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RECTUS DIVARICATION: DIASTASIS RECTI POST PREGNANCY

Discussion in 'Physical Therapy' started by Anthony Maximilian, Jun 13, 2019.

  1. Anthony Maximilian

    Anthony Maximilian Young Member

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    RECTUS DIVARICATION: DIASTASIS RECTI POST PREGNANCY EFFECT, HEALTH RISK AND PHYSIOTHERAPY
    Rectus Divarication commonly known as diastasis recti post pregnancy is an abdominal separation, a gap of 2.7cm and above between the two recti muscles. “Six pack muscles”( recti abdominus) is a paired vertical muscle located on at belly region. This muscle lie closely on the left and right side of your belly and are connected and separated by a layer of connective tissue called the linea alba in the midline of your belly. Transversely, these muscles are anchored by the rectus sheath at three tendinous insertion dividing the muscle into three or more.

    When this muscle is tensed in muscular people, the areas of muscles between the tendinous attachments bulge. This bulge has resemblance of a six beverage cans hence the name “six packs”.

    This muscle together with other muscles located on the belly functions to move the trunk and help maintain posture. It helps support and protect abdominal organs, compress the structures in your belly to increase the intra-abdominal pressure. This is to aid expulsion of air during respiration, coughing, sneezing, nose blowing, screaming, defecation, urination, vomiting and child birth.

    WHAT IS DIASTASIS RECTI?
    Rectus Divarication commonly known as DIASTASIS RECTI is a Pregnancy predisposed abdominal separation, gap of 2.7cm and above between two recti muscles at the linea alba.

    During pregnancy, the expanding uterus stretches out the six pack muscle so as to accommodate the growing baby. Hormones released during pregnancy such as relaxin and estrogen softens and makes the connective tissue between this muscle lax. The delivery of the baby can also cause abdominal separation ‘diastasis recti’ of the so called “Six pack muscles”(recti abdominus).

    As nature would have its way, all women experience this muscle abdominal separation during pregnancy but what determines who gets this condition after delivery is the extent of the separation. Hence the definition of rectus divarication as a gap of 2.7cm and above or more than two finger length between the two recti muscles. The distance between the right and left rectus abdominis muscles is created by the stretching of the linea alba, a connective collagen sheath.

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    RECTUS SHEATH HERNIA
    For better and understanding of the focus topic diastasis recti, it is imperative that you have the knowledge of the difference that exist between rectus divarication, an abdominal separation and rectus sheath hernia.

    Hernia is an abnormal protrusion of an organ or tissue through a defect in the structure by which it is normally contained. It can be congenital or acquired and is classified according to its anatomical location. A posterior rectus sheath hernia is a very rare type of abdominal wall hernia, described only in a few published cases. These hernias are considered interparietal because the sac lies between the layers of the abdominal wall. The majority of these hernias are postsurgical or posttraumatic, with limited spontaneous cases being reported in the literature. “Journal of Surgical Case Report”

    HOW DO I KNOW THAT I HAVE DIASTASIS RECTI POST PREGNANCY?
    This question is often asked by a lot of women mostly those with diastasis recti pain during pregnancy. Quite unfortunate that majority of moms might have heard about this condition but they don’t know what it actually means. Perhaps, it is not discussed or made known to them as part of what to expect in pregnancy and child birth by their physicians and midwives.

    The best time to check for rectus divarication is after delivery. The funny thing about diastasis recti is that it makes one have a pregnancy look after several months of delivery. This is because of the bulge or ridge on your abdomen “mummy tommy” which is more pronounced when the abdominal muscles are tensed like during coughing, sneezing etc.

    Diastasis Recti Post Pregnancy is better diagnosed by a physiotherapist or a physician as they will give you an accurate measurement of the extent of the separation using a caliper.

    These are outlined steps to self examine yourself for Diastasis Recti Post Pregnancy:

    • Step1: lie on your back, with your knees bent and feet flat on the ground.
    • Step2: place your one hand under your head and the Fingers of the other hand placed Across the mid line of your belly on the umbilicus.
    • Step3: Push down the fingers deeper while lifting the head and shoulder off the ground with the hand placed under the head.
    • Step4: move your fingers back and forth and observe how many finger lengths can fits into the gap. Look out for Rectus Divarication above and below the umbilicus.
    WHAT IF I HAVE RECTUS DIVARICATION?
    Having a diastasis recti or abdominal separation does not mean that you should panic. Although, sometimes the worries are inevitable. During my internship programme, I once had a woman who came to me with a complaint that she doesn’t look attractive anymore to her husband. Her husband now laments that her tommy is out of shape. The painful part of the story being that she has done virtually everything within her power to fix the diastasis recti but to no avail.

