasing your ability to produce forced closure, you could be compensating without realizing it, potentially leading to tissue breakdown in the areas that are taking over in lieu of the deep core. This leads to further stress and strain of the affected tissues.


How do you identify poor regulation of IAP during exercise?


1. presence of visible tenting/doming/gapping of the abdominals during movement and exercise

2. sensation of pelvic pressure/bulge/dragging in the vagina or pelvic area during movement and exercise

3. presence of pelvic, low back, deep hip or other pain during exercise

4. presence of urinary or fecal incontinence during exercise


It is integral to discontinue any movements and exercises that cause the above symptoms. If you’re experiencing any or all of these, get yourself in to a pelvic health specialist for an assessment! Skilled clinicians will perform functional movement assessments to identify mobility and control issues in particular areas that will help guide the treatment approach for each individual client. Additionally, if you’re a clinician and your patient is reporting any of these symptoms, you’ll want to have a knowledgeable pelvic health expert in your referral network!


How do you address Diastasis Recti?


If you’re trying to address a DR, it is helpful to understand what it is that creates the stress and strain to the linea alba in your body. This is not the same for every individual. The body functions similar to any other ecosystem, relying on a complex network of interconnected systems to function optimally. For movement to be optimal and sustainable, every part of the ecosystem must be healthy. If one small part is not functioning optimally, it can cause ripple effects of ailments throughout the remainder of the system. When considering DR, the most important piece to address in restoration of function is the ability to connect with and properly recruit the deep transverse abdominis and pelvic floor musculature to properly tension the linea alba…regardless of the gap! Forced closure is key to successfully preventing or healing DR.


What if there are underlying musculoskeletal dysfunctions that are preventing the forced closure mechanism?


Professional evaluation is necessary to obtain the most effective plan of care. A pelvic health specialist can perform an individual assessment to identify the primary driver involved in each case of non-optimal function in the body. It is vital to accurately identify the muscles and movement strategies responsible for silencing the deep core system. Failure to restore optimal load transferring strategies through the trunk is detrimental to complete healing.


Oftentimes, especially in my postpartum clientele, it is imperative to achieve a reset to the tissues preventing proper forced closure prior to reinforcing healthy recruitment strategies and reloading of the tissues. The reset restores the homeostatic balance in the tissues which will allow optimal function. My personal preference to achieve this reset is to utilize dry needling with intramuscular electrical stimulation to the tissues involved in disrupting the forced closure mechanism. In my practice, the power of the tissue reset that dry needling provides has yet to be paralleled by another treatment method.


Once the tissue reset is achieved I am then able to provide guidance to my clients in reinforcing optimal strategies for task-specific movement, progressive reloading of the tissues and achievement of regulation of IAP and the forced closure mechanism. This approach has yielded the best functional results for prevention and healing of DR.


To health + wellness for your pelvis,

Kelly

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