Mind the gap: diastasis / abdominal separation

Credit: Burrell Education. Reproduced with permission.

The most common concern amongst my postnatal clients is whether pregnancy has left them with a separation of their “6-pack muscles”, or a diastasis recti as it’s more formally known. I think this is largely due to the positive intentions of many professionals and our increased focus on female core and pelvic floor muscles, but the flip side is a huge amount of misinformation, confusion and scare stories on the internet and social media.

For those of you not familiar with the term diastasis, the phrase literally means “separation of normally joined parts” referring to the two sides of your “6-pack muscles”. It’s kind of misleading though, because whilst they are absolutely connected by fascia and tissue, they were never actually joined in the way that many women think. And as most of us never assessed/had our abs assessed pre-pregnancy we don’t even have a “before photo” or baseline measurement to compare our postnatal bodies to.

Approximately 2/3 of postnatal women return to a gap near their normal baseline measure, leaving c. 1/3 with a larger gap & some level of dysfunction. (See references 1, 2 and 3) 

Most conversations understandably focus on the gap, but what’s equally (if not more) important is the tension, or lack thereof, that you can create along your midline. Consequently it’s possible to have:

  • A gap in a core that functions perfectly well (what we call a functional diastasis)
  • A gap (large or small) in a core that struggles to generate any real tension
  • A gap and tension that improve dramatically with rehab OR that don’t, leaving surgery as potentially the only remaining option (and one not without complexity)
  • A distended stomach / bulging looking abs for other, non-diastasis related reasons, e.g. bloating / digestive issues, hernia, fat distribution, etc.

So yes the gap is relevant, but closing it is not always possible, nor the be all and end all.

So what should you focus on instead?

  • Change comes from being challenged, what we call progressive overload in the fitness world. So if the exercises you’re doing are too easy they may not be enough to generate the contraction and tension in your midline that’s needed to strengthen it – and so may not see the improvement you’re hoping for. Similarly if they’re too difficult you may not be able to generate that tension for the opposite reason (and you’ll typically see significant doming accompanying this). It’s best therefore to mix up the exercises that you’re doing and to change the position that you’re doing them in. Much like pelvic floor exercises, some exercises are easier lying down, tougher when seated and hardest in standing. Whilst others, like planks, become more challenging the lower you get to the floor.
  • Connected to this, dedicating just a couple of minutes here and there is unlikely to reap the benefits you’re looking for. You need to fatigue those muscles and then allow them to rest and recover on a regular basis, so daily initially and then more like 3-5 times a week as you move away from rehab and towards strength work.
  • Ensure that you have a functioning pelvic floor, as its engagement will help you to fire your lower abs and to keep the tension that you’re trying to achieve. If you’re fatiguing or have too much tension in your pelvic floor you may find creating tension in your abs more challenging. And being able to engage your transverse/deep/low abs is an essential starting point.
  • Be a detective. As you’re working out look and feel for what’s happening along your midline so you can adjust the exercise (or your breathing and engagement strategy) as needed. And part of this is very much noticing if other muscles are taking over and doing the work you want your lower abs to be doing. Check out what your ribs are doing!
  • Measure progress beyond shrinking the gap. Can you do more difficult exercises now with good tension and engagement? How do you feel in your body?
  • Be mindful that connective tissue takes more time to strengthen than muscle, so depending on your tissue laxity, your progress might be slower or faster than other people’s. Eat well and stay hydrated to help your healing and your body more broadly. 
  • And finally, whilst back pain, hernias, prolapse and various other challenges are often blamed on weak core muscles, they’re not always to blame, so seek professional help and look more holistically at your whole body.

If you’re feeling bewildered by the whole thing, get in touch for some 1-2-1 support (from me and/or a women’s health physiotherapist) or come along and join one of my postnatal classes and we can take it from there. 

HOW TO TEST FOR A DIASTASIS

WHY ISN’T MY DIASTASIS IMPROVING

(1) Mota PG, Pascoal AG, Carita AI, Bo K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship to lumbo-pelvic pain. Man Ther. 2015; 20: 200-205. http://dx.doi.org/10.1016./j.math.2014.09.002
(2) Boissonnault J, Blaschak MJ. Incidence of Diastasis Recti Abdominis During the Childbearing Year. Physical Therapy. 1988; 68: 1082-1086.
(3) Lee D, Hodges PW. Behavior of the Linea Alba During a Curl-up Task in Diastasis Rectus Abdominis: An Observational Study. J Orthop Sports Phys Ther. 2016; 46(7):580-9.

(Image courtesy of Burrell Education.)

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