There is A LOT of hype about diastasis in the fitness and mom world right now so I wanted to give you a bit of information about it from a pelvic physio perspective.
Let's start with what it is. Diastasis is a separation of the rectus abdominus (6-pack) muscles occurring when the connective tissue (linea alba) between each side of this muscle becomes thinner and strettttttched. Everyone has some amount of a gap between their abs; if we didn’t, really ripped individuals would look like they had a giant sheet of muscle instead of a 6 pack. That gap is often 0.5 to 1.5 finger widths. In research studies, diastasis is often defined as a separation greater than 2 finger widths somewhere along the linea. Other signs of a diastasis are if you have a dome or a cone pop up along the middle of your abdomen or a sort of valley (the reverse of a dome) during activities that use your abs.
Is it true that most women have a diastasis by the end of pregnancy? Yes. But is this a problem? Not necessarily. While pregnant, that baby has got to go somewhere as it grows, and a diastasis is one way your belly can accommodate that. At 6 weeks postpartum, about 2 in 3 first time mothers have a diastasis(1). By 1 year postpartum, about 1 in 3 first time mothers still have a diastasis(1). So for some mamas, diastasis will resolve on its own as they recover after pregnancy. For others that increased separation might never go away despite their best efforts.
Newer research is suggesting that rather than focusing exclusively on narrowing the gap, it is important that the linea alba can firm up/hold tension during movement to create effective load transfer from one side of the abdomen to the other(2). In my opinion this is great news! A diastasis may never “go away” but when the focus shifts to function, many women can achieve excellent outcomes. It is possible that the gap could narrow while you focus on improving function, but even if it doesn’t go back to a smaller gap size (which sometimes is the case), you can still have good functional results. It is a more important goal to focus on attaining good core and pelvic floor muscle function and effective management of intra-abdominal pressure in your daily activities than a goal to try to close a gap.
Does diastasis even matter? To date most research has focused on defining diastasis as a separation and has not looked at the “squishiness” of the linea alba/the ability to generate tension in the linea alba. The research is a bit mixed but mostly shows that diastasis doesn’t seem to be related to back pain, incontinence, or pelvic organ prolapse (so basically it says that mothers with a diastasis are not at more risk of developing these problems than mothers without a diastasis)(1,3,4). It is possible that it might be related to these things if researchers looked more at the tension in the linea alba or at the size of the diastasis rather than just classifying women as having a diastasis or not, but there isn’t much info available looking at diastasis that way yet. Diastasis can change the appearance of the abdomen and it is also related to reduced strength and endurance in the abdominal muscles(5).
So how can you go about improving your ability to create tension in the linea alba? What is the best way to rehab diastasis? Should you avoid crunches? Should you avoid planks? Should you use a belly wrap? It depends on many factors. Every woman is different and there is not a one size fits all approach that will work for everyone. One thing I focus on is teaching women how to properly engage their transverse abdominal muscles and pelvic floor muscles in isolation and then during progressively more challenging exercises with the goal of helping each client regain enough function and tension in the linea alba to resume the activities they want to do. It is also important to consider your daily activities and how the things you do can repetitively put pressure on the abdominal wall or pelvic floor. You’ll want to learn more about which movements and tasks increase pressure within your abdomen in your daily activities and how to best manage that pressure to avoid unnecessary or excessive strain. Doing a little generic set of exercises a few days each week is probably not the best way to address a diastasis because it may not transfer to the activities you want to eventually get back to and it probably will not address the day to day situations of higher intra-abdominal pressure.
Final side note: improving a diastasis will not get rid of stretch marks, loose skin, or abdominal fat. I have had a fair number of clients who think that their tummy looks the way it does because of a diastasis when this is not the case. I think our society and fitness industry has a bit of an obsession with the word “mummy tummy” and it may be more useful to focus on function rather than appearance. This is a great time to say that your body accomplished an amazing thing carrying life during a pregnancy! The value of your body is SO MUCH MORE than its appearance. If appearance changes are your goal, addressing a diastasis may help, but it won’t get rid of certain changes listed above.
Key take home points:
· If you feel your tummy and there is a 1 finger gap, DO NOT PANIC, that is normal!
· If you feel your tummy and there is a 2+ finger gap, this still might not be a big deal as long as you can generate good tension in the space between the gap.
· If you feel a gap at the end of your pregnancy or very early postpartum, you shouldn’t panic because this can significantly improve over the first few months and even up to a year postpartum.
· A generic program claiming it will fix your diastasis might not be the most effective treatment option.
Pelvic physiotherapists can help women with diastasis learn strategies during pregnancy and postpartum to optimize pelvic floor and abdominal muscle function. This can include exercises relevant to your specific concerns and current level of function as well as looking at more general strategies to apply in day to day life, amongst other things. If you live in the Hamilton area and want some help managing a diastasis, feel free to drop me a line or book an assessment online.
References for the research lovers:
1. Sperstad JB, Tennfjord MK, Hilde G, et al Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med 2016;50:1092-1096.
2. Lee D, Hodges PW. Behaviour of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study. J Orthop Sports Phys Ther 2016;46(7):580-589.
3. Bo K, Hilde G, Tennfjord MK, et al Pelvic floor muscle function, pelvic floor dysfunction, and diastasis recti abdominis: prospective cohort study. Neurourol Urodyn 2016;36:716-721.
4. Fernandes da Mota PG, Pascoal AG, Carita AI, et al. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther. 2015; 20(1): 200–205
5. Liaw LJ, Hsu MJ, Liao CF et al. The relationship between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study. J Orthop Sports Phys Ther. 2011; 41: 435–443