Diastasis Recti: What to Do?

diastesis
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One of the most common issues women suffer after pregnancy is Diastasis Recti, which is a separation of the Rectus Abdominis muscle. Normally, you can feel the separation around the belly button, but also a separation can sometime be felt above or below the belly button. To test for Diastasis you can have client lie supine and put your finger above, on top or below the belly button and see how many fingers width wise can fit in the space in between the two sides of the Rectus Abdominis muscle. If there are more than one finger width, there is a problem.

When pregnant, the belly grows and the lower back gets tight. After the baby is delivered, the back may still be tight, pulling on the abdominal muscles and further accentuating a Diastasis. Exercises that stretch the middle and lower back can allow the fascia and muscle tissue of the Rectus Abdominis to come back together.  The oblique abdominal muscles can exacerbate the Diastisis because of the direction of their pull. 

Strategy:

1. Stretch and Release the muscles and fascia of the middle and lower back and oblique abdominals. 

2. Strengthen the Transversus Abdominis.

Exercises

  • Cat on the Mat or Cadillac
  • Roll Downs with heavy loaded springs to support the spine. If there is Lordosis then put a small pad under lower back.
  • Reverse Knee Stretches on Reformer; round back version

Strengthen and Tighten the Transversus Abdominis

Tranversus Wrap: Sit up in neutral spine (preferably up on a yoga block or pillow to make it easier to maintain a lumbar curve. Wrap a Theraband or belt around your waist and slowly tighten it, drawing the organs back toward your spine. Hold and count aloud for 30 seconds, thinking of pulling the skin away from the band on every count.

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Don't do abdominal curls. When you lift your head off the mat, the rectus abdominis is being shortened and loaded. This puts undue strain on the muscles that is already been over stretched, so these should be avoided.

Do Neutral Supine Spine Stabilization like Tiny Steps

  • LIe supine with knees bent feet flat on floor, pelvis in a neutral position.
  • Inhale into your upper back and sides of your ribcage.
  • Exhale draw navel to spine as you lift one leg up to table top.
  • Inhale return leg to starting position. 
  • Switch sides and repeat 10-20 times.
  • •Cue client to draw ASIS together or "narrow the front of the pelvis" to really get the transversus abdominis to fire.

Do Eccentric Abdominal Curl; Extension to Neutral

  • Use a Gertie Ball, roller, bolster or rolled up towel under upper back. I like to put another ball or magic circle in between my knees/thighs.
  • Place the Gertie ball under your upper back a bit below your shoulder blades and lie back over it, coming into extension of the spine,  hands behind your skull, fingers interlaced, knees bent with your feet flat on the floor.
  • Draw chin gently in toward chest, push head back into hands, and come up to neutral spine by folding at the sternum. Keep head pressing back into hands- do not let head get in front of torso.