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The Truth Behind the Abdominal Gap

As a team, we have spent an enormous amount of time and brain power learning during 2022! Dr. Becca and I have completed over 50 hours of training specific to pelvic health in the year. The demands of staying up to date with research to provide the best client care is one thing we pride ourselves on. The world of PT has changed dramatically in the last 11 years in general, but so has the world of pelvic health. Pelvic therapy is no longer about clamshell exercises, kegels and recommendations from a specialist to go to pelvic therapy 2-3x/week for 4-6 weeks. No! This generation of 30 to 40 year olds are done with leakage, pelvic pain, pressure and are no longer patiently “waiting to see '' what happens during pregnancy, postpartum and perimenopause transitions. They are committed and ready to take on these challenges with grace and strategic planning!

We covered a multitude of topics, therefore the 2023 blogs and information we share will provide you with the most up to date info! This month’s topic is diastasis recti aka a split or gap in the abdominal wall. Read on to learn the facts about what it is and how we can support healing the abdominal wall.

Diastasis Recti- What is the gap all about?

At full term, 100% women will have diastasis recti. This naturally occurs for women during pregnancy due to hormonal and physical changes allowing the linea alba, a thick fascial connection between the left and right sides of the abdomen, to make room for the growing uterus and baby. Think of the “stretching or “gap” as the second zipper on your suitcase that you can unzip to allow for a bit of extra room to pop in your favorite heels. Because you know a girl’s gotta have options!

At 6 months postpartum, 1 in 5 women will experience persistent DRAM (diastasis of the recti abdominal muscle) or gapping in the abdominal wall greater than 2.2 cm as noted by ultrasound.

For reference, 2.2 cm is a little over the width of your pointer fingers. This gapping is found mainly in the linea alba expanding from under your ribcage to the pubic bone. The most expansive area of the gap is found:

  • 59% above the umbilicus

  • 8.5% at umbilicus

  • 1.2% below umbilicus

The average gap or separation width is 22 mm (About 2 of Dr. Amanda or Dr. Becca finger widths) of space above and/or below the umbilicus. This is all considered normal physiological changes for postpartum people. Somehow we have turned it into a “thing” we must close, heal, shape or surgically correct. It is difficult to say what exact recipe is necessary to heal, but what we do know is every woman is different, but is not alone in her journey to heal herself.

“I am afraid exercise will make my DRA worse. How can I close the gap in the abdomen?”

The social media jury of “how to heal a diastasis” is completely all over the board. Charging postpartum people to do planks, do not do sit ups, lift weights, or do not do anything for 6 weeks. But there is research noting best practice for closing the gap. Here is what we learned regarding exercise and DRAM:

To assist in closing of a DRAM at 6-8 weeks postpartum, women who performed crunches versus performing a transverse abdominal (TVA) drawing in action of the abdomen noted significant closure of DRAM around 15 weeks PP. Performing core activities focused on “drawing in the belly button to the spine” (aka the transverse abdominals) with a coordinated pelvic floor muscle contraction was found to lead to an increase in the gap! It is no longer about kegels friends. Based on the biomechanics of the abdominal muscles and the ability to create tension along the linea alba, we need to focus movement strategies that protect and close the gap!

“My OB/midwife checked me for diastasis with her fingers and said I’m fine. Is that enough?”

The goal standard of assessing a DRAM is to use ultrasound. An ultrasound has always been on my Christmas list, but calipers, tape measures and finger measurements have a similar reliability for ultrasound. Calipers have the strongest correlation to ultrasound, so they will make an appearance in 2023 in the office.

Many women will become obsessed with checking “how many fingers of a gap” they can palpate. However the amount of resistance felt between the gap in the direction of depth is more relevant and provides a better sense of how much stretch the muscles and fascia have endured.

Imagine feeling the space between your muscles. In some areas you may notice there is more “give or mushy” sensation verses a trampoline like tension. We like to feel a trampoline-like tension between this space. The more “give or mushy” the tissue or the more depth we can feel between the gap, signals the more challenging it is to create tension throughout the linea alba. Ultimately requiring more time for healing and a challenge to the overall prognosis of closing the gap. Learn how to self check your diastasis here with Dr. Amanda