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Myth #3: It's All About That Width

Updated: May 13, 2021


This is the fourth post of a 5 part series - 4 Myths about Diastasis Recti. You can read the original post HERE.

 

I’m sure you don’t need me to tell you this, but women with DR often cite lower rates of body satisfaction than the general population (1).

I’m sure if you are reading this, your hierarchy for healing goes:

1. Look better

2. Feel better

3. Function better


I hear you and I am here for you.


But here is my little secret.


If you come see me (or any other specialist trained in DR recovery), my plan of attack is built around how you function. How you look and feel are glorious byproducts of that functioning.

Beyond these lower rates of body satisfaction, the implications of DR are unclear. It has been suggested that women with DR are at increased risk for low back pain, stress incontinence, or pelvic organ prolapse; however, numerous studies have found NO significant relationship between DR and these other conditions (1, 2).


The majority of studies, such as the ones previously mentioned, use the inter-rectus distance (IRD - science talk for ‘width’) as a measure of DR with the assumption that “narrower is better.”


This view may in fact be short sighted.


The rectus abdominis muscles are not supposed to connect – we’re going for a “6-pack,” not a “3-pack.” Therefore, the idea of “closing the gap” is an unrealistic goal. The LA’s purpose is force transfer (as is with most fascia) and maintaining intra abdominal pressure (IAP). Instead of only looking at IRD, the focus should be on improving the integrity of the LA.


Lee and Hodges (2016) looked at the behavior of the LA using ultrasound during a variety of curl-up movements. They found that while a curl-up with transversus abdominis (TrA) activation actually had a larger IRD than a curl-up without, there was more distortion and a slackening of the LA. When the IRD is reduced, the attachments of the LA approximate, thus reducing LA tension. This distortion is seen as bulging (or “doming”) in the presence of increased IAP. This also limits effective force transfer between the rectus halves (3).


It is my opinion that should any of the previously mentioned studies be repeated using LA integrity as opposed to IRD, there would be a clear relationship between DRA and other conditions related to IAP.


TRY IT YOURSELF:

  1. Lay on your back, knees bent, feet hip-width apart, arms down by your side

  2. Curl up your head until your shoulders just clear the floor and feel along your LA

  3. Come back down

  4. Repeat, but this time, right before you lift your head, purposefully exhale, engaging your transverse abdominals

  5. You should feel the gap get stronger and tighter

“But Katie, how the heck do I engage my transverse abdominals?”


Here are a few of my favorite cues:

  • Draw together your sits bones (like a Kegel), then hips bones, then bottom of the ribs in that order as you exhale

  • Exhale like you’re blowing up a balloon

  • Exhale every last drop like wringing water from a dishcloth (That’s a Joe Pilates image)

  • Imagine you’re pulling up Spanx. Starting at the bottom, feel the draw in AND up, bottom to top.

Need more ideas?


A good pelvic floor contraction can jumpstart your transverse.


CHECK OUT every strange (and not so strange) pelvic floor cue I can think of!


Let’s continue the conversation! Join our Facebook community of mamas and mamas-to-be on our journey to look, feel, and function better.

 

References

  1. Keshwani, N., Mathur, S., & McLean, L. (2018). Relationship between interrectus distance and symptom severity in women with diastasis recti abdominis in the early postpartum period. Physical Therapy, 98(3), 182-190.

  2. Fernandes da Mota, P. G., Pascoal, A. G., Carita, A. I., & Bø, K. (2015). Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual Therapy, 20, 200-205.

  3. Lee, D., & Hodges, P. W. (2016). Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: An observation study. Journal of Orthopaedic & Sports Physical Therapy, 46(7), 580-589.

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