Abdominal diastasis

(Credits:David Roseborough from Los Angeles, United States, CC BY 2.0 , via Wikimedia Commons)
Abdominal diastasis. (Credits: Anež&Han. Edited image with original text removed)

Abdominal diastasis is a separation between the two rectus abdominis muscles resulting from a thinning and widening of the linea alba. The linea alba is a narrow, thick fibrous tissue that connects the two rectus abdominis muscles in the midline. It is a raphe tendon that goes from the xiphoid process of the sternum to the pubic symphysis.

Dawn line (Credits: Henry Vandyke Carter. From the book "Anatomy of the Human Body" in Henry Gray )
Formation of the linea alba (Credits:Henry Vandyke Carter, Public domain, via Wikimedia Commons)

Any separation greater than 2 cm or to the width of 2 fingers is considered signition. It can occur above, below or to navel level[1]Acharry N, Krishanan Kutty R.Abdominal exercises with bracing. A Therapeutic Efficacy in reducing Diastasis recti among postnatal females. [2]International Journal of Physiotherapy and Research, 2015; 3-2-999-1005. [3]Kisner C, Lynn Allen Colby.Therapeutic exercises, womens health. Obstetrics and pelvic floor.5th edition 2007; 797-824. [4]Mentle J, Haslam J, Barton S.Physiotherapy in obstetrics and gynecology .2nd edition 2004. [5]Biossonnault S J and Blaschak J M.Incidence of Diastasis recti abdominis during the childbearing year. Journal of American Physical Therapy Association.1988; 68-1082- 1086.

During pregnancy, the increase in levels of relaxina, progesterone and estrogen cause a change in the consistency of the connective tissues and, consequentially, also the weakening of the linea alba[6]Chiarello M C, Falzone A L, McCaslin E K , Patel M, Ulery K. The Effects of an Exercise Program on Diastasis Recti Abdominis in pregnant Women. Journal of women’s health physical therapy. 2015 … Continue reading[7]Parkee A M, lynn millar A, Dugan S. Diastasis rectus abdominis and lumber pelvic pain and dysfunction- are they related. Journal of womens health physical therapy. 2008-9- 32-1, particularly sensitive to the influence of these hormonal changes. The growth of the fetus then determines a continuous increase in tension in the abdominal wall. Increased pressure on a weakened structure are the predisposing factors for the diastasis recti[8]Kisner C, Lynn Allen Colby.Therapeutic exercises, womens health. Obstetrics and pelvic floor.5th edition 2007; 797-824. [9]Mentle J, Haslam J, Barton S.Physiotherapy in obstetrics and gynecology .2nd edition 2004. [10]Pascoal A. G, Dionysius St, Lamb F, Mota P. Inter recti distance in postpartum women can be reduced by isometric contraction of abdominal muscle; A preliminary case controlstudy. Published by… Continue reading [11]Misha A, Maria L, Umar M, Kanwal R.Prevalence of diastasis recti among pregnant female presenting at holy family hospital Rawalpindi. International journal of rehabilitation sciences. 03 -1 – … Continue reading.

Symptoms.

Women with abdominal diastasis usually do not perceive no pain at rest. They feel discomfort, pain and swelling of the of the abdominal wall during physical activities. Pain may appear in cases where the diastasis is particularly accentuated. It can occur at the lumbar level or within the abdominal muscles. AND it is common in multiparous women, because the muscles were “stretch” many times. When you are faced with a particularly marked diastasis, in the last part of pregnancy it is possible to see protruding the upper part of the pregnant uterus from the abdominal wall[12]Boot camp and Military fitness institute; Diastasis recti. An overview; 21sep.2015; available from www.bootcampmiliteryfitnessinstitute.com/injury/diastasis- recti- an overview/.

