Restore Your Core
Diastasis recti sounds a lot scarier than it is.
And although you may have heard from your doctor, girlfriends, or Google that your ab muscles have separated, please rest assured that it is a very common and very treatable condition.
There are many myths and and misconceptions about what diastasis recti is and how to best treat it. But if you want to see results, it’s important to get your facts straight.
We follow the most up-to-date research when working to help restore your core. We’d love to share what we know works. Will you join us to learn for yourself?
Personal trainers, osteopaths, physiotherapists, fitness pros, and sports medicine specialists may all have a slightly different understanding of what the core is.
This is why it’s so important to define what we mean when we refer to the core.
In our practice (and for most pelvic health physiotherapists), the core refers to a set of muscles deep in the abdominal wall which work together as a unit. They are:
- the transversus abdominis (TA) – in the front
- the multifidus – at the back
- the diaphragm – at the top
- the pelvic floor – at the bottom
These muscles make up the innermost layer of muscles you’d hit before getting into the peritoneum, which is the sac that holds all the abdominal and pelvic organs. We sometimes refer to these four core muscles as the “deep core” or the “inner unit”.
In a well coordinated core system, these muscles turn on in advance of movement to provide a stable and controlled platform for movement. Core training involves engaging all these muscles in the right sequence, to the right degree, in the right timing, and in anticipation of any movement.
If that sounds like too much to think about, it is. Usually your brain is in charge of coordinating everything. But sometimes it needs retraining too. As we improve the motor control function of your core, we retrain your brain to automate your body as well so you can get back to movement, activity, and fun – without having to think so hard about it!
Diastasis Rectus Abdominis (DRA) is technically defined as a separation of the rectus abdominis (6 pack) muscle.
However, the most current research is showing that the problem is less about a separation (or gap) and more about the integrity of the connective tissue that runs along at the midline of the abdominal wall from bottom to top – kind of like a closed zipper.
This tissue is called the linea alba and it should have a certain tension and texture to it. It should be able to transmit forces from our upper body to our lower body and across our abdomen. It also helps to counteract pressures generated within the abdominal cavity.
To help you better understand how the linea alba functions: imagine a suspension bridge strung across a deep and/or wide canyon. In this example, the width of the canyon is the separation between the rectus muscles and the suspension bridge is the linea alba.
In order to walk across the bridge safely, you would need the bridge to have a certain amount of tension to it, right?
Now imagine if the bridge’s suspension ropes were super lax, overstretched, and droopy. You would not feel safe walking across. You certainly wouldn’t be able to carry a heavy load across the bridge. So the problem is not the canyon itself but rather, the problem is poor integrity of the suspension bridge and inability to handle your weight and load without compromising the entire situation.
The goal of physiotherapy treatment for DRA is to improve the integrity of the linea alba, and to restore the normal function of the entire core. Often that comes with an improvement in the degree of separation (ie. the gap) – but not always. Sometimes that equals a flatter stomach, but not always.
Why not you may ask?
Great question. Here are a few answers:
- Some people have a deep diastasis, but not a wide separation. They may not get much change with the width.
- In some people, the separation actually increases a bit even as there is much improved tension across the suspension bridge.
- There are other factors that affect the appearance of the abdominal wall. A DRA can be part of the picture, but if your goal is to have a flat stomach, you’ll need to consider other things as well like:
- Hormonal profile and metabolism
- Adipose tissue
- Your standing postures/positions
- Diet – do you eat foods that cause bloating?
- Overstretched skin
- Muscle tone before and after pregnancy
- Connective tissue/collagen quality
To summarize – we don’t obsess about the gap and we don’t want you to either. Our goal isn’t to give you a flat stomach or washboard abs (although with commitment to training you might be able to get there)! But rather, we focus on rebuilding the integrity of your abdominal wall, the quality of your movement, and restoring the function of your core.
The causes are multifactorial. Men, women, children, even babies can have a DRA.
Most often at our practice, we see diastasis recti on women who have had one or more babies.
During pregnancy the abdominal wall expands, the rectus muscles move apart to make room for the growing baby, and the linea alba softens, stretches, and gets thinned out. These adaptations are actually normal.
However, for a variety of reasons in some people, the linea alba does not return to its usual state after pregnancy is over. Research is still figuring out exactly why some people experience ongoing DRA and others don’t.
