Wednesday, 14 November 2018

Rectus Diastasis Treatment Update


Rectus Diastasis Update
Research in physiotherapy is continuously on-going. What we once thought was true, can shift as new perspectives along with new information become available. This is true for the ab separation. There is an abundance of popular media, fitness news, as well as social media information on the internet that can make it very challenging for therapists, never mind clients to figure out what is true.
There is some exciting new research soon to be published on rectus diastasis. A panel of the top Canadian educators and clinicians in physiotherapy came together to try and reach some consensus on the assessment and treatment of ab separation. I want to high-light a few points that I learned, that may be helpful to you as a consumer. The information presented is a summary of points presented by Dr. Sinead Dufour at the 2018 Healing Birth Summit.
In my previous blogs about rectus diastasis, I mentioned that the size of the gap was less important in comparison to the function and the ability to tense through the connective tissue which holds the two rectus abdominal muscles. If you haven’t read my previous blogs, you can go back anytime to read them.
The panel of Canadian experts did reach consensus that the gap is not really helpful as it only tells you what the gap is, but not why. I always thought it was the rectus abdominis muscles that were the problem and that if you pull those muscles closer together and work them out, the problem would be solved. Clinicians are still treating rectus diastasis with an exercise that pulls those muscles together with a mini crunch. However, from the new research, it turns out this isn’t the best exercise and I’ll explain why.
The problem with rectus diastasis is not the muscles, but rather the fascia connecting them. We call the fascia between the two recti muscles the linea alba. The function and ability of the linea alba is to draw tension with the rest of the core and in response to activity, is what is the focus should be on.
The fibers of the linea alba are intertwined with the transverse abdominis (TA) muscle and the TA muscle co-contracts with the rest of the core muscles, which includes the pelvic floor, diaphragm and multifidus.

What we need to actually assess is not just the gap, but whether or not the linea alba tensions when you perform a voluntary pelvic floor or deep abdominal muscle contraction. How well can you contract your core individually and as a team? This will help us understand why, the abs remain separated. We also need to assess how your core responds to activity and exercise.
Treatment will be dependent on what is specifically needed and what part of the system is not working well for you.
I received this question a couple times from my pregnant soon-to-be moms:  “Is there anything I can do during pregnancy to avoid or reduce my risks of ab separation?” So firstly, by the third trimester all women will have a separation. Yup! This is normal and what our tissue is suppose to do to make room for baby. There are a few things you can do to reduce the amount of pressure on your tummy however. You can have your core assessed and the physiotherapist can teach you how to activate all the muscles of core individually and then together. A stronger core during pregnancy has the benefit of a better recovery postpartum.
The second thing you can do is avoid repetitive increases in abdominal pressure during pregnancy. Examples would include avoiding straining on the toilet or to avoid activities that make your abdomen bulge. There are several benefits to doing a pre-natal session with a trained pelvic floor physiotherapist. Seeing a physiotherapist has the benefits of them teaching you various strategies for reducing abdominal pressure and modifying activities.
So let’s talk about a few things postpartum. We were taught in our training to assess for an ab separation between 6-8 weeks postpartum. It turns out that it is normal to have a separation for the first 13 weeks postpartum. This is known as the fourth trimester and it is the healing trimester which includes the ab separation. Yes it can improve on its own and this is dependent on how well your core is healing and activating. A 6-8 week postpartum assessment certainly can help you with recovery by giving you the right types of exercise to promote your core healing.
If there is a separation present after 13 weeks, it can become problematic and we need to really investigate why that is. Every good treatment for rectus diastasis should have an offensive plan, which includes exercises to optimize the function of the core and defensive strategies such as education on reducing intra-abdominal pressure and how to perform activities that puts the least amount of stress on the tissues.
Another question I get asked a lot is about specific core exercises. Ladies will come in after researching on the internet what exercises are “good” and which ones to avoid. While it is true that certain exercises “tend” to be more challenging for the core, it is not true for everyone. For example, you may read that planks are “not good” for an ab separation. While that may be true for some, it may also be a fantastic strengthening exercise for another. It’s best to see a therapist who can assess what your core can handle. Rather than avoiding these activities, get tested and learn what to look for that might indicate a problem.
I found these points from the Healing Birth Summit very educational and helpful in giving me guidance on how to best serve clients. Hopefully this blog gives you some more information to ask questions or seek out help from a trained professional.

The Pelvic Health Lady

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