What to expect – PT for diastasis recti abdominis

You just gave birth to your beautiful baby, and you are suggested by your doctor to go get physical therapy for a condition called diastatsis recti abdominis – the stretching of your abdominal muscle along the connective tissue called linea alba. You may have an inter-recti distance (IRD)(distance between the two halves of the abdominal muscle near your belly button) of about 2.5 – 3.4 cm(mild), 3.5 – 4.9 cm (moderate), or 5 – 20cm or greater (severe).

Although the condition is most common amongst women in their third trimester of pregnancy and immediately post partum, anyone – men or women, who experience increase in intra-abdominal pressure through heavy lifting, chronic obstructive pulmonary disease and obesity may develop diastasis recti abdominis. History of midline abdominal surgery, menopause or significant hormonal changes can also place you at risk for developing diastasis recti abdominis.

If left untreated, diastasis recti abdominis may lead to lower back pain (most common), pelvic pain, urinary incontinence, fecal incontinence, organ prolapse or abdominal hernia. You may actually have consulted a doctor regarding onset of these symptoms in the first place, before diastasis recti abdominis was ever an issue. In addition, depending on the severity of the diastasis, your abdominal aorta (a large artery in front of your spine around the belly button) will also be at risk of injury from compression or blow to the stomach.

Diastasis recti abdominis may be surgically corrected with procedures such as abdominoplasty, but there have been case reports of successful resolution through physical therapy.

Your physical therapist will do a thorough examination including the size of the IRD, strength of your core muscles, your standing and sitting posture, and motor control strategy for how you carry, lift and push. The PT sessions will ultimately focus on how you can efficiently turn on your core muscles – most notably your transverse abdominis and pelvic floor muscles, so your rectus abdominis (which is not a core muscle) is not placed under excessive tension and activation.

If you have a severe IRD, you may be recommended to wear an abdominal binder to approximate the recti abdominis muscles and told to avoid any activities that may increase the intra-abdominal pressure such as sit ups, being in hands and knees position, Valsalva maneuver (holding your breath) and heavy lifting. When you laugh, sneeze or cough, you may be instructed to hug your recti abdominis muscle to prevent further increase of the diastasis.

Your PT will spend a lot of time on soft tissue and joint work to make sure your pelvic girdle and trunk can be in an efficient standing and sitting posture, so that your core muscles can most effectively activate when you perform your exercises and when you do any of your daily activities. You will be provided with a progressive therapeutic exercise program that will focus on stabilization exercises, as well as functional training to most effectively carry, lift and push without putting stress onto your diastasis.

You may wonder what PT can do for your diastasis recti abdominis, but I highly encourage you give it a try. There are case reports available in literature that presents cases of postpartum women with IRD as severe as 11.5 cm reduced to 2.0 cm after 4 months (18 sessions), with improved endurance of sitting and holding her baby from 5 minutes to > 30 minutes.

References:

Lito, Karen (2014) Progressive therapeutic exercise program for successful treatment of a postpartum woman with a severe diastasis recti abdominis. J Women’s Health PHys Ther. 38(2)58 – 73

Keeler, J., Albrecht, M., Eberhardt, L, Horn, L., Donnelly, C., and Lowe, D. (2012) Diastasis recti abdominis: A survey of women’s health specialists for current physical therapy clinical practice for postpartum women. J Women’s Health PHys Ther. 36(3) 131 – 137