What you need to know about that stubborn gap between your ab muscles
So you had a baby. You don’t have the core strength you used to. Your abs don’t feel like they used to, and your stomach bulges when you try to do sit-ups. What’s the deal? You probably have diastasis recti, or ab separation. So what are you supposed to do about this diastasis recti? Can you fix it? How? What if it has been years since you had a baby? Is it too late?
What is diastasis recti?
You have several layers of abdominal muscles in your core. The one closest to the surface (toward your skin) is called the rectus abdominis. This muscle is what we typically think of when we think of “6 pack abs”. It extends from your ribs to your pubic bone and attaches in the middle at a layer of fascia (or connective tissue) called the linea alba. When you have a diastasis, the layer of fascia between the two sides is wider than usual. We define diastasis as a gap of greater than 2 finger widths.
Diastasis recti can occur in any population, but occurs most often during pregnancy. If you carry your baby beyond 36 weeks, you are almost guaranteed to experience some level of ab separation. For many women, the separation closes by 6 months, but for about 45%, it does not.
But it’s not just the width that we care about. The other, deeper abdominals also have to stretch to give your growing baby room. When we measure with our fingers, we also pay attention to how deep our fingers go. This matters because it helps measure your ability to contract the deepest abdominal layer called the transversus abdominis. The transversus abdominis is a stabilizer of the lumbar spine (low back) and the pelvis. It is made to contract before movement of the arms or the legs, but if it isn’t firing properly due to an ab separation, problems can arise! But more on that later.
The rectus abdominis muscle is extremely important in helping us do daily activities such as bending over. When flexed, this muscle increases intra-abdominal pressure, or the pressure inside your abdominal cavity. It stabilizes and also helps to control the tilt of the pelvis forward or backward.
Put simply, diastasis recti is the separation (or increased distance, rather) of the abdominal muscles.
Why does the gap matter?
Okay, so now you know what diastasis recti is, and maybe you have identified that you think you have it. Why should you care? A diastasis recti that doesn’t close on its own usually means there are other problems going on that are preventing the ab separation from closing. If a diastasis persists, it can cause low back pain, leaking, pelvic pain, sexual dysfunction, or prolapse. Diastasis recti and pelvic floor dysfunction often co-exist, because the diastasis prevents proper pressure management of the core.
Pressure management? What does that mean? Your abdominal muscles encase your abdomen and protect your internal organs. In the process, they form a pressure system. If you keep your throat closed and push as though you are going to have a bowel movement, this increases your intra-abdominal pressure. We call this specific movement a valsalva maneuver, and it can be dangerous and lead to prolapse, weakness, incontinence, and more. Some other times that intra-abdominal pressure changes are: forced breathing, labor, defecation (bowel movements), and micturition (urination). No wonder we are always talking about pee and poop over here ;)
Okay, so this diastasis thing seems like a problem, so how do you fix it?
How to fix diastasis recti
Like we talked about a little bit ago, intra-abdominal pressure has a lot to do with why a diastasis won’t heal. If you are continually increasing the pressure inside your abdominal cavity, it continually bulges out on the diastasis, which doesn’t allow it to heal and come together.
So the first step to fixing a diastasis is learning to feel the difference between increasing and maintaining intra-abdominal pressure. The next step is to learn how to manage this pressure and not increase it while doing daily activities. And finally, you must figure out how to maintain this pressure while doing higher level activities such as working out.
The number one exercise I recommend starting with is diaphragmatic breathing. Here is a list of other ab separation exercises that might be helpful for you to try out.
Ab separation exercises
Diaphragmatic breathing
Modification of activities
Managing intra-abdominal pressure
Engaging the transverse abdominis with all “core” exercises (planks, bird-dogs, dead bugs, crunches, etc)
If you have any questions about what these exercises are, how to do them, or if these are going to help you, call us today at 612-568-2462 so we can discuss how starting physical therapy can help you on your journey to healing your diastasis!