Diastasis recti is most commonly spoken about as a postpartum condition but the condition normally starts in pregnancy. Diastasis recti is separation of the rectus abdominus which is the most superficial abdominal muscle, commonly referred to as the six-pack muscle. It is held together by a connective tissue called the linea alba. The linea alba stretches and thins to allow the muscles separate. During pregnancy this happens to allow the abdomen to grow. Studies have shown around 30% of women at 20 weeks have a diastasis, and at full term anywhere from 80-100% have a diastasis.
Although a diastasis can be normal and needed to make room for the growing baby, putting excessive force through the linea alba is not ideal. Connective tissue is not meant to take the majority of the stress, the abdominal muscles are meant to take the stress. When the linea alba is stretched and stressed it will appear as an outward bulge commonly referred to as 'doming,' 'coning' or 'tenting.' This bulge is more concerning than the diastasis is. Bulging occurs when there is a mismanagement of intra-abdominal pressure and the linea alba is not being supported well by the other abdominal muscles.
View from above the abdomen looking down while relaxed and while leaning backwards putting stress on the linea alba.
When doming is noted there is excessive stress on the already stretched linea alba. This should be avoided if possible. This does not mean you need to completely stop any activity in which doming occurs. The human body is amazing! The linea alba can take some stress and heal well but repetitively stressing the tissue is not advised. There are many strategies to reduce or eliminate doming. The first strategy to try is to exhale through the activity which you notice doming. For instance if you see doming when you pick your toddler up try inhaling deeply through your nose, start your exhale through your mouth and then lift your toddler through the exhale. If this strategy does not work for an activity you need to do often then other strategies should be tried. Although strategies can be very helpful there may be some activities that simply will not be able to be accomplished without doming. These activities really need to be looked at for risk versus reward. For instance a women who is 38 weeks pregnant and her diastasis started bulging this week when lifting a toddler and the bulging is reduced by exhaling but still visible may decide to continue lifting her toddler, through exhale, for the rest of her pregnancy. A women who is 14 weeks pregnant and notices doming during sit-ups, pull-ups and planks and it is unable to be controlled with strategies or modifications may need to think about discontinuing these exercises. While she may feel good during these exercises through the doming the amount of excess force going through the linea alba could stretch it farther than needed for the pregnancy and make healing after birth tougher, or it could put so much force it could cause a tear or hernia. With better education pregnant women can make smarter decisions for themselves and their body.
Common Activities to See Doming
1. Lifting toddler
2. Getting out of bed/couch
3. Sit-up
4. Plank
5. Pull-up
First Strategy
1. Exhale through the lift.
2. Exhale while getting up.
3. Exhale while sitting up.
4. Exhale and inhale slow and deeply while holding.
5. Start your exhale at the bottom with arms extended then pull through the exhale.
Second Strategy (While still using breathing strategy)
1. Hold child as close to you as possible before lifting.
2. Roll to your side before getting up.
3. Reduce the range of motion.
4. Perform the plank with hands or elbows on a raised surface.
5. Assisted pull-up or ring rows.
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