Thursday, May 19, 2022

“At my six-week follow up visit, my obstetrician said I have a separation in my abdominal muscles. Can I do anything besides wait for this to get better?”

What my client is referring to is what is clinically known as Diastasis Recti. Diastasis Recti is the separation of the rectus abdominus muscles (the muscles commonly known as the “six- pack”) resulting in a space between right and left sides of the rectus muscle and creating a line or ridge down the middle. While this condition can happen to anyone, it is especially common in pregnancy. There is also a greater risk of developing Diastasis Recti in women who have preexisting weakness in their abdominals; women over 33 years old; women who have had a c-section or abdominal surgery, have delivered large babies, or have had multiple pregnancies.

As the fetus grows, the abdominal muscles stretch, and there is increased intra-abdominal force and pressure on the connective tissue that joins these muscles. The connective tissue is

compromised and thinned out as the muscle is overstretched for a prolonged period of time, resulting in this split. When the overstretched tissue does not return to its original length, the rectus muscles become weakened with limited ability to generate the force necessary to sufficiently stabilize the trunk.

Diastasis Recti may not be evident until after delivery, as the space is harder to detect during pregnancy. The condition can be detected by lying on your back on a firm surface, with your knees bent. While gently lifting your head and shoulders off the ground, reach your arms out in front of you. With one arm reaching toward your knees, use your other hand to feel your abdominal muscles above and below your umbilicus. The rectus abdominus muscles run vertically from the ribcage to the pubic bone. The area between your abdominals should feel soft. Gently measure how many fingers you can fit in the split between your muscles; this will tell you how much separation you have between the right and left side of your rectus muscles. If you are only able to measure one finger’s width between the two sides, this is within the range of normal. If you are able to measure two or more, you may have a Diastasis Recti. (Ed. note: Do NOT diagnose yourself. If you believe you have this condition, contact your doctor before you do anything else.)

In more severe cases, where there is actual tearing of the connective tissue away from the abdominal wall, a ventral hernia may result, a condition that may require surgical repair. Consult your physician for a complete diagnosis and to determine the most appropriate course of treatment.

When functioning properly, the rectus muscles work to support the back and internal organs. When these muscles are weak, they are unable to perform their job as effectively. While the condition may heal itself over time, if left untreated, it may result in abdominal muscle imbalances with compromised low back and pelvic stability. Subsequently, many women are left with pelvic floor dysfunction, low back and pelvic pain.

Unfortunately, common abdominal exercises, such as sit-ups, may cause more harm than good, as they increase intra-abdominal pressure. The good news is that this problem can often be resolved with appropriate physical therapy. An experienced physical therapist can provide instruction in therapeutic exercises that facilitate closing the diastasis, and bring the abdominals into correct alignment. This promotes healing of the connective tissue as it adapts to the new corrected position. When properly executed, therapy will correct muscle alignment, improve function, and provide relief from low backaches and pains.

Rivki Chudnoff PT, MSPT is a NY/ NJ licensed physical therapist with 14 years experience in both pediatrics and women’s health rehabilitation. Her practice areas address the needs of women related to pelvic pain, sexual dysfunction, prenatal and postpartum related pain, and incontinence. Rivki and her family live in Bergenfield. She can be reached at [email protected]

By Rivki Chudnoff, PT, MSPT

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