Rectus Diastasis occurs when there is a gap or separation between the rectus abdominus (six pack) musculature. The muscles themselves don't necessarily separate, it is the linea alba (a fibrous band that runs between the six pack muscles) that stretches. As this band stretches the abdominal muscles start to gap and open up.
Who gets RD?
There are three populations who are seen to experience RD:
- Pregnant and postnatal women (most commonly)
- Children - when the sealing of the linea alba does not occur - this is more common in premature babies
- Men - due to prolonged heavy lifting, straining, excessive abdominal muscle exercises or when carrying excesses abdominal fat aka "beer belly"
During pregnancy, the linea alba, like all other ligamentous and tendinous tissues, becomes soft and stretchy due to the softening hormones surging through the body in preparation for delivery. Pair this natural laxity with the pressure from the growing foetus plus the prolonged sway posture as a result of the centre of mass shifting forward with the growing belly. Cumulatively, these factors put an increased strain and eventual stretch on the linea alba, leading to a separation between the abdominal muscles. Then, if the woman goes through a vaginal delivery where she is pushing and straining to birth her baby - this too can have a straining effect on the linea alba where we see this separation persisting into the postnatal period. NOTE: You can still have rectus diastasis after a caesarean section!
What does RD look like?
The presentation of a RD depends on the severity of the separation.
A mild RD will present when there is a force or pressure being placed through the abdominal wall for instance when the patient is sitting up or straining. In this case the linea alba is being stretched and the force generated in the abdominal cavity is being forced up through the linea alba which creates a little cone. Imagine a Toblerone block of chocolate running up and down between your abdominal muscles. (See below)
A more severe case of RD can be seen when the patient is lying flat or standing. There is instability and laxity throughout the abdominal wall at rest which is exacerbated when forces are placed through the abdominal wall like twisting, sitting up, bending, straining and lifting. In these cases the entire abdominal wall attempts to stabilise the RD hence when the above forces are placed through the trunk you commonly see a bulging effect of the abdominal wall where the entire abdominal wall bulges up and out.
The issue with Rectus Diastasis:
Most women are concerned about the aesthetic complications of a rectus diastasis, however as a physio I am wanting to address any rectus diastasis as it can be a precursor to many serious long term issues.
If you think about your thorax or trunk as a canister - your abdominal wall forms the front, your spine forms the back, your obliques and thoracic cage form the sides, your pelvic floor forms the bottom and your diaphragm forms the top. With a RD there is an element of instability or increased movement at the front so the back, sides and bottom are exposed to increased forces and have to work harder to hold the can together. It is with this that we see patients 'gripping' most commonly with their upper abdominal muscles which we refer to as "chest gripping". Please refer to our article "The Mummy Tummy - chest gripping" for further information. With gripping, whether it be in the upper abdominals, butt or back, the pelvic floor / core complex is unable to activate effectively and the abdominal instability can not be controlled.
Over time, this anterior instability and subsequent increased loads can lead to the following issues:
- Back pain
- Pelvic pain
- Weak pelvic floor / core
How to treat a Rectus Diastasis?
There is a common misconception that if you have a RD you should do more abdominal exercises such as sit ups to strengthen the abdominal muscles which will bring the separation back together again... WRONG!!! Doing sit ups without an effective pelvic floor / core contraction is one of the WORST things you can do if you have a RD. The reason being - when you do a sit up without your pelvic floor / core engaged, your abdominal muscles shorten and stretch apart so this can make the separation more pronounced and weaken your pelvic floor furthermore.
Unfortunately, the gradual stretch between the abdominal muscles is inevitable with the growing foetus and postural changes however, you can limit and restrict the amount of stretch by doing the following things:
- DO NOT DO SIT UPS, PLANKS, V HOLDS, DOUBLE LEG LIFTS etc etc - you need to see a women's health physiotherapist to be prescribed specific abdominal and core exercises
- Avoid straining and becoming constipated
- Avoid heavy lifting - limit the weights you are doing at the gym but best to have a chat to your women's health physiotherapist to be guided on what and how to lift!
- See a women's health physiotherapist to be trained PROPERLY on how to activate your pelvic floor and core - this will be your true saving grace! Learn how to functionally brace with your pelvic floor and core during every day tasks such as getting in and out of bed, standing up from a chair, lifting other children or objects and exercising
- Ensure that you are getting in and out of bed by rolling through your side - do not sit up from bed.
- Gentle abdominal support either in the way of tubigrip, pregnancy compression stockings or pregnancy shorts to lift and support the abdominal wall (unless advised otherwise) can be effective. Firstly getting uplifting compression reduces the overwhelming sensation of weight and heaviness coming down into the pelvis and secondly it supports the abdominal wall, back and pelvic floor by gently reducing excessive movement.
There is an optimal 6-12 week window postnatally where you can significantly improve the healing and recovery of your rectus diastasis. That is not to say after 12 weeks you can't improve your abdominal wall but the first 12 weeks you are wanting to do absolutely everything you can RIGHT to improve your chances of a better recovery. I suggest the following things to all my postnatal girls to improve the healing of their rectus diastasis:
- SEE A WOMEN'S HEALTH PHYSIOTHERAPIST to have an assessment of your rectus diastasis + pelvic floor / core
- Get into a compression garment - whether this be a pair of Berli Shapewear, Solidea or SRC recovery shorts! Having a little help to support your abdominal wall not only feels good but it is reducing the potential strain going through the abdominal wall, back and pelvic floor. I suggest wearing compression when you are active - doing the shopping, exercising, cleaning, pushing the pram etc as these are the times that you may be putting a strain through your body. It is always best to talk to your physiotherapist or doctor prior to getting into compression just in case there are any contraindications.
- Strengthen your pelvic floor / core - again you need to see a women's health physiotherapist to be guided specifically on what muscles to use, how to activate them and what specific exercises YOU should do for YOUR recovery. You need to learn how to functionally 'brace' with your pelvic floor when you lift your baby, roll over, stand up, exercise and bend. In activating your pelvic floor and core during these times you are actually activating your inner 'gusset and corset' which supports not only the abdominal wall but your back, pelvic floor and pelvis.
- Avoid heavy lifting, sit ups, planks, v holds etc in addition to straining and becoming constipated