Updated: Mar 4, 2020
This is the fifth post of a 5 part series - 4 Myths about Diastasis Recti. You can read the original post HERE.
Let me start by saying that yes, some women may in fact need surgery. The choice is ultimately up you, but I want to help you become as educated as possible before making this decision. I am not your doctor, nor your surgeon, so be sure you’re asking them ALL THE QUESTIONS before arriving at a decision you’re comfortable with.
Now if you’ll excuse me, I’m about to get on my soapbox:
Overall, there is no official consensus on “normal” IRD. Some surgeons advertise the idea that any gap is bad and can only be closed with stitches and mesh. While this may be the case for some women, I am of the mind that all options should be exhausted prior to surgery. As stated in my initial post, the right and left RA are separate halves – otherwise we’d all by working out for a “3-pack”! If the gap a postpartum woman is experiencing is due to the inability to properly recruit the TrA, surgery will only provide a temporary fix if the TrA is not retrained. Similar to ACL repair – if the movement patterns aren’t addressed, the problem will come back.
Diane Lee, renowned Canadian physiotherapist (she was the one whose study found that linea alba integrity and tension were more important than IRD) has a great article about when surgery would be beneficial. The following suggested guideline are from her website, which is linked below (1):
When should consideration be given for a surgical repair of a diastasis rectus abdominis? The current clinical hypothesis is that:
1. The woman should be at least 1 year postpartum (Coldron et al., 2007) and a proper multi-modal program for restoration of effective load transfer through the lumbopelvis (Lee, 2004; Lee & Lee, 2004a) has failed to restore optimal strategies for function, resolve lumbopelvic pain and/or urinary stress incontinence.
2. The inter-recti distance is greater than mean values (Beer et al., 1996) and the abdominal contents are easily palpated through the midline fascia.
3. Multiple vertical loading tasks reveal failed load transfer through the lumbopelvis
failure to control segmental and/or intrapelvic motion (SIJ/pubic symphysis) during single leg loading (Stork or One leg standing test) (Hungerford et al., 2004, 2007)
failure to control segmental and/or intrapelvic motion (SIJ/pubic symphysis) during a squat or sit to stand task (Lee, 2004; Lee & Lee, 2004a)
4. The active straight leg raise test is positive (Mens et al., 1999) and the effort to lift the leg improves with both approximation of the pelvis anteriorly as well as approximation of the lateral fascial edges of rectus abdominis (Lee, 2007).
5. The articular system tests for passive integrity of the joint of the low back and/or pelvis (mobility and stability) are normal.
6. The neural system tests are normal. The individual is able to perform a co-contraction of transversus abdominis, multifidus and the pelvic floor yet this co-contraction does not control neutral zone motion of the joints of the lumbopelvic which demonstrated failed load transfer on loading (Lee, 2004; Lee & Lee, 2004a).
As you can probably tell by the language and movements referenced, only a physical therapist (or physiotherapist) with knowledge of DR would be able to assess you for the items on this list.
So if you’ve tried every virtual program out there but still haven’t achieved the results you are looking for, please reach out to someone you can see in person. A professional eye, the right descriptive word, or a simple hands-on cue may be all you need to take that next step in your recovery.
It is my sincerest hope that this series of posts has been beneficial to you in some way. If you know someone who would benefit from this knowledge, I would be honored if you shared it with them!
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Lee, D. (n.d.). Diastasis rectus abdominis & postpartum health. Retrieved from http://dianelee.ca/article-diastasis-rectus-abdominis.php