Part of our new Blog Take Over! series from Niamh Morrin, SOMA Movement
See Lucy and Niamh talk about this new development on Dance Mama on IGTV
“It’s all about the gap”
“Once my gap has closed I am safe to do any exercise”
“My rectus abdominal muscles tore during pregnancy”
“I can’t do any front-loaded exercises with my diastasis”
“I must do x,y,z to heal my diastasis”
“I am too long postnatal to heal now”
“A diastasis recti always looks like a distended tummy”
“A diastasis recti is only related to the rectus abdominal muscles”
There are many myths and misunderstandings surrounding the diastasis recti (DR). Myths can instil fear of movement and delay healing. The following article will hopefully disperse these myths and provide a fuller understanding of a DR.
What is Diastasis Recti?
Diastasis recti is the term used to describe the stretching and thinning of the connective tissue that runs down the middle of the abdomen between the two sides of the rectus abdominal or 6 pack muscles. Diastasis recti is a natural process and according to Mota et al., (2015) 100% of pregnant women will have it at their due date – some womens’ diastasis will heal on their own whilst many others will need specific exercises to help it heal.
The connective tissue involved in a DR is called the linea alba. There are a number of abdominal muscles that contribute to the formation of this connective tissue. Most obviously the linea alba connects the two sides of our rectus abdominal muscles. In addition, tendon like extensions of our lateral abdominal muscles feed into and contribute to the make-up of the linea alba – these muscles include the external obliques, the internal obliques and transverse abdominals. The linea alba therefore acts as a midline anchor for all the abdominal wall muscles and it is therefore all these muscles that pull and generate force at the linea alba. What is most important here is an understanding that all our core muscles need to be involved in the postnatal rehabilitation of the core and successful healing of a DR.
Figure 1: Core muscles to work on if you have a diastasis. Reference: Hudani, M (2020). Diastasis Rectus Abdominis: Start here (Part 1). Available at: https://www.munirahudanipt.com/single-post/diastasis-rectus-abdominis-start-here-part-1
What does a Diastasis Recti look like?
As a dancer, aesthetics and how we feel about our body can be a big part of what we do and who we are. We can assume that all DR’s look like a distended tummy or pooch but understanding that it can look and feel very different from person to person is very important.
You might have a “mummy tummy” or “mummy pooch” where the lower and/or middle part of the abdomen is loose and distended out.
·Your whole abdomen could look like it is still rounded out or distended.
You might not have any abdominal distension but you might notice a vertical “gap” down the midline of your abdomen.
You might not notice anything too different aesthetically, but you just feel much weaker and disconnected to your core.
How do you check for a Diastasis Recti?
It is usually best to have a postnatal exercise specialist, a pelvic health or women’s health physiotherapist check this for you – however, you might want to check it yourself also so let’s make sure you have a few pointers to get an accurate finding.
What we are looking for when checking for a DR is any gapping between the two sides of the rectus abdominal muscles and any squishiness or sinking feeling in the linea alba. Traditionally a DR was only assessed by the “gap” however a DR is now more commonly assessed by width and depth. A DR is confirmed as having a gap of more than 2 finger widths and/or a sinking feeling down into the linea alba. A healed diastasis is firm or trampoline feeling for depth, and a gap that is under 2 fingers.
You can do a self-check for DR by following these simple steps:
Lie down on your back – it is best to get into this position by rolling from your side and over onto your back.
Halfway between belly button and rib cage: Find a place in the middle between your belly button and your rib cage. Pick your head up a very small bit off the ground. With two fingers laid horizontally, feel the gap between the two sides of your rectus abdominal muscle. How wide is this gap? Do your fingers squish/sink in? Relax your head and note down what you felt.
Above your belly button: Place your fingers right above your belly button. Pick up your head a very small bit off the ground. Feel the gap between your rectus abdominal muscles. How wide is is? Do your fingers squish/sink in? Relax your head and note down what you felt.
Below your belly button: Place your fingers right above your belly button. Pick up your head a very small bit off the ground. Is there any gapping here? How wide is it? Do your fingers squish/sink in? Relax your head and note down what you felt.
Adding in the breath: Now check your DR whilst adding in a breath. This tells us what your breathing system is like and what your pelvic floor is doing. Take an inhale and on the exhale lift your head, think about drawing your pelvic floor up, drawing your hip bones together and bringing ribs in and down. What’s your gap (in all three areas) like now? Does it get more squishy or more firm? Do your rectus abdominal muscles pop up? Do you get doming out of the linea alba? We’re looking for the changes that happen here when you exhale and how well your system handles pressure.
Figure 2: Location of a diastasis recti. Reference: Core exercise solutions, how to check for a Diastasis Recti. Available at: https://www.coreexercisesolutions.com/how-to-check-for-diastasis-recti/
Is your Diastasis Recti…Wide? Squishy? Below belly button? Above belly button?
A DR can be noted anywhere along the linea alba. A DR can appear in different places on different people (Figure 2). Some will be wide but firm, some narrow but squishy and others wide and squishy. Some will just have a DR below the belly button and others will have it closer to the ribs – others might have it the entire length of the linea alba. Everyone’s DR can be different. It is because of these variations that individualised approaches to healing will be most beneficial – especially if you have tried a general exercise programme for DR healing and it is not working.
In general, the depth or squishiness of a DR is affected by the function of your deep core (Transverse Abdominals and Pelvic Floor) and the width is affected by the function of your more superficial core (Rectus Abdominals and Obliques). Traditionally it was gap closure that was deemed most important in the healing of a DR – however, current thinking is less to do with the gap and more to do with firmness in the linea alba and the core’s ability to manage and regulate loads, pressures, and forces.
