Mind The Gap

Diastasis, what is it and do you have one?

If you google the word ‘Diastasis’ Wikipedia will describe it as ‘an abdominal separation that is commonly defined as a gap of roughly 2.7 cm or greater between the two sides of the rectus abdominis muscle’ (your six pack – yes we do all have one. Whether we see it depends on how defined it is and if its hiding behind a layer of abdominal fat). This condition has no associated morbidity or mortality.

 

It is a common occurrence for a woman during pregnancy and post birth due to the growing uterus stretching the abdominal wall and separating the borders of the recti muscles to accommodate the growing baby. This is completely normal with approximately 60% of women experiencing it. However, it is not just expectant mums that can experience a diastasis. Ladies who have not given birth; men; and small children can also have a diastasis. Why?

If an individual has been lifting heavy weights incorrectly or has been performing abdominal exercises in an unsafe way, after a while the pressure placed through the abdomen can become too much and the muscle separates. If you suffer from constipation or bloating this can also cause pressure on the abdominal wall and therefore a separation. Your posture can also be a factor.

For new-born babies, a diastasis is present due to their abdominal muscles not being fully developed and connected. The condition usually corrects itself with time.

How to tell if you have a diastasis?

Aside from performing a physical assessment on the abdominals, there are some signs and symptoms that could indicate the presence of one.

  • A pooch or bulge in the centre line of your abdomen especially when you strain/contract the muscle.
  • Lower back pain
  • You look in the mirror and see a dip down the middle of your ab muscles.

You can check your own abdominals to see whether you have a diastasis although it is always recommended that a professional do this along with other useful assessments to ascertain core functionality. Follow the instructions below:

  1. Lie on your back with knees bent and feel flat on the floor.
  2. Gently raise your shoulders off the floor slightly and look down towards the abdominal wall.
  3. Using your fingers, gently press above and below your belly button and then along the midline of the rectus abdominis muscle and see if your fingers drop into a gap.
  4. If you feel a 1-2 finger gap you have a mild diastasis. It’s important to feel for tension along this line also, as a firmer tension confirms the muscles are in a reasonable position to withstand pressure. A weak, soft midline will indicate that the muscles are weak and therefore not as able to maintain pressure through the core, hence why the lower back is placed under strain and you get pain.

If you have found a gap it’s wise to have this confirmed by a professional who can perform further checks and ascertain core functionality.

IMPORTANT – you can have a small diastasis and the core be able to do its job well!

 

Can it be fixed?

The answer is yes!

If a diastasis is considered to be of a particular width or the edges of the muscle are not strong enough, where the abdominal pressure cannot be managed, then work can and needs to be done to help.

For some women, diastasis recti may correct itself after delivery as the abdominal muscles regain their strength. However, if you’re still experiencing symptoms or separation eight weeks post birth then certain exercises may help. After an assessment, a women’s health physiotherapist, postnatal fitness specialist or Holistic Core Restore® coach can provide you with specific exercises that you can perform at home or at work to help strengthen those muscles and help bring the 2 edges of the rectus abdominis muscle closer together.

 

As highlighted above the core muscles can still work sufficiently even if there is a small diastasis, so the focus will NOT be on getting the abdominal wall to join completely but to just get it to a position where it is considered the pressure can be managed. This will be constantly monitored by your physio or core specialist.

The key thing here is how well the person is able to manage any intra-abdominal pressure when lifting or moving. If that individual holds their breath when lifting, or lifts too heavy, or lifts incorrectly or performs exercises that their bodies are just not able to support then pressure in the core unit will be increased and therefore place unnecessary load either through the abdominal wall causing an increased diastasis or worse a hernia, or the pressure moves down into the pelvis and causes a prolapse through the pelvic floor muscles. Again, your specialist will coach you through the correct way to breath when you lift and how to activate the core and pelvic floor when you do so. They will also look out for other muscles that may fire instead of the ones that should be. This imbalance can also slow down the recovery of a diastasis.

 

How Bumps Lumps and Star Jumps can help you.

Bumps Lumps and Star Jumps offers specific programmes to help with healing a diastasis. Prior to any exercise programme, a complete and through assessment is completed which helps ascertain EXACTLY where that lady is with her pelvic floor and core function. From there a blend of massage therapy, releases for stuck tissue and core specific techniques are used to help start the process. Once the abdominals begin to respond then the exercises are progressed further and are designed around the typical movement patterns we use in day to day life getting us ‘Fit for Function.’

