Postpartum Core Dysfunction Series: Diastasis

In the postpartum, there are a number of core dysfunctions that can result in decreased function, increased pain and frustration.  In the next several posts, we will be discussing common core dysfunction (pelvic floor included) and strategies that may alleviate some of these issues through movement.  As a note, these blog posts are not medical advice, and we always recommend that you consult your medical practitioner or pelvic floor physical therapist.

Diastasis, mummy tummy, ab gap, and mommy pooch are common buzz words associated with an actual core dysfunction of the postpartum.  While the slang terms for it sound incredibly unappealing, and can cause some serious distress to knock out a ton of sit ups and crunches to make it go away, it's not as scary as we may think, nor will ab exercises help it "go away."  

Diastasis Recti (DRA) is a normal adaptation that our pregnant bodies undergo to accommodate for our growing baby.  Diastasis is the separation of parts of the body that are normally joined together, and during pregnancy each half of our rectus abdominis (six-pack abs) separate in order to allow you baby to grow without your bladder becoming nonexistent.   

Between your rectus abdominis is a connective tissue called the linea alba, and this tissue stretches as the two halves of your rectus abdominis separate.  As your trimesters progress, DRA becomes more prevalent amongst mamas, and almost 100% have it by the time they give birth.  

While the research on DRA is growing, there are some current studies that research the prevalence, potential causes, and how to potentially heal a lingering DRA.  While the numbers in the studies may differ, the overall trend tends to stay the same.  The first 6-8 weeks postpartum is when the spontaneously healing tends to occur.  If DRA is still persistent after 8 weeks postpartum (studies show this is anywhere from 50-60% of mamas), the chance of it spontaneously healing without any intentional rehab strategies is much lower.  

So what is healed then?  Less than 2 fingers width distance and less than a knuckle deep is considered "healed".  The most accurate way to measure this would be via ultrasound, but seeing as most of us don't have one of those lying around, using your fingers to measure is another option.  

BUT, the gap distance is not the only indicator of restored function.  The density of the tissue (how far you can press into your abdomen via the linea alba) is also incredibly important!  There was a point when there was an inverse relationship between gap distance and function; the smaller the gap distance, the higher the function.  However, if this is the ONLY goal, function may not be restored.  As with everything in the human body, there are multiple components that need to come together for us to function properly.  

In the study by Diane Lee & Paul Hodges, they looked at when only the rectus abdominis (six pack abs) is activated, when only the transverse abdominis (corset abs) is activated, and then when both the rectus and transverse are activated to evaluate the current clinical approaches to helping heal DRA. 

While the rectus only activation results in a small gap distance, the linea alba is most aggravated, which may result in a disruption in healing and function.  When only the transverse was activated, there was a stretching laterally of the linea alba. 

Activation of only the rectus abdominis can result in doming, also known as coning.  This is when the linea alba cannot meet the demand of the intra-abdominal pressure that is being created interally, and is pushed outwards.  This can result in a "leak" in energy, and decreased function.

Activation of only the rectus abdominis can result in doming, also known as coning.  This is when the linea alba cannot meet the demand of the intra-abdominal pressure that is being created interally, and is pushed outwards.  This can result in a "leak" in energy, and decreased function.

But when both the transverse and rectus were activated together (surprise), the tension of the linea alaba (tension=strength) was able to meet the demand of the intra-abdominal pressure (aka increased function).

The difference between activation of only the rectus versus activation of both the rectus and transverse abdominis is shown here.  In the activation of only the rectus, note the doming of the linea alba as it is being pushed outwards by the intra-abdominal pressure.  In the activation of both the TA/RA, the linea alba's tension is able to meet the demand of the pressure.

The difference between activation of only the rectus versus activation of both the rectus and transverse abdominis is shown here.  In the activation of only the rectus, note the doming of the linea alba as it is being pushed outwards by the intra-abdominal pressure.  In the activation of both the TA/RA, the linea alba's tension is able to meet the demand of the pressure.

So while the closing the gap of diastasis recti is necessary for healing, the density of the linea alba is just as important!  How do you heal DRA?  There are a number of potential movement strategies that you can implement that we will get into in future posts. 

But to start, focus on what movements help you FEEL your transverse and rectus activate together, and avoid movements that you feel aggravates your linea alba (stretches it vertically, causes doming).  Not sure what TA activation feels like?  Try coughing or laughing!  Your transverse is what turns on when you laugh or cough!        

 

xoxo the mama in us honors the mama in you.

-Gina

 


References:

  • Lee, D., & Hodges, P. (2015). Behaviour of the linea alba during a curl-up task in diastasis rectus abdominis: A new interpretation with clinical implications. Physiotherapy, 101. doi:10.1016/j.physio.2015.03.3403
  • Sperstad, J. B., Tennfjord, M. K., Hilde, G., Ellström-Engh, M., & Bø, K. (2016). Diastasis recti abdominis during pregnancy and 12 months after childbirth: Prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine, 50(17), 1092-1096. doi:10.1136/bjsports-2016-096065
 
Gina Conley