Fixing the Ab Gap
Diastasis Recti Abdominis. No, this is not a Harry Potter spell. Yes, this is an extremely common condition!
What is it? Diastasis means “separation” and the Recti Abdominis refer to your superficial “six-pack abs”. These muscles attach to the Linea Alba (meaning “white line” because it is comprised of collagen connective tissue) which runs from the xiphoid process to the pubic symphysis.
Who is at risk?
Any Body! This condition is a PRESSURE PROBLEM, although it is commonly listed as one of many "pregnancy problems" a woman experiences before and after delivering a baby*. Growing a human significantly increases intra-abdominal PRESSURE, but so does bad posture, chronic bloating, and poor loading technique (bearing down or sucking in) during everyday tasks and exercises.
Know anyone with a history of hernia repair? Prolapse? Abdominal surgeries? These are all signs of core trauma and weakness. Chances are high they have DRA.
*From recent research1,2, here is a summary of stats regarding how many women have DRA during & after pregnancy:
100% at due date1
60% at 6 weeks postpartum2
39-45% at 6 months postpartum1,2
32% at 12 months postpartum2
What do these findings suggest?
DRA is a natural symptom as intra-abdominal pressure increases and abs get stretched out by end of pregnancy.
There is some healing that occurs naturally after childbirth.
However, as many as 1 in 3 post-partum women will need corrective care even a year after delivery.
Here is a video of my DRA (check out the doming) when I was 8 months pregnant with my first child. (Sorry I didn't know how to take good selfie back then... heck I still don't ha!)
One thing that really upset me when I asked my doctor for tips, was her response: "You can just have surgery to fix that when you're done having kids!"
My reply: "What am I supposed to do until then? What about women who can't afford it? Are we all just out of luck?!" I was really frustrated that she didn't seem to understand the function of the core muscles that affect a person's everyday life! Surgery might help narrow a significant gap, but it will not fix how the muscle is supposed to fire and function. That's a brain thing!
How to check yourself*:
Lie on your back with knees bent and feet flat on the floor.
Place your fingers vertically just above the belly button.
Slowly lift your head off the floor. Concentrate on feeling for the borders of the Rectus Abdominus.
Assess for WIDTH and DEPTH/FIRMNESS. How many fingers can you fit in the gap (width)? How deep does your finger depress (firmness)?
Check along the length of the Linea Alba by repeating 2-3 inches above & below the naval.
*This assessment can actually be performed in any position. I periodically test myself in different postures -especially before I attempt a progressive exercise that challenges my loading strategies TONS more than when I'm just lying down! One of my favorite sayings is to "Check yourself, before you wreck yourself!"
What exercises can help "Close the Gap"?
First of all, nothing is truly "safe" if you have a poor loading plan. Anything that increases intra-abominal pressure and strain must be managed with a great breathing strategy that coordinates with the rest of the inner core.
Traditionally, the "no-no's" for a DRA include sit-ups, V-ups, leg lifts, scissor legs, and even planks. During the early stages of healing, it's best not to perform heavy lifting or dynamic activities like running or jumping. (This was a struggle for me as a former collegiate track & fielder...I didn't think that pregnancy and delivering a baby should stop me from living my usual life. I was really active and healthy during my first pregnancy...
(Taken on my due date: getting in a walk/jog during my lunchbreak.)
...and I even decided I should be fine to run a 5K six weeks post-partum! I "felt good" but that doesn't change the fact that my body needed to do some more healing after a bit of birthing trauma. I thought I could carry the same determination through my second pregnancy but ended up with a bad disc injury that I'm still forced to respect today!)
Sometimes it is a struggle to accept the Truth: that just because you can do something, doesn't mean you should (even when you first start to "feel" fairly normal after an injury- in reality, you're probably not really ready to handle aggressive activities). BUT, once you restore the inner core and learn how to load properly, then the sky can be the limit for activities you want to enjoy!
Here's how to begin:
360 Breathing. (It all starts with a good Breath!)
Pay attention to your Posture. Avoid slumped sitting and work on stacking the ribs over pelvis.
Avoid aggravating factors. Remember, it's all about managing Pressure! Eliminate crunch-like motions, sit-ups, or high-impact activities at first. You should be able to resume planks, running, and jumping when you can maintain proper core control throughout these activities.
"Stabilize before you mobilize!" We need to have a steady trunk from which to move and load or limbs. Try to engage the inner core and pay attention to technique EVERY time you bend, lift, reach, turn, etc!
For more information on how to check for DRA and specific corrective exercises, consult your trusted women’s health expert, physical therapist 🙋🏽, or chiropractor. I've included a quick list of people I particularly love to follow (just not in a creepy way ha!)
Dr. Sarah Duvall, PT, DPT, CPT*
(*click here to begin the Diastasis Fix program)
(*click here to become a Postpartum Corrective Exercise Specialist)
Julie Wiebe PT
Happy Healing!! XO
References:
1) Patricia Goncalves Fernandes, Augusto Big Brites Andrade. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual Therapy. Volume 20, Issue 1, February 2015. 200-205. (Note: 84 women, first pregnancy)
2) Sperstad JB, Tennfjord MK. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med. 2016 Sep;50(17):1092-6 (Note: 300 women, first pregnancy)