Diastasis Recti is described as a condition in which longitudinal abdominal wall muscles separate creating a ridge that runs along the length of the abdomen. Occurring quite regularly in women post partum it is caused by prolonged stretch of the abdominal muscles during the pregnancy and birth. Although Diastasis Recti normally tends to heal on its own the shape of the abdomen never quite retracts to the pre-pregnancy form. The degree of deformity may vary from practically unnoticeable to grossly disfiguring and cosmetically disturbing to women. Not widely acknowledged, but it also has significant repercussions to the locomotors system.
Diastasis Recti also occurs in infants and is considered to be a normal condition by the mainstream medicine. This is a vastly outdated misconception however. It has been shown that in infants Diastasis Recti forms as a result of a kinesiologic irregularity and is one of the signs of Central Coordination Disorder (CCD), the condition characterized by disturbed and delayed motor development. The degree of CCD could range from something very subtle that might be missed entirely by pediatricians or pediatric neurologists (due to unfamiliarity of developmental kinesiology) to moderate motor impairment, which makes parents to actually seek treatment, culminating, in the worst case scenario, with Cerebral Palsy.
As nervous system of an affected infant matures the diastasis gets smaller and sometimes even appears imperceptible to an untrained eye. In 30 percent of such children however the Diastasis Recti persists in some form into the adulthood and forms the base of dysfunction of muscles that constitute the abdominal wall. This type of developmental condition causes abnormal position of the rib cage with oblique alignment of the diaphragm and inability to co-contract deep abdominal muscles responsible for healthy breathing and deep stabilization. This results in abnormal breathing stereotypes and decreased spinal stability. These patients are invariably destined to have low back pain and other distressful manifestations in the locomotor system.
Unfortunately the connection between structural abnormalities and subsequent locomotor dysfunction has long eluded the majority of the main stream medicine practitioners. Until recently there has never been any established cross reference between treatment of adult spinal dysfunction and neurodevelopmental disorders. Developmental Kinesiology is a new rapidly evolving branch of medicine that addresses this issue providing physiological and experimental basis for new approaches to diagnostic and treatment of developmental disorders and evaluating their impact on the locomotor system.
Even though the causes of Diastasis Recti in postpartum women may be different from those in an infant, the developing dysfunctional pathology is the same. While, in the immediate term, the main concern for women remains the cosmetic appearance, it must be understood that the condition does have great repercussions eventually affecting the locomotor system in causing a great degree of pain and discomfort throughout the entire body.
Low tone of abdominal musculature is not the sole cause of Diastasis Recti in post partum women. Most commonly it is the outcome of the overall lack of balance between all muscles within abdomen as well as the diaphragm and the muscles of pelvic floor. Another contributing factor could be improper training with the emphasis on the strength of rectus abdominis placing it outside of the abdominal muscle system. Diastasis Recti could also be lingering in the negligible form since the childhood unobserved by the patient. The pregnancy in this case might aggravate the already existing pre-condition resulting in the mechanical failure (tear or separation). If tearing occurs a surgical intervention could be advisable although the damage could be significantly reduced and managed by specific manual stimulation procedures and exercises. Manual stimulation of this kind, when applied to infants with Diastasis Recti, creates ideal coordination of all abdominal muscles and the retraction of the diastasis could be observed within few minutes into the procedure. For years this type of stimulation (Vojta therapy, see Vojta therapy.com) has been practiced in Europe where it is considered a treatment of choice by the mainstream medicine for children with Cerebral Palsy and other neurodevelopmental disorders. In all of these conditions the dysfunctional contractions of abdominal wall and abnormal breathing are inherent parts of the disorder.
The same therapeutic principles and methods can be applied to women with Diastasis Recti caused by pregnancy. Women with Diastasis Recti should completely abandon “abdominal crunches” and other similar exercises that tend to overwork the abdominal wall musculature. Instead they should learn how to relax and practice exercises that activate the entire abdominal muscle system including the diaphragm and the pelvic floor.
The popularity of isolated training of Transversus Abdominis that persists among physiotherapists is also misguided. This muscle is not designed to contract on its own. It belongs to a deep musculature group and deep muscles are controlled differently by the Central Nervous System. Deep muscles are designed to co-contract in concert with other deep muscles. These contractions are automatic in nature and are not under any voluntary control. Transversus Abdominis should be trained with exercises based on the principles of Developmental Kinesiology. The proper coordination of abdominal wall musculature should only be done in conjunction with all abdominal muscles including the diaphragm and pelvic floor. This is especially true in the case of Diastasis Recti. It must be noted however that isolated training of Transversus Abdominis is possible and has a limited application in a certain type of dysfunction which is not the case with Diastasis recti.