Diastasis Recti has become a buzz word of late. 5 years ago it was difficult to find any information on the condition and today we are overwhelmed with it. Unfortunately much of that information is not good. There is a lot of fear and confusion surrounding the diastasis. Its name alone does not really even define the problem well. The word “Diastasis” refers to a separation of a part of the anatomy that is normally joined. “Recti” refers to the rectus abdominal muscle, “diastasis recti” therefore coming to mean the abnormal separation of the rectus abdominis muscle (the muscle that makes up the “six pack”). The problem with this definition is that the rectus abdominis is not, and never was, one solid muscle but is two bodies joined down the midline by the linea alba (the connective fascia). The separation is not abnormal but a normal physiological response to pregnancy and the growth of a fetus. It is supposed to happen, which leads me unto the first myth…
MYTH 1: DIASTASIS RECT CAN BE PREVENTED DURING PREGNANCY
Diastasis Recti is a normal part of pregnancy. 100% of women at 9 months pregnant have diastasis recti. The relaxing and stretching of the transverse abdominis, rectus abdominis and as a result, the linea alba, happens in direct response to the need to create space within the abdomen to allow the growth of a fetus. It cannot be prevented. This is also why women who have abdominoplasty (a tummy tuck) are often advised to do so after they have finished childbearing. The reason is because another pregnancy would result in the relaxation and stretching of the abs and linea alba. It would in essence undo the surgery, if it didn’t the baby would not grow and the pregnancy would be terminated.
MYTH 2: DIASTASIS RECTI IS NOT NORMAL
Every postpartum woman has a diastasis recti. For most women the abs will return to the proximal resting position within the first 8 to 12 weeks postpartum. It is when this does not happen that special attention must be paid to the condition. A problematic diastasis recti tends to be more common in subsequent pregnancies and when carrying multiples.
MYTH 3: IT IS ALL ABOUT THE GAP
The gap can be startling to notice and easy to focus on. However, diastasis recti is not about the gap. The problem lies with function. The stretched linea alaba, which makes the left and right sides of the rectus abdominis sit further away from each other, may not carry tension well. If the linea alba cannot carry and transfer tension it cannot transfer load to the abs effectively. The transverse abdominis is often weaker postpartum. As a result this muscle, which is known as the body’s internal corset, may not contract as efffectively as it once did meaning it may not be managing changes in internal pressure, and may not be supporting your lower back. The rectus abdominis has been stretched over several months of pregnancy. Muscle fibers that are overstretched cannot contract well, meaning that the rectus abdominis may not be responding to changes in internal pressure. The pelvic floor muscles have been under incredible load during the pregnancy and under incredible pressure during labour so they too have weakened. The Transverse Abdominis (TA) and pelvic floor co-contract so if the pelvic floor is not responding to tension, the TA cannot respond well either.
Diastasis Recti is not about the existence of a gap between the abdominal wall, it is about changes within the core that mean it is not functioning as effectively to manage internal pressure. Your body is always under pressure. It is known as intra-abdominal pressure and is necessary to keep your organs in position and support your spine. However, constant levels of unmanaged intra-abdominal pressure are dangerous and can cause harm to the body.
MYTH 4: EXERCISE DOESN’T WORK FOR EVERYONE
I hear this a lot especially in social media groups. Unfortunately (or fortunately!) this claim is just not true. What is true is that the same strategies do not work for everyone. A one size answer does not fit all. There is no magic exercise or fitness routine. What works for Jane may not work for Sally. You need a program that is customized to your body and to your specific struggles. It is important to look for a team of people you can work with; a pelvic floor physiotherapist, a core fitness physiotherapist, a certified postnatal fitness trainer with knowledge in diastasis recti. It took me years to make sense of the literature and years to sort out fact from fiction. Not everyone that talks about diastasis recti knows what they are talking about. It’s hard to find the right answers but I promise you the problem is not with your body’s ability to heal. Find people that create programs based on how your body specifically is responding to it. Find people that give you answers and refer you when they don’t know. Find people that can admit when they are out of their depth. Keep looking for answers. Get second, third and fourth opinion. If you dig and don’t find, dig a little deeper.
MYTH 5: SURGERY WILL FIX IT
This is another mentality I see a lot on social media. Let me say this loud, and let me say this clear: SURGERY DOES NOT NEGATE EXERCISE. Surgery and exercise are not two sides of a coin, they are both on the same side of the coin. You need to re-train and rehabilitate your body. Surgery may address the aesthetic result of damage and is often used when the fascia has been damaged to the point that it cannot maintain tension when relaxed or cannot transfer load effectively. How do you know your fascia is in this condition? After using different strategies to try and rehabilitate and strengthen it! Imagine breaking a bone and someone immediately telling you that you would never walk again. This would be a ridiculous statement because bones heal. The condition of a bone day 1 post-breakage and day 340 post-breakage would be very different. Often broken bones are not operated on but set and left to heal. Did you know during a cesarean section 7 layers of body tissues are cut into but only 3 layers are stitched back up? Four layers are left to heal naturally because doctors understand that your body can and does heal well on its own. Your bones heal, your muscles heal and your fascia heals. But they need time.
Surgery and exercise are not one and the same. Surgery addresses the result of damage but not the cause. If you never address the cause of the damage it will keep reoccurring. Exercise addresses the cause. Exercise helps you rebuild a connection with your deep core muscles that is often lost postpartum. It helps you re-train the muscles to respond to your movements appropriately. And it helps you learn new strategies to manage changes in intra-abdominal pressure so the pressure is not harmful. Those who have the most successful recoveries post-surgery do so because of proper exercise both before the surgery and after the surgery.
MYTH 6: SURGERY IS A LAST RESORT
Surgery is a tool to achieve better function of your core muscles. It should not be based on fear but come from a place of understanding. Surgery should not be a last resort, and if you have seen no improvement and are seeking surgery because you don’t know what else to do, you have not found the right team. Here are a list of places you can begin to start finding better help:
MYTH 7: IT IS TOO LATE FOR EXERCISE TO HELP
As long as you are living and breathing it is never too late. You body regenerates constantly and it regenerates according to your food and movement patterns. Better food and better movement patterns means your body regenerates in a better way.