Diastasis Recti is a midline separation of the right and left sides of the abdominal wall. It can happen to men and women, regardless of age, weight or fitness level. It is caused by the most common compensation pattern for Functional Core Weakness: consistent forward and forceful pressure against the abdominal wall. This pressure can be from chronic poor postures, traditional abdominal exercises like crunches, sit-ups or planks, chronic constipation, and habitual bracing or bearing down.
With Diastasis Recti, the connective tissue that runs down the center of the abdominals (the linea alba) becomes thin and your organs push forward, contributing to a bulging tummy and increasing the risk of a hernia. Because the abdominal muscles help support the back and organs, a separation will cause the support system to be weakened leading to instability and pain. The overall Functional Core Weakness also contributes to digestive tract issues, menstrual cycle issues, prostate issues and pelvic floor problems for men and women. Pregnant and postpartum women tend to be more susceptible to developing Diastasis Recti due to the extreme stretching of the abdominal wall combined with the effect of relaxin hormone on the connective tissue that occurs during pregnancy.
Unfortunately, even with the high prevalence of diastasis in our culture and the life impacting health consequences of diastasis, most medical professionals have not been adequately trained to check for it. As a result, most of our past resources have been directed toward clients and educating them on how to check themselves for a diastasis. While this has been extremely helpful and validating to clients, it is not changing the missing need that persists in the medical, birth and fitness professional community.
Diastasis checks require practice just like every other palpation skill we learn in our training. It is ok, if you do not feel confident with every DR check you perform in the beginning. Every client is different and some muscle borders are harder to feel at first. But knowing how to check and checking every client will quickly improve your skills and your confidence.
Here is our step by step guide (for professionals and clients) to check a diastasis.
- Have the client lie on their back with knees bent and shoulders and head flat.
- Place the pads (not the tips) of your fingers in a vertical position (pointing toward the feet or head of the client) at the navel.
- Press gently down with your hand remaining flat.
- Have the client slowly lift their head up off the surface (instruct them NOT to do a crunch).
- If you feel a fully or gab between the two sides of the rectus abdomens that is more than one finger width, there is a diastasis.
- Repeat this process, checking 3 inches above the navel and 3 inches below the navel.
Considerations When Evaluating:
- Your measurement should be made when you first feel the recti engage. This is your baseline and is most reproducible and accurate.
- Measure how many fingers/ or cm you can place in the gully as well as how deep you can gently press in.
- In women the separation is often most severe at the navel. In men the separation is often most severe above the navel.
- In severe cases, you will need to use 2 hands to measure the width of the diastasis.
When Evaluating Connective Tissue:
- As professionals, we are checking more than just the size of the separation. We are also checking the integrity of the connective tissue.
- Healthy resilient connective tissue is firm with very little “give” when you press on it.
- Consider the feeling between the knuckles of your ring and pinky finger as a gauge. This gap is typically less than 1 finger width and 1 finger depth and feels similar to healthy connective tissue.
- Softer or absence of this connective tissue “end feel” indicates vulnerable connective tissue.
- Your measurements should be a number and a depth at 3 locations along the linea alba: the navel, 3 inches above and 3 inches below. For example: 3 deep, 4 deep, 2.5 medium is a measurement that indicates a 3 finger wide and minimal connective tissue integrity at 3 inches above the navel, a 4 finger wide and minimal connective tissue integrity at the navel, and a 2.5 finger wide and with soft connective tissue 3 inches below the navel.
How to Determine Depth:
Shallow: separation is only 1-2 fingers/cm wide; you can feel fairly firm connective tissue in your fingers.
Medium: separation is typically 2-3 fingers/cm wide and connective tissue is palpable but has a soft end-feel.
Deep: typically any separation >3 finger/cm will have very little or no resistance of the connective tissue. Sometimes this feels like a hole or you may feel a pulse or the movement of the intestines.
Common Mistakes When Checking for a Diastasis:
- Having the client do a full sit up or come up too high when performing the check.
- Pressing too hard or digging in with your fingertips to feel the separation.
- Not checking pregnant women
- Not checking clients that are overweight
- Not checking men
- Not checking….
When to treat or refer for Core Rehab:
Diastasis recti is a treatable condition with a specialized functional core rehabilitation approach. As a medical and fitness community we need to stop overlooking this condition and stop neglecting clients that are suffering. Treatment is available and highly effective, even if you need to send them to another specialist or our online courses to get the care they need.
Please recommend treatment for:
- Clients with a diastasis of more than 2 fingers/medium, regardless of other symptoms.
- Clients with any size diastasis (or no diastasis) who present with any of the following Functional Weakness Symptoms: back pain, pelvic instability, pelvic floor dysfunction, constipation, sciatica, collapsed postures or disconnect.
If you are a professional and want to learn more about the treatment of diastasis recti check out our Professional Training.
If you want to learn more about how to check yourself for a diastasis. The Tummy Team has several videos walking you through the process. Check these out:
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