Diastasis Recti: What it is, Where to start, and What to do?

Dr. Ashlee Richardson, PT, DPT

What is it?

Diastasis recti, pronounced, dī-ˈas-tə-səs l rek-ˌtī, is the separation of the connective tissue that holds the right and left abdominal muscles together in the midline of the abdomen due to increases in intra-abdominal pressure. This most often occurs with pregnancy, however other factors can contribute such as improper mechanics and muscle activation with abdominal exercises, repetitive heavy lifting, and rapid increases in weight. The presence of a diastasis recti can also be related to symptoms including:

  • Pelvic floor dysfunction[4]

  • Low back pain

  • Pelvic/Hip Pain

  • Posture impairments

  • Abdominal muscle weakness

Where to start?

The best place to start is prenatally! Unfortunately, diastasis recti is not a condition that can be prevented during pregnancy. However, studies have shown that beginning a core and pelvic floor muscle stabilization program is highly effective in improving function both during and after pregnancy. It is highly recommended women work with a physical therapist during their pregnancy to learn safe and effective exercise strategies.

If you think you may have diastasis recti or are suffering from any of the symptoms above, the earlier you see a physical therapist the better! A physical therapist who specializes in women’s health and pelvic floor physical therapy can diagnose whether diastasis recti is present and to what severity. Your physical therapist and healthcare provider (OB-GYN, Primary Care Physician, or another medical doctor) can work with you to determine if conservative treatment like physical therapy and/or surgical treatment is the best route for you. 

What to do?

You may have been told to draw the abdominal wall in and engage the deeper abdominal muscles to help with diastasis recti. While this can help to increase support and stability through the torso, it is not the whole story. Our torso is like a canister[1]; think about when you squish a water balloon on one side and it squishes out of the other side of your hand. Our "canister" will act in the same way. If we are drawing the abdominal wall in alone, pressure will increase and send forces in a different direction.  Whether that increase in pressure is directed up into the diaphragm, down into the pelvic floor muscles, or back into the muscles along the spine, it can lead to stresses elsewhere in the body. It is important to coordinate breathing with the proper firing of the muscles to decrease stresses throughout the abdominal region and prevent worsening the diastasis (abdominal muscle split).  

Muscle and connective tissue tightness may also play a role in pulling the abdominal muscles away from the midline of the abdomen.  A recent series of case studies have shown that soft tissue mobilization and massage of the abdominal region with a technique called visceral manipulation, has been effective in resolving diastasis recti. [2] C-section scarring, and/or other abdominal surgery scars may also contribute to diastasis recti. Scar tissue massage can aid in improved movement and function of the abdominal wall to aid in healing.

A physical therapist with special training in women’s health and pelvic floor physical therapy can help diagnose and treat diastasis recti. The techniques described above along with specific exercises, body mechanic education, binders, and taping techniques to aid in realigning the abdominal muscles can assist in pain reduction and symptom-free function.

Good news! Ashlee Richardson, PT, DPT has the expertise to help treat these symptoms and get you back to a healthy, active lifestyle.  Have questions or would like to schedule an appointment.

Resources:

1. Lee D G, Lee LJ, McLaughlin L 2008 Stability, continence and breathing - The role of fascia in both function and dysfunction and the potential consequences following pregnancy and delivery. Journal of Bodywork and Movement Therapies 12, 333-348.

2. Kirk B, Elliott-Burke T. The Effect of Visceral Manipulation on Diastasis Recti Abdominis (DRA): A case series.

3. American Physical Therapy Association. APTA, Women's Section Help Clear Up Misinformation in NPR 'Mummy Tummy' Report.

4. Spitznagle T, Leong F. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J Pelvic Floor Dysfunct. 2007 Mar;18(3):321-8

Ashlee Richardson, PT, DPT is the owner of CoreWorks Physical Therapy and co-owner of Pilates Center of Omaha. She specializes in women’s health and pelvic floor dysfunction. If you would like more information or set up a physical therapy appointment click here.