Lower back pain (Credits: https://www.myupchar.com/en, CC BY-SA 4.0 , via Wikimedia Commons.. Use: I only extrapolated a part of the original image)
Abdominal pain

The abdominal muscles play a role crucial role in the control of the trunk and its weakening can lead to important limitations during physical activity. The mainly impaired movements are flexion, trunk rotation and inclination. A weak abdominal wall also has a negative impact on breathing and the protection and containment of the abdominal viscera[13]Mentle J, Haslam J, Barton S. Physiotherapy in obstetrics and gynecology .2nd edition 2004. [14]Chiarello M C, Falzone A L, McCaslin E K , Patel M, Ulery K. The Effects of an Exercise Program on Diastasis Recti Abdominis in pregnant Women. Journal of women‟s health physical therapy. 2015 … Continue reading [15]Pivarnik J, Chambliss O H, Clapp F J, Dugan A S, Hatch C M, Lovelady A C, et al. Impact on physical activity during pregnancy and post partum on chronic disease risk. Journal of the American College… Continue reading [16]Boot camp and Military fitness institute; Diastasis recti. An overview; 21sep.2015; available from www.bootcampmiliteryfitnessinstitute.com/injury/diastasis- recti- an overview/.

The main risk factors[17]Khandale, Sanjivani Ramesh, and Deepali Hande. “Effects of abdominal exercises on reduction of diastasis recti in postnatal women.” IJHSR 6.6 -2016- 182-191. [18]Boot camp and Military fitness institute; Diastasis recti. An overview; 21sep.2015; available from www.bootcampmiliteryfitnessinstitute.com/injury/diastasis- recti- an overview/ [19]Benjamin, D. R., A. T. M. From the Water, and C. L. Peiris. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy… Continue reading [20]Cavalli, M., et al. Prevalence and risk factors for diastasis recti abdominis. A review and proposal of a new anatomical variation. Hernia 25.4 -2021- 883-890. of the diastasis recti are the age (women over the age of 35 years), the high weight of the child at birth weight, twin births, cesarean birth, performing excessive abdominal exercises after the first trimester of pregnancy, the presence of previous abdominal surgery and diabetes. Abdominal diastasis is not a condition exclusive to pregnant and postpartum women. It can also occur following a significant weight loss, spontaneous or due to bariatric surgery.

Age (credits: James Baillie, Public domain, via Wikimedia Commons)
High baby weight at birth (Credits:http://www.Pexels.com, CC0, via Wikimedia Commons)
Twin birth (Credits: Mypurplelighter, CC BY-SA 4.0 , via Wikimedia Commons)
Cesarean section or previous abdominal surgery (Credits:jessica raphaela, CC BY-SA 2.0 , via Wikimedia Commons
Excessive abdominal exercises after the first trimester of pregnancy (Credits:Someone272, CC BY-SA 4.0 , via Wikimedia Commons)
Diabetes (Credits:formulatehealth, CC BY 2.0 , via Wikimedia Commons)

REHABILITATION

The most used method for the rehabilitation of abdominal diastasis is the Caufriez Hypopressive Gymnastics (GAH).

Regular practice of appropriate exercises, carried outbefore pregnancy and in the subsequent postpartum period, contributes on the one hand toreduce the risk ofto develop diastasis of the recti and on the other areduce its size the possibility of recurrencein the women who developed it[21]Khandale, Sanjivani Ramesh, and Deepali Hande. Effects of abdominal exercises on reduction of diastasis recti in postnatal women. IJHSR 6.6 -2016- 182-191.. In patients undergoing a rehabilitation program with GAH, adecrease in tension and rigidity of the linea alba, of the tension and elasticity of the transversus abdominis muscle and the internal oblique but also of the pelvic floor[22]Khandale, Sanjivani Ramesh, and Deepali Hande. “Effects of abdominal exercises on reduction of diastasis recti in postnatal women.” IJHSR 6.6 -2016- 182-191. [23]Ramirez-Jimenez, Miriam, et al. Effects of hypopressive exercises on post-partum abdominal diastasis, trunk circumference, and mechanical properties of abdominopelvic tissue. A case series; … Continue reading [24]Cañamero-de León, S., et al; Effects of an exercise program on diastasis recti in women;  International Journal of Health Sciences and Research 9.10; 2019; 90-9  [25]Arranz-Martin, Beatriz, et al.;  The impact of hypopressive abdominal exercise on linea alba morphology in women who are postpartum. A short-term cross-sectional study.; Physical Therapy 102.8; … Continue reading.

Note

Note
1 Acharry N, Krishanan Kutty R.Abdominal exercises with bracing. A Therapeutic Efficacy in reducing Diastasis recti among postnatal females.
2 International Journal of Physiotherapy and Research, 2015; 3-2-999-1005.
3, 8 Kisner C, Lynn Allen Colby.Therapeutic exercises, womens health. Obstetrics and pelvic floor.5th edition 2007; 797-824.
4, 9 Mentle J, Haslam J, Barton S.Physiotherapy in obstetrics and gynecology .2nd edition 2004.
5 Biossonnault S J and Blaschak J M.Incidence of Diastasis recti abdominis during the childbearing year. Journal of American Physical Therapy Association.1988; 68-1082- 1086
6 Chiarello M C, Falzone A L, McCaslin E K , Patel M, Ulery K. The Effects of an Exercise Program on Diastasis Recti Abdominis in pregnant Women. Journal of women’s health physical therapy. 2015 – 29-1- 11-16.
7 Parkee A M, lynn millar A, Dugan S. Diastasis rectus abdominis and lumber pelvic pain and dysfunction- are they related. Journal of womens health physical therapy. 2008-9- 32-1
10 Pascoal A. G, Dionysius St, Lamb F, Mota P. Inter recti distance in postpartum women can be reduced by isometric contraction of abdominal muscle; A preliminary case controlstudy. Published by Elsevier. Physiotherapy – 100-2014- 344-348
11 Misha A, Maria L, Umar M, Kanwal R.Prevalence of diastasis recti among pregnant female presenting at holy family hospital Rawalpindi. International journal of rehabilitation sciences. 03 -1 – 26-31.
12, 16, 18 Boot camp and Military fitness institute; Diastasis recti. An overview; 21sep.2015; available from www.bootcampmiliteryfitnessinstitute.com/injury/diastasis- recti- an overview/
13 Mentle J, Haslam J, Barton S. Physiotherapy in obstetrics and gynecology .2nd edition 2004.
14 Chiarello M C, Falzone A L, McCaslin E K , Patel M, Ulery K. The Effects of an Exercise Program on Diastasis Recti Abdominis in pregnant Women. Journal of women‟s health physical therapy. 2015 – 29-1-11-16.
15 Pivarnik J, Chambliss O H, Clapp F J, Dugan A S, Hatch C M, Lovelady A C, et al. Impact on physical activity during pregnancy and post partum on chronic disease risk. Journal of the American College of Sports Medicine. Medicine Science in Sports & Exercised.2006; 10.1249/01.
17, 22 Khandale, Sanjivani Ramesh, and Deepali Hande. “Effects of abdominal exercises on reduction of diastasis recti in postnatal women.” IJHSR 6.6 -2016- 182-191.
19 Benjamin, D. R., A. T. M. From the Water, and C. L. Peiris. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy 100.1 -2014- 1-8.
20 Cavalli, M., et al. Prevalence and risk factors for diastasis recti abdominis. A review and proposal of a new anatomical variation. Hernia 25.4 -2021- 883-890.
21 Khandale, Sanjivani Ramesh, and Deepali Hande. Effects of abdominal exercises on reduction of diastasis recti in postnatal women. IJHSR 6.6 -2016- 182-191.
23 Ramirez-Jimenez, Miriam, et al. Effects of hypopressive exercises on post-partum abdominal diastasis, trunk circumference, and mechanical properties of abdominopelvic tissue. A case series; Physiotherapy Theory and Practice 39.1; 2023; 49-60.
24 Cañamero-de León, S., et al; Effects of an exercise program on diastasis recti in women;  International Journal of Health Sciences and Research 9.10; 2019; 90-9
25 Arranz-Martin, Beatriz, et al.;  The impact of hypopressive abdominal exercise on linea alba morphology in women who are postpartum. A short-term cross-sectional study.; Physical Therapy 102.8; 2022; pzac086