    To be frank, this woman was really looking depressed becaused she had an obvious bulge on the abdomen that gives her the look of a 5months pregnant woman, though she is not. Find out here best ways to manage depression. Once you are diagnosed of diastasis recti, do not prescribe exercises or treatments on your own. Talk to your physiotherapist, he or she knows the best abdominis corrective exercises that could help manage the diastasis recti.

    RECTUS DIVARICATION: DIASTASIS RECTI POST PREGNANCY RISK FACTORS
    Studies has shown that the following can be risk factors to diastasis recti.

    1. Maternal body mass index above 35kg/m2:Having a body mas index of greater than 35 means that you are overweight. During pregnancy, the mother is more likely to gain an additional weight which will put so much stress on the belly muscles.
    2. Over weight babies: The trending thing now is giving birth to babies that weigh up to 5kg. Yes, there are fewer good sides to this. Pregnancy has it’s pros and cons and it does not encourage for over weight babiers. The more the weight, the more the pressure it puts on the belly muscles. Causing Rectus Divarication on the long run.
    3. Primiparous mothers: primiparous mothers are moms that are in their first child birth. That first pregnancy has already stretched the muscles, It may not lead to diastasis but it will stand as a risk factor for diastasis in subsequent pregnancies.
    4. Maternal age above 35: Aging comes with a lot of changes and muscular changes are not exempted. Aging could lead to changes in collagen formation and deposition. This could result to a more laxed muscle fibres predisposing one to diastasis recti post pregnancy.
    5. Multiple birth: Women that give birth to twin or triplets stand a chance of having abdominal separation.
    6. Women that had complication of diastasis in their first pregnancy are also predisposed to the risk of rectus divarication.
    DIASTASIS RECTI PREVENTION
    Separation of rectus abdominus muscle during pregnancy is unavoidable but you can actually engage in the following to prevent diastasis recti.

    • Avoid heavy lifting or any exercise that increases abdominal pressure during pregancy.
    • Watch your weight before and during pregnancy.
    • Constantly go for abdominal diastasis check after delivery.
    • Constantly engage in exercises that builds abdominal strength after delivery strictly prescribed by a physiotherapist.
    IS DIASTASIS RECTI MEANT FOR MOMS ALONE?
    No, there are other causes of diastasis recti like too much abdominal fat (obesity), improper abdominal exercises , genetics, lack of exercises, premature birth in children etc. For the sake of this article, we are concentrating on diastasis recti post pregnancy.

    DIASTASIS RECTI SYMPTOMS AND HEALTH RISKS
    • Chronic back pain: weak abdominal muscles often result in back pain after pregnancy.
    • Urinary incontinence: weak abdominal muscles cause pelvic floor dysfunction and this often leads to urinary leakage after birth.
    • Constipation: abdominal muscles contract to produce the force needed in defecation. Weakness of the muscles can cause constipation.
    • Poor support to abdominal organs.
    • Pelvic tilt, instability and poor posture.
    • Abdominal hernia.
    • Poor body image.
    DIASTASIS RECTI PREGNANCY – SHOULD I GET PREGNANT WITH UNTREATED DIASTASIS RECTI?
    It is not advisable. I will tell you why. back to my story about the woman with diastasis recti post pregnancy. During my assesment she told me that she was diagnosed with this diastasis after her first child birth and she was advised to see a women’s health physiotherapist by her physician and to use a tummy belt by her friends but she didn’t listen to them. She went on and became pregnant for the second time and her condition worsened. Pregnancy with yet to be fixed diastasis recti worsens the condition and can predispose you to the above mentioned health risks.

    HOW TO FIX DIASTASIS RECTI?
    Yes, in minor cases without any intervention diastasis recti can heal on its own. But in most cases, it requires treatment. Diastasis Recti Physiotherapy has been found to be the best management form for abdominal separation.

    DIASTASIS RECTI BELT – DOES IT HELP?
    No. Thanks to our grandmothers that always advice their daughters or daughter in-laws to tie wrapper, piece of cloth or tummy belt on their abdomen after child birth especially during “omugwo” to treat diastasis recti post pregnancy. All these are good ideas but not sufficient enough to treat abdominal separation. What diastasis recti belt does for you it to close the gap between the two muscles and help you suck your tommy and support your back thereby reducing the symptom of your belly bulging.

    This is synonymous with giving someone having malaria tepid sponging to reduce his or her high body temperature in place of an effective anti-malaria drugs. Tummy belt or abdominal binders helps reduce diastasis recti symptoms but does not address the underlying issue which is the separated weak abdominal muscles that requires Strengthening. If you base your treatment on belly binders, then be prepared to wear it for long. An electronic abs Toning Flat Tummy Device Could be of help in diastasis recti exercises.