For further details click here.

 

 

 

 

 

 

 

 

Why Your Abdominal Scar Could Be Stopping You From Reconnecting With Your Core.

Why Your Abdominal Scar Could Be Stopping You From Reconnecting With Your Core. January 2019

If you have had abdominal surgery what advice were you given to help with your recovery? Lots? A little? Nothing? And if you were given advice, how useful was it?

Were you informed about what type of foods would help promote your healing; what exercises would help or hinder your recovery; or given any self-care tips to make your recovery as positive as possible. Were you given some advice as to how to look after your scar?

Based on the conversations I have had with women who have had some form of abdominal surgery, myself included, I would say that most people’s experiences didn’t blow them away. In fact, it left them feeling a little bewildered and anxious.

It’s really quite important to understand your body and its process of healing. Without this knowledge we could end up doing things or not doing enough to help the body and therefore feel worse than we did pre-surgery. Tissues can get stuck and tight, the scar site itself may not be healing well enough, or you may start finding injuries occur elsewhere in the body due to compensatory movement patterns that were brought on by discomfort at the scar site.

 

How long does tissue take to heal?

 The whole process of healing can take at least a year. The chart below is from woundeducators.com and helps us see what the phases of wound healing are and how long each takes.

As you can see it can take a while for our tissue to recover completely and even then, the strength of that tissue may not be what it was prior to the disruption.

With respect to exercise its key to know when it is appropriate to be loading this new tissue. If it’s not quite ready there is a risk that that tissue can be damaged further, and healing slowed, or if not worked on through stretching or scar tissue therapy then the tissue can become stuck and cause a change in movement due to a lack of flexibility. A balance needs to be struck with appropriate care.

 

How a scar will affect the function of other body parts including the core?

A well respected manual therapist named Thomas Myers has proposed that we have 12 ‘myofascial lines’ that run through our body and connects all the body parts, muscles and tissues that run through each of these lines. With this in mind you can see how cutting through one part of the body can have an impact on the rest of the body including the core and pelvic floor. A lack of control or connection around the scar means a weakened connection and response to its surrounding areas. So, if the abdominal wall has been interrupted then it stands to reason the connection to the core muscles will be affected.

 

 

How can we fix this?

There are ways that this disconnection can be improved. If a scar and its surrounding tissues can be manipulated, it is possible to increase blood flow (helping provide oxygen to the skin), improve mobility around the site of the scar and the surrounding areas (helping you move better and not compensate in other areas) and start to make that scar feel more apart of you, as sensation is improved! If we feel more in our abdomen we can connect to those muscles better and train them to work to support our back and our limbs and let them do the job they are designed to do.

Taking on a course of scar tissue therapy and combining this with some bespoke personal training sessions that work on improving flexibility in and around the scar site and then strengthening the core and pelvic floor muscles will really improve any symptoms being experienced.

During scar tissue massage sessions various techniques are used on and around the scar. This includes hands on skills, manipulating the tissue with fingers; an instrument assisted soft tissue massage tool; a yoga tuning ball or similar; and more specific stretches that can performed on a massage table. Treatment sessions are generally sixty to ninety minutes long.

Personal training sessions focus on specific techniques that help reconnect the core with breathing, and then coordinating that with movement, minimising any unnecessary pressure in the abdomen.

Regardless of the age of the scar, results can be achieved, albeit a little slower for an older scar than a more recently attained one.  Work can begin on a scar as soon as it is healed and there is no inflammation, weeping or soreness.

Certain techniques can even be taught to the client so that they can continue work outside of treatment sessions and long into the future. It must be said that, as scar tissue has a blood supply and is innervated by nerves, just like other tissues, it can grow and proliferate just like the roots of a plant. If not kept in check, symptoms experienced prior to work, can begin to reappear.

Its also important to stress that your body needs nourishment, with good ‘clean’ ‘real’ foods. Diets high in sugar and that is processed, is highly inflammatory to the body and will drastically slow down its healing. Keeping hydrated is important to, as our tissues are 75% water. Being dehydrated will cause your tissues to respond slowly and become stuck and stiff if not looked after well.

If you have an abdominal scar and are feeling disconnected to your core and pelvic floor please drop me a message and I can arrange a consultation with you to see what work can be done to reconnect you back with that area of your body.