I have a diastasis, can I plank / do front loaded core exercises as part of my training or choreography?
Maybe! As mentioned above its important to know how well your core is managing and regulating pressure. Take for example, two different dancers, both with a 3-finger width diastasis – these two dancers might handle loads differently and therefore a plank type of movement could be good for one and poor for the other.
What we are looking for is for the core to fire as a cohesive unit – if it is not firing cohesively we might get increased squishiness in the linea alba, doming of the rectus abdominal muscles or doming out of the linea alba (Figure 3a). If it is firing cohesively (Figure 3b) we should get a firmness in a linea alba and flattening across the abdomen – this is a sign that we are getting a more even core contraction. No matter the “gap” some women will be able to recruit the core well and do front loaded exercises whilst others might need to work more on establishing good core recruitment in easier positions first – regardless, each dancer will need to progress at their own pace depending on how the core is handling load and managing pressure.
Figure 3: A) the rectus abdominal muscles are over recruited whilst the transverse abdominal muscles are under recruited. The abdominal wall appears domed out.
Figure 3: B) The core is firing as a cohesive unit. The transverse abdominal muscles are recruited together with the rectus abdominal muscles. The abdominal wall has a flatter profile.
Healing a Diastasis Recti – building the foundations first
#1 Breathing
Correct breathing is the foundation stone for correct core (and pelvic floor) function and therefore DR healing. For our core to function well we need our inhales and exhales to lengthen and shorten our entire core system respectively. Faulty breathing mechanics will disrupt this natural muscle function and prevent the core muscles getting the stimulus needed for adaptation.
Example of faulty breathing mechanics:
1) Our inhale is all neck and shoulders
2) We maintain a constant level of tension in our abdomen (i.e. suck in our belly button, grip with our upper abs)
3) Our inhale is all belly
4) Our rib cage motion is limited and only moves up on an inhale (with very little back and side expansion)
When we take an inhale we are looking for a 360 degree rib cage expansion – this encourages lengthening in the entire abdominal wall (and pelvic floor). Following the inhale, the exhale should provide 360 degree compression where the whole abdominal wall shortens – just like pulling a corset tight.
#2 Core firing
For good core muscle recruitment, we are looking for balanced muscle activity from the bottom to the top of your abdomen. This balance needs to be maintained so that pressure within the core system is maintained and stability is provided for your body (Figure 3b). So, for example, allowing the rectus muscle to become more dominant over the deep transverse abdominus will result in doming and pressure leaking out on the front of the core (Figure 3b). This is a sign that the deep core stabilisers aren’t fully on board – thus leaving you vulnerable to injury and stalling or regressing your DR healing.
#3 Progressive overload
There are many core exercises and there is unfortunately not one set of magic exercises to heal a DR – everyone’s DR could be slightly different and therefore different exercises would often be chosen based on the individual, their stage of healing and location of the DR. However, once good breathing mechanics and core firing have been checked and established, challenging the core in a progressive and varied manner is important. Progressing exercises based on achieving solid technique and good pressure management strategies would be advised.
#4 Address the entire body
Diastasis recti is a whole-body issue. Strengthening the abdominal wall without addressing poor movement habits and muscle weaknesses above and below the core could halt your DR healing.
Working on good movement patterns and strengthening weaknesses whilst applying them to workouts (i.e. dance) as well as to day to day life and activities (lifting children, heavy shopping etc) can go a long way. So, for example if you are unable to move your hips and shoulders from a stable foundation (i.e. core) and independently from your rib cage then every time you perform an upper (e.g. port de bras, partner lifts) or lower body (e.g. plie, jumping) exercise or movement you might be failing to recruit your core appropriately and/or continually put pressure out on your DR.
Diastasis Recti – myths unravelled
Diastasis recti is a diagnosis that can be treated, no matter how new or old the diastasis is. Understanding that a diastasis is not just to do with the gap between the rectus abdominal muscles and entirely to do with our deep and superficial core muscles, our breathing systems, our core firing patterns and our whole kinetic chain is the first step to progressively healing a DR and improving the function of the core system.
References
Dufour et al., (2019). Pregnancy-related diastasis rectus abdominis: Impact of a multi-component group-based intervention. International journal of Gynecology and Obstetrics, 10(2).
Dufour et al., (2019). Establishing Expert-Based Recommendations for the Conservative Management of Pregnancy-Related Diastasis Rectus Abdominis: A Delphi Consensus Study. Journal of Womenʼs Health Physical Therapy. 43(1).
Mota, P., Pascoal, A.G., Carita, A.I., & Bø, K. (2015). Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual Therapy, 20(1), 200-205.
About Niamh
Niamh is a graduate from a BSc in Sport Science and Health (Dublin City University) and MSc in Dance Science (TrinityLaban). Throughout her years working as a performance enhancement practitioner at the Centre for Advanced Training (TrinityLaban) and as a visiting lecturer in Dance Science (University of Bedfordshire) she continued her professional development and qualified as a Sports Massage Practitioner with Sports Therapy UK and completed a PhD in Exercise Physiology (Buckinghamshire New University). Her most recent stop along the professional development road was at a Pre and Postnatal Corrective Exercise Specialist course (Core Exercise Solutions) which has culminated in the development of her own business "Baby&I" - a business designed to coach, educate and inspire women to maintain strength and function and therefore participation in sport and dance during and after their child bearing years. https://www.babyandi.org.uk
Niamh is passionate about the use of the right exercise prescription to increase strength, reduce pain and improve function in the pre and postnatal body. Niamh believes that pregnant and postnatal dancers should not be left to navigate the complexities of prehab, rehab and their return to dance without being given the tools to do so safely and effectively.
Niamh is also a member of Dance Mama's Research Advisory Group
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