PT Perspective

with Jason Lau, Doctor of Physical Therapy

Ever noticed an unusual bulge in your belly that resembles a ball protruding from your stomach? If so, you may have diastasis recti (abdominal separation). It is a fairly common condition among women and men. Specifically for women, the event that triggers the condition is often pregnancy, but both men and women can succumb to this condition due to weakness in the core muscles.

What is happening is a stretching out of the tendinous line in the midline of the abdominal muscles called the linea alba. Once stretched out, any outward abdominal pressure will cause the weak part of the abdominal wall to protrude. 

 It seems obvious why women who have given birth would have such a condition. With so much outward abdominal pressure provided by the baby, I’m surprised it isn’t more common among this group. But why do some women get it and other’s don’t? Most likely the reason is due to many factors including age (which effects collagen levels and elasticity), ratio of the size of the baby to the mother, pre-pregnancy fitness condition, and activity during pregnancy.

So the question is why would this condition occur in men and women who have not gone through labor? The answer to this is the 1st key to the cure. Core weakness is to blame. Specifically weakness in the transverse abdominal muscles (TA).

 The TA muscles are one layer deep to the recurs abdominals, which are the six-pack muscles. In general terms the TA muscles pull the abdominal wall in, while the RA pushes the wall out.  

Is there hope for a cure from diastasis recti? The short answer is yes! There are always surgical options, but most people opt out of the surgery because diastasis recti does not interfere with everyday functioning. There are also physical therapy options. Physical therapy options boil down to strengthening the TA and avoiding further stretching of the linea alba. This is simple, but not easy.

Not easy because the process can take several weeks to several months depending on the severity of the condition. Also not easy because it takes a slow gradual approach that requires a lot of patience. You may be able to do 50 sit ups, but were you able to do them while controlling the bulge from the belly? If you were not able to control the protrusion then you are not ready to do sit ups. Because every time you exert intra abdominal pressure that causes the protrusion, you are encouraging a further stretch of the linea alba. So even if you can do 50 sit ups, they don’t count unless you can do them without the bulge. Most people are unable to do one abdominal crunch without a bulge on their first day of PT let alone 50 sit ups.

In summary, there is hope. Strengthen your TA, core, pelvic floor, and be patient. If you need more detailed guidance, a physical therapist can give you a plan and coach you through the process.   

Submit your questions for future PT Perspective columns to Jason Lau, Doctor of Physical Therapy at jasonlaudpt@gmail.com