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    Using Muscle Stimulator Belt will help in Diastasis recti exercises

    Contra-indication
    Pregnancy
    Seizure Patients

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    DIASTASIS RECTI PHYSIOTHERAPY
    Physical therapy remains the most effective treatment for rectus divarication. The treatment protocol is on diastasis recti abdominis corrective exercise prescribed by a women’s health physiotherapist.

    Some women, when they hear that exercises helps diastasis recti abdominis correction, they begin to engage in all form of corrective exercises which eventually worsens the situation.

    Not all corrective exercises helps abdominal separation. Infact, any exercise that makes your stomach bulge more when performing it will not help and can worsen it. Such exercises are sit ups, crunches, planks, twists, jumping out of bed etc.

    Exercises prescribed by a physiotherapist strengthens the abdominal muscles and helps you boost your self esteem and confidence. Book an appointment with a women’s health physiotherapist here.

    DIASTASIS RECTI EXERCISES – PHYSICAL THERAPY
    These four basic core exercises according to L. Augustyn, (Physical Therapist) of Fitness Blenderis best self exercise protocol for treating rectus divarication.

    [​IMG]DIASTASIS RECTI ABDOMINIS CORRECTIVE EXERCISE ONE
    The first exercise is activating the deep abdominal muscles in a side lying position. Start by lying on your side and then use your fingers to feel your abdominal wall just inside your pelvic bone. Activate your lower abdominal wall by gently drawing inward the lower abdominal muscles. Maintain this abdominal activation or contraction for up to 10 seconds. You can start with a 5 second hold and then progress to 10 seconds as tolerated. Make sure you breathe normally throughout the diastasis recti abdominis corrective exercise and then relax your abdominal wall back to a resting position in between repetitions. Your upper abdomen should remain relaxed throughout the exercise. To progress this corrective exercise extend the duration of this hold for up to 10 seconds at a time as long as you are correctly able to activate the lower abdominal muscles.

    DIASTASIS RECTI ABDOMINIS CORRECTIVE EXERCISE TWO
    The second exercise is to activate the deep abdominal muscles when lying flat. Start by lying on your back with your knees bent and feet flat. Keep the normal curve of your lower back throughout the time. Place your fingers on your lower abdominal wall just inside your pelvic bones. Gently activate your deep abdominal muscles (the same technique as exercise one. Maintain this abdominal activation/contraction for up to 10 seconds and continue to breathe normally throughout the exercise and then relax your abdominal wall back to resting. Just like the previous exercise your upper abdomen should remain relaxed throughout the corrective exercise. Make sure you learn to correctly activate your deep abdominal muscles before extending the duration of this hold for up to 10 seconds at a time.

    DIASTASIS RECTI ABDOMINIS CORRECTIVE EXERCISE THREE
    The third exercise is bent knee fall outs. This is a progression of the first two exercises. You want to start by lying on your back with your knees bent and feet flat while again keeping the normal curve in your lower back. Activate your abdominal muscles like in exercises one and two and then gently lower one leg out the side while keeping the other leg bent and pointing upwards towards the ceiling. Keep your pelvis stable throughout this exercise and try to avoid trunk rotation. Return your leg to the starting position as soon as you feel you compensate with trunk movement. Relax your deep abdominal muscles and then repeat 2-3 repetitions on each side and progress to increased reps as tolerated. Increase the challenge by increasing the number of repetitions without releasing your abdominal contraction.

    DIASTASIS RECTI ABDOMINIS CORRECTIVE EXERCISE FOUR
    The fourth exercise is heel slides. This will also further progress the challenge for your core muscles. Start in the same position as the last exercise. Place your fingers to feel your abdominal muscles just inside your pelvis. Gently activate your deep abdominal muscles as you extend your right leg (sliding your foot until your knee is straight). When you feel your low back begin to arch bring your leg back to the starting position by bending your knee. Relax your deep abdominal muscles. Repeat 2-3 repetitions on each side when just staring out and you can progress by doing a number of repeated exercises in a row without releasing the abdominal contraction.

    These are the first four basic exercises to start out with and then you can continue to progress to more challenging exercises including straight leg raise with an abdominal contraction and seated heel slides with abdominal contraction. Further progressions are available but just remember to avoid intense core exercises. Always involve your physical therapist in progress of your exercise sessions.

    Remember we always encourage you before enacting any exercises, self diagnosis or treatment plan, always talk to your personal healthcare provider who has all of your healthcare information. You can also reach out to our expert team by booking an appointment with us.



    Enweluzor, Onyinye k

    Anthony Maximilian
     

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