When the abdominal wall does not return to baseline, the tissue at the midline remains lax and may be unable to generate much tension. Imagine a piece of saran wrap that has been over stretched. It bubbles a bit, loses its form and elasticity, and cannot do its job all that well.
We’ve noticed there are at least three factors contributing to an ongoing DRA:
- A change in linea alba integrity
- Daily positions and postures where the core and abdominal wall muscles are not balanced or coordinated
- Unmanaged intra-abdominal pressures where extra pressure in the system continues to be directed towards the front of the abdomen – ie. the area of tissue laxity
We don’t know. But probably not.
We don’t know until we can actually evaluate you.
If you think your workouts are negatively impacting your abdominal wall or are worsening your diastasis recti, it’s probably a good idea to pause and get checked before continuing.
If you’re not sure how your workouts may be impacting your abdominal wall, then again, get evaluated.
Some people who absolutely love working out, sports, and fitness are afraid to come see us because they think we will tell them to stop doing what makes them happy.
Cue sad face. =(
We get it though because in the not so distant past, the prevailing message was “no, stop, don’t do this, don’t do that” if you have a diastasis recti.
But we don’t think that way. We do our darndest to say “yes, go, do this and do that…in a way that will keep your abdominal wall happy”.
We want to you to move, exercise, be fit, and be strong. It’s actually really really hard for us to tell people to stop doing what they love. Our approach is to have you do as much as you can do without further compromising the integrity of your core.
That usually means that we play around with modifications to your activities and find ways to scale down or up depending on your current capacity.
And bear in mind that with training, your capacity will grow.
We start with an evaluation. We want to know how all the four core muscles are working. We check your abdominal wall for tone, texture, degree of separation, diastasis depth and area of separation. We check your pelvic floor to see if it’s coordinating well with the rest of the core (it’s a very important piece in treating diastasis).
We will also evaluate your typical postures. How do you sit, stand, and walk? How is that impacting your abdominal wall? We check out your diaphragm. How are you breathing? Is your typical breathing pattern helping or hindering abdominal wall healing?
We’ll look at functional movement. What happens when we cue your inner core with movement? Does it change how you move? Are you able to get better range of motion, or better quality of movement, or less pain, or more power?
We take a look at you pressure system and teach you to recognize where pressure is going and how to redistribute it.
We discuss other factors in your life that can help accelerate abdominal wall healing – such as restorative sleep, diet and nutrition, and more.
Often a diastasis recti can be resolved in 4-12 weeks. With more significant DRAs, rehab can last longer. There is a very small percentage of women with diastasis recti whose linea alba are so overstretched that they are unable to generate tension despite dedicated physiotherapy and training. In these cases, we may recommend consulting with a surgeon.
Our Diastasis Recti and Core Restore Programs
We start by getting to know you and understanding your experiences. We want to know how your diastasis is affecting your life, what you have tried, and what your goals are. We’ll ask questions about your abdominal and pelvic health and look at your overall health and movement strategies as well.
After this, we check out how your unique body is working and let you know what we find. Our programs include custom recommendations, hands on strategies, practical advice, step by step home exercise protocols, email support, accountability, educational resources, product recommendations, letters to your healthcare team, and more.
All that we offer is designed to help restore your core and get you moving and functioning beautifully.
Our diastasis and core restore programs will serve you well if…
You’re willing to look at your core from a whole body perspective
Your goal is to improve the overall function of your abdominal wall, and not only the aesthetics
You are able to respect your current physical capacity while progressively challenging and increasing it
I saw Ibbie for issues with my abdominal and pelvic floor muscles not healing correctly after the vaginal birth of my second child. These issues had likely existed since my first pregnancy and c-section with my daughter. Ibbie was excellent at assessing and identifying areas that needed healing and strengthening in order for me to get back into a great state of health. I am so grateful, that with her help I have healed properly and have been been able to return to my full exercise routine. As women I think we tend to ignore issues we have with our pelvic health (such as incontinence) and just credit them as being a “normal part of childbirth”. But Ibbie has taught me that it’s not only possible, but important to heal properly so we can enjoy the life long benefits of a functional pelvic floor and core. I am so grateful for Ibbie’s knowledge, professionalism and coaching and I would recommend her services to any mama. I will continue to use the exercises and information she taught me for the rest of my life.