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| Picture from Lamaze.org |
She has diastasis recti of about 2 fingers width. She was afraid that she would have low back pain and incontinence if the diastasis recti was not corrected.
Diastasis recti (DR) is the separation of the rectus abdominis (or 6-pack ab) muscles during and after pregnancy. The rectus abdominis runs in a straight line along the front of your stomach. A band of connective tissue called the linea alba divides the rectus abdominis into left and right sides. In simple terms it is the separation of the six-pack muscles into 2 halves.
It happens when the rectus abdominis muscles separate during pregnancy after being stretched. The linea alba becomes thinner and gets wider as it gets pushed by the uterus when it expands. The criteria for the diagnosis of DR is a gap or separation of more than 1.5 cm at one or more points of the linea alba.
Here is how I measure/check for the tummy gap. I get my patient to lie supine with knees bent and hip width apart. I place 2 fingers above her belly button. Then I get her to slowly lift her head, neck and shoulders off the bed like a low level sit-up. I then move my fingers below and above the belly button length wise and feel for any gaps and whether I can fit more than 2 fingers width wise. It's easy to feel for the gap this way.
After the baby is delivered, the linea alba can retract as the connective tissue is highly elastic. It can retract (like a rubber band). This usually happens for some new mums, the linea alba repairs itself within 10-12 weeks. However, when the linea alba loses its elasticity from being overstretched (larger babies) and/ or from a second and third pregnancy, the gap widens in the rectus abdominis.
Many patients have been told (by healthcare practitioners) that if DR continues after 10-12 weeks, their stomach/ core muscles cannot function efficiently and cannot properly support the lumbar spine (low back) or stomach contents.
These same healthcare practitioners that treat diastasis recti will NOT be happy reading what I write next. Yes, women with DR may have weaker abdominal muscles (and perhaps more abdominal pain) BUT no higher prevalence of pelvic floor disorders (or incontinence), low back pain and pelvic girdle (hip) pain than women without DR (Gluppe et al, 2021).
In fact, subgroup analyses comparing women with severe and moderate DR to women without DR showed no difference in abdominal strength, pelvic floor disorders (incontinence), low back pain, pelvic girdle and abdominal pain (Gluppe et al, 2021). This is actually the first study to investigate possible consequences of DR in a subgroup of women with moderate to severe diastasis.
I did not come up with that. There are many published research contrasting all that BS (excuse my language) about getting low back pain if you don't 'fix' your diastasis recti (Benjamin et al, 2019).
These studies contradict the common belief there there is an association between diastasis recti and pelvic floor disorders. It does not mean that you definitely need treatment if you have a gap in your tummy after giving birth. Do not allow others to frighten you by saying that you will have back aches/ pain, weak core, hip, pelvic girdle pain and even incontinence if you don't 'fix' it.
So did I manage to reduce the tummy gap in my patient? I did and that may have to be a different post.
References
Benjamin DR, Frawlwy HC, Shields N et al (2019). Relationship Between Diastasis Of The Rectus Abdominis Muscle And Musculoskeletal Dysfunctions, Pain And Quality Of Life: A Systematic Review. 105(1): 24-34. DOI: 10.1016/j.physio.2018.07.002
Giuppe S, Engh ME and Bo K (2021). Women With Diastasis Recti Abdominis Might Have Weaker Abdominal Muscles And More Abdominal Pain, But No Higher Prevalence Of Pelvic Floor Disorders, Low Back And Pelvic Girdle Pain Than Women Without Diastasis Recti Abdominis. Physiotherapy. 111:57-65. DOI: 10.1016/j.physio.2021.01.008
*Thanks to Kaylee and Vean for getting me the articles
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