DIASTASIS RECTI

BY AMRIT KAURASST.PROFESSORNDMVP COLLEGE

OF PHYSIOTHERAPY,

Nasik

INTRODUCTION

Abdominal muscles form an elaborate

corset which supports your stomach

contents and your back. The central set

of abdominal muscles are the rectus

muscles. These are div ided into r ight

and lef t halves, jo ined together by a

th in, f ibrous band of connect ive t issue.

Diastasis recti is a separation of the

rectus abdominis in the midline at

the linea alba.

The etiology of this separation is

unknown; however the continuity and

integrity of the abdominal

musculature are disrupted.

Any separation larger than 2 cm or

two fi nger widths is considered

signifi cant

INCIDENCES

Diastasis rect i may occur in pregnancy

as a result of hormonal effects on the

connect ive t issue and the

biomechanical changes of pregnancy;

i t may also develop during labor,

especial ly whi le excessive breath

holding during the second stage.

I t can occur above, below, or at

the level of the umbil icus but

appear to be les common below

umbil icus

I t appear to be less common in

women with good abdominal tone

before pregnancy.

SIGNIFICANCEMay produce musculoskeleta l compla ints ,

such as low back pain, possib ly as a resul t

o f decrease abi l i ty of the abdominal

musculature to s tabi l ize the pelv is and

lumbar spine.

Funct ional l imi tat ions

Decreased feta l protect ion

Potent ia l for hern iat ion.

EXAMINATIONTest the pregnant pat ients for presence

of diastasis rect i before performing any abdominal exercises.

wait unt i l three days after del ivery to perform the diastasis check, as the muscles wi l l be too slack for a rel iable result .

I f you had a C-sect ion, you should wait approximately six weeks or unt i l your incision has healed.

INTERVENTION

Lie on your back, knees bent.

Cross your hands at your waist and guide your

recti muscles toward the midline to stabilize them.

Take in a deep breath.

As you slowly exhale, perform a pelvic muscle

contraction and raise your head off the bed (keep

your shoulders on the bed).

While you lift, gently pull your underlying

muscles together with your hands. If your

tummy is too large, wrap a sheet or large

towel around your body, and grasp the

ends with opposite hands. Apply same pull.

Slowly return to the starting position as

you breathe in.

Try to do 10 in a row, at least three times a day.

Do not perform a standard curl-up (raising

your shoulders off the bed) until your center

seam does not bulge or hollow and you feel only

2 finger widths or less separation between the

recti muscles.

If at any time (weeks, months, years later) you

notice the gap returning, just repeat this

exercise to decrease it.

Poorly executed abdominal exercises can cause

an increase in intra-abdominal pressure, this

force may cause further recti separation and its

accompanying bulge/hernia to worsen.

Hence, it is important to monitor DRA (and the hernia if any) before prescribing any abdominal exercises. Unsuitable abdominal exercises include sit ups, straight leg raises, Pilates movements, especially trunk rotation activities, such as criss-cross sit ups which target the obliques, can strain the abdominals excessively.

Weakness in the core muscles contributes to insufficient force closure of the sacroiliac joint leading to pelvic instability, which can eventually lead to lower-back and hip pain. In the worst-case scenario, this recti separation can result in a hernia.

At the initial visit, the patient is given instructions on i) correct body mechanics, ii) proper posture, iii) appropriate exercises to activate the abdominal musculature, and iv) appropriate exercises to re-approximate the recti bellies without increasing intra- abdominal pressure

progressionHead lift with pelvic tiltPelvic tilt exerciseLeg slidingTrunk curlsModified bicycleCore muscle strengthening

SPECIAL PRECAUTIONSAvoid all activities that place stress on the midline, that

stretchor overly expand the abdominal wall.i.eRepetitive trunk movements or diagonal twists i.e.

during a tennis serve. Exercises that require lying backward over a large

exercise ball.Yoga postures that stretch the abs, such as “cow pose,”

“up-dog,” all back-bends, and “belly breathing.” Abdominal exercises that work the exterior abdominal

muscles, such as crunches and oblique curls. Exercises that cause the abdominal wall to bulge out

upon exertion. Lifting and carrying very heavy objects. Intense coughing while abdominal muscles are

unsupported.