Diastasis: Core Evaluation and Training

 The question was recently posed to me, “What do you do to treat a diastasis recti?”

In short, I’m not an expert in diastasis management.  However, in performing a full body assessment and assessing intraabdominal pressure (IAP) per DNS, this is often a finding in patients who I treat for a variety of conditions.  Diastasis recti is a sign of lack of coordination the abdominals/core that results in a separation at linea alba.  This can appear as a bulge outward or a pulling inward (see below).  Diastasis is ‘normal’ in newborns and typically resolves with development, it is also commonly seen during pregnancy during which time it is not treated.  Post-pregnancy, and when present in the adult population this may be something that warrants further evaluation and treatment.  Appropriate exercise selection is essential to success.

 

 

 

 

 

Evaluating and Training Diastasis:

Some diastasis, such as below, are quite obvious.  Others are more subtle.  Evaluation must occur with careful observation and in a variety of positions that create a challenge to intraabominal pressure.  Check out a DNS course to learn more.  For those who haven’t been exposed to the Prague school methods, perhaps for now consider evaluating in whatever ‘core exercises’ you already do.

I wonder how many of these are overlooked as clinicians focus on the back rather than the front during spine evaluation and as fitness trainers and coaches train the majority of their athletes with shirts on.  Are you assessing for this during your examination or intake screening? 

Are the exercises you’re using appropriate for the patient/client? 
I have heard Craig Liebenson, DC often proclaim to train “the hardest thing they do well”.  I apply this same principle to core training in the presence of diastasis.  I would define ‘well’ in this case as with control of the diastasis.  Below are three images:  1) Core at rest with prominent rib flare.   2) Core activation that is relatively high threshold for this patient; diastasis clearly present.  3) Controlled core activation without diastasis.  I have intentionally narrowed the view so it is unclear what exercises were used in pictures 2 & 3.  Why??? Because it doesn’t matter.  The appropriate level of challenge will differ for each individual, it is your job as a skilled rehab or fitness professional to select the right one.

At times soft tissue mobilization/reduction of fascial restriction can facilitate progress once the appropriate exercise is selected.

I tend to like the control that can be gained in the 3.5-4.5 months supine progression and may use ‘wall bug’ or vertical foam series to challenge the core control.  (See video below.)

At rest

 

With high load exercise

 

Controlled Core Training

 Please note: These photos were taken 1-2 minutes apart.  This does not represent training effect, but should clearly display an appropriate level of training for the individual.  While the goal is to promote function, independence and activity in the individual, the aim regarding the diastasis is that with repeated challenge (training within the functional range) that it becomes smaller, resolves, and/or can handle a greater abdominal challenge. This does typically take time (6-12 months or so).

 

Other diastasis posts:

Dr. Jeff Cubos: Diastasis recti

Dr. Jeff Cubos: Diastasis recti… again

What NOT to do (Thanks to Dr. Oz): http://www.doctoroz.com/pregnancy-videos/baby-belly-workout
The role of rib position/mobility and diaphragm cannot be ignored.  Good video here with training in 3.5-4.5 month position beginning at 3:45, the breathing work before that is valuable as well:

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Comments

  1. Great article on Chiropractic.