Dooley Noted: 4/6/2016
Diastasis Recti (DR) is a condition involving the separation of the two bellies of rectus abdominis (RA) from the midline, where they insert on the linea alba.
DR commonly occurs after quick, intense anterior expansion of the abdomen.
Conditions that can cause DR:
– Pregnancy
– C-section
– Abdominal surgeries (esp. ventral wall hernia repair)
– Fast and steady weight gain
– Central adiposity, due to disease processes or medications (i.e., Cushing’s disease/syndrome, corticosteroid or anabolic steroid usage)
Not all people get DR under these conditions. So, a biomechanical separation is present between people who get DR and people who escape it.
The difference is in how well the rectus abdominis is kept in place by the rectus sheaths. These sheaths are composed of tendons from the external and internal abdominal oblique (EAO, IAO), as well as the transversus abdominis (TVA). The sheaths are then anchored to the linea alba, to which the RA also attaches.
In manual muscle testing, we focus on testing the concentric contraction of a muscle. But remember: any muscle that lacks an ability to stretch cannot reach its potential in concentric contraction.
To remember this: When you want to flick a rubber band across the room with the greatest force, what do you do to it first?
You stretch it by pulling it back.
In the case of DR, commonly the abdomen is being mis-queued for respiration in the building of intraabdominal pressure (IAP).
Many people, especially pregnant women, want to prevent DR as much as they want to reduce a current DR.
If a DR currently exists, keep consistent measurements of the distance between medial borders of the rectus abdominis.
Typical acceptable distance equals one index finger breadth. Always use the patient’s own finger for this arbitrary measurement.
To measure: Have the patient do an abdominal crunch and find the medial borders of RA on each side. Measure with the finger. For more accurate measurements, measure with flexible tape.
Since 2 of every 3 pregnant females have some degree of DR due to their quick abdominal expansion, prevention is key through addressing risk factors.
Risk factors/signs of possible DR formation:
1. Umbilical piercings
2. Abdominal surgeries (i.e., cholecystectomy, appendectomy, C-section)
3. History of central wall hernia (i.e., umbilical or inguinal hernias)
4. History of breathing dysfunction
5. History of rib flare on inhalation (oblique weakness)
6. More than 1 fingerbreadth distance at linea alba
7. Decrease in lower and lateral abdominal expansion on inhale (indicating lack of extensibility of TVA and IAO muscles on inhalation)
8. Anterior pelvic tilt and/or low back hyperextension, matched with a lack of posterior abdominal expansion on inhalation (lack of multifidus activation in eccentric loading)
Common muscles to compensate for exhalation muscles or structures, exacerbating DR:
1. Scars, which will limit 360 degrees of abdominal expansion on inhalation
2. Diaphragm
3. EAO
4. Rectus Abdominis
5. Thoracolumbar erector spinae
Common muscles to lack full abilities to protect the rectus position and exacerbate DR:
1. TVA
2. IAO
3. Multifidus
4. Lumbar erector spinae
To assess compensations versus down-regulated functions for DR:
1. Assess risk factors and address them.
2. Utilize breathing tests in supine 90 90 position. (See my Dooley Noted: Diastasis Recti video for examples.)
3. Apply release techniques to compensators to improve extensibility and concentric contraction of down-regulated muscles.
Examples:
– proper scar work
– diaphragm facilitation (for rib flare, including history of GERD or circulatory issues)
– upper extremity soft rolling patterns (for EAO)
(Note: see my Dooley Noted videos on scar and diaphragm releases, as well as rolling patterns)
Note: All release work should focus on prolonging the exhale while the release is completed. This up-regulates the function of exhalation muscles that are commonly down-regulated (i.e., IAO, TVA, multifidus)
DR patients don’t need fancy exercises.
They need to learn to properly build IAP, and then apply strength principles to this major foundational goal.
Then, DR can be prevented or limited in its formation.
To learn more about abdominal assessments that may be linked to DR, check out our seminar series links below, as well as helpful Dooley Noted links below.
As always, it’s your call.
– Dr. Kathy Dooley
www.immaculatedissection.com
Diastasis Recti Video:
Diaphragm release:
Rolling for obliques:
Supine 90 90 breathing: