Redefining Health Physical Therapy is located in Portland, Oregon, which employs the best physical therapy treatment for diastasis recti through a unique, natural, holistic and scientifically proven method we call The Radiant Bump Way. Pregnant women, postpartum women, multiparous women, and adult men with diastasis recti who undergo this method can improve their lives through our offering of hands-on care, a customized wellness plan, a visceral manipulation modality, a goal-oriented exercise program, and an ideal approach to a dietary plan unique to you and helpful to other members of your family.
What are the benefits of in-home Physical Therapy for Rectus abdominis Diastasis?
Bringing the service to your home is one of The Radiant Bump Way’s successes for someone receiving physical therapy for diastasis recti. And here’s the reason…
And possibly Pugsley, your small-framed but brilliantly temperamental dog in the room.
Exercises and activities that are specific and specialized are already more relatable for you.
It is best to have convenience and accessibility because our bodies are designed to repair diastasis recti, but we must create the environment for it to happen. You have the authority of your own space.
Our physical therapist’s travel in their personal vehicle with minimal equipment because the rest of the tools are in the therapist’s clinical expertise, reliance of their hands and creativity. We then give you the tools for the healthy years to come.
Several changes occur in the body during pregnancy and birth. Hormones can cause ligament laxity, resulting in muscle imbalances and mobility issues. Changes in posture might result in hip pain, low back pain, or sciatica. Physical therapists can be consulted as soon as one to two weeks after giving birth if you have particular postpartum problems such urine incontinence, severe diastasis recti, or pelvic pain. There is so much we can do including educating you on crucial components of healing. It is crucial to address the pain issue as soon as possible and get you moving pain free.
What is Diastasis Rectus Abdominis (Diastasis recti or Diastasis or DRA)?
During pregnancy, the uterus expands to grow your baby and puts more strain on the rectus abdominis muscles that run vertically along the front of the abdominal wall. Diastasis recti occurs when there is separation of the left and right sides of the abdominal walls. It causes tension on a connective tissue called linea alba, which runs down the middle of the abdominal region and connects the left and right rectus abdominis muscles. The band of connective tissues widens and thins because of the tension in the abdominal muscle. This creates more room between the right and left abdominal wall muscles, which can appear as a protruding bulge. Injury or previous pregnancies and labors can cause the rectus abdominis muscles to partially or completely separate from one another.
Who is more likely to get diastasis recti?
Diastasis recti is most common in babies and following pregnancy. Diastasis recti typically experiences an independent postnatal improvement in the third month after birth. The numbers of parity in women, pregnant with multiples, pregnant later in life are risk factors to developing DRA.
DRA can also happen to newborns, men and postpartum women. Usually, pregnant women are at higher risk of developing diastasis recti. (1) The third trimester of pregnancy and the postpartum phase are both times when DRA is most common. In newborns, the rectus abdominis muscle is not fully developed and may not be sealed in the midline. It is more common in premature births and black newborn babies. (2)
Adults with increasing weight, diabetes and stomach obesity are common factors in a person’s weight and a hedonistic lifestyle may cause excessive stress to the body. (3)
Adults that lack proper nutrition, lack of sleep, and exposure to environmental toxicity may attribute to changes in cellular physiology of the muscles, connective tissue, hormones and bones of the body.
Other considerations that have shown to increased risk of a DRA are postural alignment, low muscular tone, increased intra-abdominal pressure, and smoking. Adult men in particular can experience DRA caused by improper weightlifting/exercise technique.
What are the symptoms?
A common physical presentation is when you contract your stomach muscles while supine and instead of your stomach flattening out, your abdominal area protrudes upward, giving you a mid-line bulge or a pooch in your stomach. Also, another indication is the apparent gap that is felt between your rectus abdominis muscles which is most visible when your abdominal muscles contract or perform and hold in position a mild abdominal crunch.
Most women are unaware of diastasis recti symptoms until after delivery. Because of the stretching that occurs during pregnancy, it’s difficult to determine whether you have diastasis recti.
A postpartum person experiencing DRA may exhibit any of the following signs and symptoms:
- Weakness to the stomach wall region. Decreased control of core muscles.
- Difficulty lifting and carrying out daily tasks because of dysfunction to core muscles.
- Poor postural control that can make you slouch or slump resulting in improper alignment.
- Difficulty easing in and out of a chair or bed and getting up or down.
- Low back pain
- Pelvic Pain
- Pain during vaginal penetration
- Bloated physically or the impression of feeling bloated but not actually being bloated
- Constipation
- Urinary Incontinence
- Abdominal hernia
- Doming is distinguished by a mounding appearance of the abdominal muscles following a contraction or when you are getting up from a laying position.
- Soft jelly belly located around the umbilicus aka “mummy tummy”
- A mummy pouch that protrudes slightly above or below the umbilicus gives your belly the appearance of being larger than it should be.
- Even after giving birth or losing a substantial amount of weight, you still appear pregnant.
Although DRA alone is not necessarily the cause of postpartum lower abdomen discomfort in women, dysfunction to pelvic floor muscles and pelvic organ prolapse (when one or more organs fall and protrude into the vagina) can lead to incontinence, constipation, a sensation of weight or fullness in the pelvic region and urine leakage. Pelvic floor muscles can also cause low back, hip, pain during intercourse and pelvic pain. Both DRA and pelvic floor dysfunction can contribute to lower abdominal or hip pain.
How does it feel?
A stomach muscle separation may seem pain free or have few symptoms. Some individuals, however, have reported health complications from DRA, such as the symptoms:
- Reported their belly, feeling “open”, like a gutted fish.
- Sometimes “unstable and weak”, feels uncomfortable.
- “I can’t do positions like I used to, such as lean on my spouse and sit comfortably on the couch”.
- Feels like there’s a “hole” in my abdominal muscle.
- Feeling like your intestines are going to drop out.
- The “drooping” sensations of the belly after you have just sucked in your stomach muscle.
How is it diagnosed?
If diastasis recti diagnosis is evident, physical therapists will assess the medical history and conduct in-depth interviews, and undertake a physical examination to feel your abdominal muscles and stomach muscles to see what’s separated.
There are different variations in where the abdominal muscle can be separated.
- Open diastasis recti occurs around the belly button.
- Open below navel diastasis recti
- Open above navel diastasis recti
- Completely open diastasis recti occurs above, center and below along the midline of linea alba.
Then your physical therapists continue further with palpation around your abdominal wall looking for gaps, finger measurement and testing muscle tonicity to establish diastasis rectus abdominis position and severity. While a pelvic floor physical therapist may use ultrasound to measure the morphology of the pelvic floor muscles, it may not be a necessary tool for DRA. (4) (5)
Although ultrasonography is seen to be the most accurate approach for evaluating the inter-rectus distance and location, a hands-on manual exam is anticipated to be more practical, affordable and accessible in its place.
In the end, the physical therapist uses DRA symptoms to choose the appropriate course of treatment, and they can use a record of DRA measurements to assess the effectiveness of the treatment strategy.
How do I know I have Diastasis recti?
Perform a DRA Self-Exam.
By lying on your back and examining the area around your belly button between your abdominal muscles, you can determine if you have diastasis recti. You might have DRA if you see a depression and feel a gap or separation of the abdominal muscles. In that case, speak with your physical therapist, who can offer a holistic approach of a treatment plan and not just fix the abdominal separation .
Steps:
- Lie down flat on your back on a leveled surface, knees bent and feet on the floor.
- Place your fingertips down the midline of linea alba towards the pubic bone. You will want to check for the depth and width of the valley at three different points. One assessment at the belly button, second assessment at 2.5 inches below the belly button, and third assessment at 2.5 inches above the belly button.
- At each assessment location lift and lower your head. Raise your head no higher than 1 inch off the floor up into a sit up while your chin points towards your chest. You might see a bulge in the middle of your stomach muscles while maintaining this forward head tilt.
- Practice lifting and lowering your head repeatedly until you can distinguish between an active and passive abdominal contraction with your fingers firmly pressed down at midline (towards pubic bone). With time and repetition, you will start to notice that when you elevate your head, your abdominal muscles should grasp the sides of your fingers. Record the width and depth of the separation.
- The width measurement is how many fingers fit in the valley. You most likely have a mild case of diastasis recti if you sense a gap or separation of one to two finger lengths. Make a consultation with your physical therapist to receive a conclusive diagnosis.
- The depth measurement is the distance from the tips of your fingers (distal phalanges) to the knuckle joint (proximal phalanges to metacarpal bone). How far down do your fingers drop between the two rectus abdominis muscle? Does the tissues drop to the distal, middle, proximal phalanges? How challenging is it to press your fingertips midline of the abdominal wall? Keep track of the depth and the ease of finger depression (easy, moderate, difficult).
How to check for diastasis recti at home postpartum
How do you treat diastasis rectus abdominis?
Non-invasive Approach- conservative treatment
Abdominal separations should be a normal part of pregnancy but diastasis rectus abdominis commonly occurs into the third trimester and may be persistent in the postpartum period. Some women may experience self correction of the DRA after birth as the abdominal muscles strengthen. If, six to eight weeks after giving birth, you are still experiencing DRA symptoms or notice a gap or separation between your abdominal muscles, exercises may be beneficial. A physical therapist specializing in diastasis repair can asses pelvic floor function and instruct appropriate exercises that are not harmful during diastasis repair.
According to experts, physical therapy, a thorough program of lifestyle adjustment, and weight loss are the preferred non-invasive techniques for treating DRA, with physical therapy being the first line of treatment above surgery.(6) (7)
Based on a study’s findings, suggest that a 12 week online abdominal rehabilitation exercise program may be a suitable and efficient way to lower DRA in postpartum women. (8) Some postpartum exercises can actually worsen diastasis recti; others can really lessen its severity. With so much conflicting information on treatments to address diastasis recti, how can you make sense of it all? Choosing the right online rehabilitation exercise course can speed the healing process of DRA if it is up-to-date, views the condition holistically, is grounded in evidence-based materials, safely strengthens core muscles, and preserves the health and integrity of connective tissue.
If you have diastasis recti, you should learn more about Core Restore Postpartum Foundations, a diastasis recti-approved online course that is used in Redefining Health’s mobile physical therapy clinic and has been clinically shown to be an effective rehabilitation treatment. It was developed by a mama and physical therapist with more than 15 years of experience to prevent or repair DRA with cutting edge postpartum foundational techniques.
Surgery
Unless there is a concomitant abdominal hernia (ie. umbilical hernia), non-invasive methods (therapeutic exercise and physical therapy) should be fully optimized before any surgical procedure. However, if rehabilitation doesn’t help you, perhaps surgery will. The most common reasons for DRA repair are aesthetic (sagging skin) or functional damage (hernias and the excessive widening of the linea alba). Surgery can only narrow the linea alba; it has no effect on the ventral abdominal wall’s overall laxity. Therefore, physical therapy core rehabilitation is still necessary to post surgical intervention.
A diastasis procedure is sometimes referred to as a “abdominoplasty” or “tummy tuck.” Diastasis recti correction surgery is extensive and should not be taken lightly. Surgery may be able to help you recover a flat, tighter stomach as well as reduce back discomfort and stress incontinence, but this course of action may not be right for everyone, especially if you hope to plan for future pregnancies. (9)
How can you prevent Diastasis Recti?
Exercise helps to maintain the tone, strength, and control of the abdominal muscles from the time of conception to delivery, according to research, making it the most effective approach to minimize the risk of DRA. Thus, there is less tension on the linea abla. In addition, women who exercise throughout pregnancy typically exercise before to becoming pregnant, which may result in them being fitter and having better-conditioned abdominal muscles than women who don’t exercise during pregnancy. (10)
Maybe this is your first time learning about diastasis recti and never done any exercises prior or during your first pregnancy. It is never too late to treat diastasis recti. Even years after having your last child, you can bridge a gap. The severity of your gap and your medical history will determine how long it takes for your diastasis recti to heal.
Here are 3 Fundamental tips to start healing today.
Step 1
Breathing exercises are important but diastasis recti repair is beyond just diaphragmatic breathing. We need the entire core to engage and restore normal breathing patterns.
Step 2
How you move determines two main components to healing a diastasis: DOING things that help repair it and AVOIDING those that cause further damage.
Step 3
Our bodies cannot restore themselves in the absence of fuel or resources. To operate successfully and efficiently, much like a car, we require the proper fuel. The right food choices and supplements design for collagen and ligaments can help accelerate diastasis repair beyond just merely diastasis recti exercises.
Additional approaches to prevent and heal diastasis recti
- Exercise Tip 1 : Avoid push ups, sit ups and any exercises that causes your midline abdominal wall, “mummy pouch” to protrude slightly above or below the umbilicus. Here is a no crunches ab workout for postpartum.
- Exercise Tip 2 : When getting out of bed, roll to one side and push up out of bed with your arms instead of “jackknifing” maneuvers which can stretch your rectus abdominis muscles even more.
- Alignment and Body Mechanics: Proper body mechanics, alignment and posture training to help decrease abdominal pressure when squatting, lifting and collecting things from the floor. Is your pelvic bones mis-aligned? Misalignment of the pelvis can restrict range of motion, putting extra pressure on the core and strain on the pelvic floor. The goal is to achieve a maximum range of motion between the relationship of your upper (rib cage area) and lower (pelvic floor) core structures. Check out this alignment checklist on how to asses alignment.
- Why eating nutritious food should be your top priority. The foods that you eat affects connective tissue repair. The building blocks (glycine, proline, lysine) required to achieve collagen synthesis can be generated by eating foods that are high in collagen or foods that promote collagen production. According to a study on, “Anti-oxidation, Facilitation of the Increase of Collagen Creation..,” collagen rich food contributes to the synthesis of extracellular matrix (ECM) proteins and creates fibroblasts (responsible for development and repair of collagen). (11) (12) In contrast, there are some foods that are damaging to collagen, and you should be aware of them. Let’s take a closer look on foods that are harmful to collagen. You can download a copy for yourself. Here’s the PDF file list on foods that destroy collagen.
- Bloating and constipation may impact intra-abdominal pressure. Bloating and constipation issues are not known to cause DRA. However, it could increase abdominal pressure and add to the list of DRA symptoms. Depending on how severe your DRA is, increasing abdominal pressure forces your abdominal wall to expand, which further strains your linea alba when you undergo strenuous movements (ie lifting, carrying, bending, squatting). Identifying the source of persistent bloating and treating digestive problems may help to lessen the discomfort associated with DRA.
Pearls & Considerations
Real, healthy food has a strong, uplifting impact on both your body and mind. A healthy diet burns fat and builds muscle. It makes skin glow, joints feeling supple, and hair shine. It generates energy, prevents depression, and maintains our psychological state. At the cellular level, both the internal and exterior surroundings influence the cell’s ability to mature, reproduce, and repair. Cellular repair is significant and will also need the right environment to maintain homeostasis. Our health and well-being depend on nourishing foods because whatever you eat becomes a component of the biological architecture of your body.
Foods that help to heal DRA?
Your diet can influence how much collagen your body produces. By eating foods that are natural sources of collagen and foods that include nutrients known to encourage collagen production, you can help your body produce more collagen on its own. This is important to someone, especially in their thirties, because collagen production decelerates as you get older. Eating meals with specific collagen-boosting vitamins, herbs, and minerals is another way to encourage collagen formation if you are not already eating foods made from natural sources of collagen.
The primary connective tissues involved with DRA are linea alba and skin. Although, if pelvic instability and pelvic floor dysfunction with or without organ prolapse exist, injury to the sacroiliac ligaments and pubic symphysis is also impacted (which is another article to discuss for next time or have a discussion with a pelvic floor specialist in women’s health physical therapy). The minerals needed to manufacture collagen are harder for your body to absorb as time goes on, so if your body struggles to maintain collagen levels, you may be deficient. Therefore it’s critical to provide the optimal conditions for connective tissue growth and repair through a nutritious diet and supplementation.
Here Are The Top 6 Foods That Help With Collagen Build
- Eggs
- Fish
- Bone Broth
- Lean meat
- Collagen infused drinks:
- Spirulina
Hot chocolate & marshmallows, peanut butter & jelly, Dandelions & daydreams, Hugs & kisses, etc , you get my point may be more appealing than simmering animals in liquids, grilled mammal flesh, salmon and shell fish bones soup. And that’s okay, if you are a vegan base diet because you can get your collagen from nutrients known to promote collagen production. But keep in mind that your body absorbs better foods that contain natural sources of collagen. If you chose the vegan route, consider: your symptoms are improving, the DRA gap is narrowing, and you are on the correct track; keep “passing GO.”
Since all collagen derives from living animals, there is no such thing as vegetarian collagen. While connective tissue comprises of fibers, amino acids, and proteins (glycoproteins, proteoglycans, and glycosaminoglycans), foods high in collagen-boosting nutrients can still help your body manufacture the building blocks of the proteins that are required to increase your collagen levels. These vitamins and minerals listed below will help your body’s natural collagen production.
Here Are The Most Crucial Vitamins And Minerals, Along With The Best Vegetarian Food Sources To Build Connective Tissue.
- Vitamin C: sources from brightly colored bell peppers, kiwi, acerola cherries, broccoli, guavas, citrus fruits and acerola cherries (14).
- Zinc: Best sources from toasted wheat germ, lima beans, baked potato, rolled oats, mustard greens, pumpkin seeds, soybeans, kidney beans, and ginger root. (15 , 16)
- Vitamin A: Best sources from carrot juice, cooked dandelion leaf, steamed burdock/yellow dock, baked sweet potato, cooked pumpkin, steamed spinach, papaya, and apricots. (17)
- Manganese: Best sources from whole grains, peas, rye, buckwheat, banana, pecans, spinach, almonds, rhubarb, lettuce, beets and sweet potato. (18)
- Lysine: Best sources from ricotta cheese, yogurt, eggs, red beans, oatmeal flakes, carrot juice, granola, peanuts, cashews, and almonds. (19) (20)
- L-arginine: Best sources found in peanuts, whole almonds, ricotta cheese, cottage cheese , cashews, wheat, oats, soybeans, eggs, whole milk, collards, and brown rice. (21)
- Copper: Sources from spinach, potatoes, chickpeas, cashews, sunflower seeds and millet. (22)
Important Insights About Collagen And DRA Recovery Include The Following
- Collagen supplementation alone is unnecessary for DRA repair but helpful in expediting healing. What is necessary is creating the ideal environment and proper fuel to facilitate restoration of your cells. If you decide that taking collagen supplements is not for you instead, you may encourage your body to produce more collagen by consuming meals that are natural sources of collagen and foods that include nutrients known to promote collagen production.
- The most essential vitamins for collagen synthesis are Copper, zinc, and vitamin C. They interact with one another to maintain the cellular framework of connective tissue, tissue function, collagen strength and flexibility. However, consuming these vitamins and minerals in excess may also interact with other medications and or impede connective tissue healing. Consult with a medical provider for help with proper dosing and interactions.
Conclusion
The right and left sides of the largest outermost abdominal muscles, known as the rectus abdominis, are separated in a condition called diastasis recti. It often continues after giving delivery and is typical during pregnancy.
Conservative methods like physical therapy exercises, weight management and proper nutrition make up the first line of treatment. A doctor might advise surgery if all conservative methods have been exhausted, DRA symptoms persist and/or severe abdominal hernias are present.
Surgery can be necessary if your DRA is especially severe, but in most situations, physical therapy can help your condition enough to prevent invasive procedures.
A healthy and balanced diet that includes enough protein-rich foods, whole grains, fruits, and vegetables promotes the natural production of collagen. Studies suggest that several high-protein diets promote collagen production because they include the amino acids glycine, proline, and hydroxyproline, which are necessary for the formation of collagen. Our bodies need vitamins and minerals like zinc, vitamin C, manganese, and copper for collagen formation. Nutrition is crucial for regenerating connective tissue.
How can a physical therapist help? How is a physical therapist able to assist?
Physical therapy can diminish or eliminate pain. Each person’s body is unique, and every patient’s body will react differently to a treatment. Even if something doesn’t work the first time or if physical therapy makes the pain worse, it is still not a failure. An infinite number of ways can alter a person’s therapy program to maintain comfort and progress. The range of physical therapy approaches includes massage, manual therapy, exercises, visceral manipulation, electrical stimulation, therapeutic ultrasound, and more. A confident physical therapist specializing in diastasis recti rehabilitation knows that even with a very large diastasis recti gap, patients suffering from low back pain, sciatica pain, abdominal hernias, and pelvic organ prolapse can find relief and recovery with the correct therapy program.
Core muscles and exercises that result in a better outcome. Improving mobility, learning with confidence proper core strengthening exercises, reshaping your bat wings (that flapping underarm fat but doesn’t give you flight) and flattening that mummy tummy may be your targeted goal of looking good and feeling good. An experienced physical therapist should know if rehabilitation comes first or personal training comes later. A therapist will train you to safe ways of improving function, demonstrate focused movements, educate on prevention, and offer a comprehensive wellness program after therapy.
If possible, invasive procedures should be your last resort with diastasis, rectus abdominis. Surgery may not be necessary if physical therapy helps you get rid of pain or recover from an injury. Physical therapy before surgery may be helpful even if it’s necessary. A solid rehabilitation DRA therapy prior to surgery can prevent an incisional hernia (such as an umbilical hernia). Most women who have DRA repair surgery do it for instant relief and aesthetic benefits. However, an online DRA guided program and physical therapy techniques used as the first line of treatment can be an efficient strategy to restore appearance and function.
Addressing women’s health and other conditions. Diastasis recti may simply not be on your radar for concern, but you are experiencing DRA symptoms that overlap, such as bowel incontinence, urine incontinence, increased urinary frequency, lymphedema, bowel issues and pelvic floor dysfunction. Physical therapists with experience in pelvic floor dysfunction can evaluate the strength, coordination, and pain referral points of the pelvic floor muscles. To strengthen and restore the function of the pelvic floor muscles, they create a detailed therapy plan.
What kind of physical therapist do I need to address DRA?
Through training and practice, all physical therapists are qualified to recognize and manage diastasis rectus abdominis, especially if they have taken a course on DRA rehab programs. A physical therapist can focus their education on many various subspecialties. Each therapist has their own preferred methods of treatment, but you should work with a physical therapist who motivates you to achieve your personal goals. In addition, consider a physical therapist that have advanced training, expertise, and skills in prenatal and postpartum therapy.
Important FAQ to know before choosing your physical therapist.
Choosing a physical therapist that specializes and/or complements in a certain field of the problem might bring multiple ways to fixing the problem faster and may have additional treatment options if one does not work. For example, with DRA repair is the physical therapist educated in sports medicine therapy, orthopedic therapy, visceral manipulation therapy, women’s health in pelvic floor care, etc. A therapist that is very knowledgeable in nutrition may add to the benefit of care. Nutrition is a part of physical therapists’ professional scope of practice.
- Your physical therapist should possess excellent manual skills so that they can rely more on their hands and not so much on machinery, which is useful when necessary.
We highly recommend manual therapy.
Let us say you have chronic back pain. A physical therapist should try to assess a variety of patient characteristics that can help them determine which patients are most likely to respond to which type of treatment. Most of the indicators that appear to be at least somewhat predictive have nothing to do with causing back pain or physical injury but they are often connected to patients’ cognitive, visceral organ restrictions and emotional reactions to pain, including how they typically manage it and how they view it.
- A customized therapy plan changes the treatment’s emphasis from reactive to proactive. The advantage for patients is that physical therapists are better able to foresee which treatments will be most effective for certain patients. Their purpose is to help you regain your prior level of functioning while promoting activities and lifestyle modifications that can help prevent further injuries and enhance general health and well-being.
- You have everything you need at home. You are already more able to relate to exercises and activities that are unique and specialized. Therapy at home may be a safer option, convenient, more quality time and you will have better care because in most cases you are the only patient.
Education is a big part in healing your diastasis recti. Consider a physical therapist as your guide. We entrust them with helping you toward your objectives and assisting you in resolving your problems because your health has a big bearing on the wellbeing of your family as a whole.
