Split Down the Middle – Rectus Diastasis
Rectus diastasis (or abdominal wall muscle separation) happens in both men and women. Women suffer at high rates due to pregnancy but there are causes such as a petit body-type, multiple pregnancies, incorrect muscle contraction of the transverse abdominals in heavy exercise, obesity, previous abdominal surgery and umbilical hernia. Despite diastasis being difficult to prevent, you can take steps to make recovery faster and smoother.
To prevent diastasis, physiotherapist Donna Gee suggests strengthening the transverse abdominal muscles and maintaining excellent posture when sitting, standing, exercising and going about your normal daily routine. Good posture is key because the correct alignment of the spine and joints facilitates the activation of the core muscles required to build and maintain tight abdominals. Having good posture also makes closing a diastasis easier with correct alignment instead of possibly making the condition worse.
For women in particular, Rhonda Scott – professional Polestar Pilates instructor – goes on to say, “As an athlete prepares the body for a race, the same could be said of the pre-pregnant state. Have a clear understanding of the pelvic floor muscles before a baby grows under the abdominals for the next nine months. Well-trained muscles have a far better chance of recovery from injury if strengthened previously. Finding the pelvic floor muscles once pregnant can be hard, but the challenge is far greater post delivery. Pilates is a great way to focus on these muscles enhancing muscle tone, strength and endurance at any stage. Pilates emphasizes postural muscles such as the upper back, glutes, lower back and inner thigh, all whilst engaging the pelvic floor.”
When addressing diastasis post-pregnancy or when rehabilitating from other causes, Donna recommends starting straight away with gentle transverse abdominal and pelvic floor exercises such as simple pelvic tilts on the floor. These can be done in a hospital bed even whilst nursing a newborn. Rhonda also recommends concentrating on the breath, as it is well documented that the pelvic floor responds to breath as on an inhale the pelvic floor lowers and on exhale it rises.
At a mother’s six-week postnatal check, have the doctor check the abdomen for separation. Walking and building up fitness levels is key. If there is a split in the abdominal muscles, consider taking these steps to improve and reduce the separation:
- Consult a physiotherapist that specialises in strengthening the pelvic floor, transverse abdominals and muscles that contribute to proper posture.
- Try abdominal binding, which may assist in starting the process. However, without strengthening exercises this will only be a temporary solution.
- Postnatal and introductory pilates and yoga classes are specifically designed to strengthen the transverse abdominal muscles without exercises that stress the separation causing further damage. This can be beneficial even after years of dealing with a separation to retrain the muscles.
The worst exercises for diastasis include crunches, spinal rotations, back extensions and the quadriped position. Getting out of bed by “jack knifing” when rising from a flat position and anything that causes the stomach muscles to bulge outwards will cause additional stress. Many dangerous positions are especially common in yoga and pilates classes, therefore be selective about the type of exercise class until the split has closed successfully.
Even with following all the recommendations, some individuals may find that the split does not close or completely heal. The final alternative is surgery, but not everyone is a good candidate. According to Dr. Kenneth Hui of Hong Kong, surgery can be helpful when a patient has a split greater than 2cm, hernias are present, and/or the patient suffers from chronic back pain due to a large separation. Dr. Hui performs on average 1-3 procedures a week on separations 4-9cm wide. Often in addition to sewing the muscles together, a mesh covering is put over the muscles to ensure stability. Recovery includes a couple of nights in the hospital with no exercise for five weeks. Patients also go home with drains attached to prevent swelling in the abdomen.
Most cases of diastasis can be closed via physiotherapy, pilates, yoga and exercises that focus on closure of the abdominal wall. Individuals can engage in exercises to close the gap at any time, as well with a great deal of success. As with any exercise, after initial results are achieved, the exercises must continue to be done in order maintain the closure.
Donna Gee is a physiotherapist with a Bachelor of Science degree in Physiotherapy from Canada. She also has her Diploma in Acupuncture, a certification in Pilates as well as B.E. T. (a method of rehab using Pilates-based-exercises). She continues to take an extensive number of courses in alternative healing to help her clients.
Rhonda Scott is from Sydney Australia and a qualified Polestar Pilates instructor. She discovered Pilates after the birth of her son 10 years ago and saw the fantastic effects it provided her body and was converted. She started studying the Pilates method and have not looked back. She has worked mainly in the corporate world before finding her dream with helping people get more from their bodies, not just after having children, but for the rest of their lives.
Both Donna and Rhonda can be found practicing at Flex Studios in Hong Kong. Donna also practices at Posture Plus.