Diastasis Recti
How Pilates can help cure it
Maya Epstein
Los Angeles, CA
BASI Training 2015
Abstract:
Diastasis recti (also known as abdominal separation) is commonly defined as a gap of roughly 2.7 cm or greater between the two sides of the rectus abdominis muscle. This condition has no associated morbidity or mortality. The distance between the right and left rectus abdominis muscles is created by the stretching of the linea alba, a connective collagen sheath created by the aponeurosis insertions of the transverse abdominis, internal oblique, and external oblique. In pregnant or postpartum women, the condition is caused by the stretching of the rectus abdominis, and by the growing uterus. It is more common in women that have more than one child due to repeated episodes of stretching. When the defect occurs during pregnancy, the uterus can sometimes be seen bulging through the abdominal wall beneath the skin. Women are more susceptible to develop diastasis recti when over the age of 35, who have had a child with high birth weight, multiple birth pregnancy, and multiple pregnancies. Additional causes can be attributed to excessive abdominal exercises after the first trimester of pregnancy. The condition can also happen to men, and small children, but is definitely more common in postnatal women. The majority of cases can be corrected or greatly improved through a specific and conscientious exercise routine. Pilates is an ideal program for women experiencing Diastasis Recti due to the precise training and focus on transverse abdominis (TA) strength. In my paper I will discuss how Pilates can help minimize the separation in a very safe and healthy way.
Table of Contents:
Title Page…………………………………………………...Page 1
Abstract Page……………………………………………….Page 2
Table of Contents…………………………………………...Page 3
Anatomical Description…………………………………….Page 4-5
Case Study………………………………………………….Page 6-10
Conclusion………………………………………………….Page 11
Bibliography………………………………………………..Page 12
Anatomical Description:
Diastasis Recti occurs as a result of excessive intra-abdominal pressure or loading, and is common in the later stages of pregnancy. It occurs in the abdomen and relates to the abdominal muscles. During Pregnancy the rectus abdominis muscles can end up separating due to internal pressure and growth of the fetus. The rectus abdominis muscles run parallel to each other and lengthwise along your abdomen. The diagram below shows a normal Rectus Abdominis, compared to a separated Rectus Abdominis (Diastasis Recti):
The Linea Alba (connective tissue) also separates and thins which reduces the support of your organs and overall trunk stability.
The majority of cases can be corrected or greatly improved through a specific and conscientious pilates routine.
Case Study:
Alyssa has two sons, ages 5 and 2, and after her second pregnancy she discovered that she had diastasis recti. She had no idea what it was and was in complete shock that her doctor did not know that she had it. Moving forward, a couple of months later, she joined a pilates studio in Westlake Village called Daily Breath Pilates. Alyssa has trouble feeling her abs working right behind her belly button and finds that when she is exercising a lot of the work is going into her lower back creating a lot of back pain. Her TA(transverse abdominals) are weak so it is not helping her bring her abdominal muscles closer together creating the back pain. We need to get her TA stronger so that she can start rebuilding her abdominal wall. I take classes with her at Daily Breath Pilates and the owner of the studio Renata has been wonderful with Alyssa in regards to helping her get rid of the gap in her abdominal wall. I observed Renata while she worked with Alyssa during a couple of her private sessions. After a lot of observation I came up with a great workout for her. The exercises I have listed below will provide Alyssa with a routine so that she can rebuild her strength and flexibility while also protecting her Diastasis Recti.
BASI Block System
Warm Up
● Roll down 3-5 to start and get your body moving
● Pelvic Curls
● Supine spine twist
● Chest lift
● Chest life with rotation
● Leg lifts/Leg changes
Foot Work on the Wunda Chair
● Parallel heels
● Parallel toes
● V Position toes
● Open V heels
● Open V toes
Footwork on the Wunda chair is especially beneficial for establishing trunk stability while working your core.
Abdominal Work on the Avalon Chair
● Roll up
● Mini Roll Up
● Mini Roll Up with Oblique emphasis
Hip Work on the Avalon Chair
● Frog
● Circles Up
● Circles Down
● Leg Openings
● Extended Frog
Spinal Articulation on the Reformer
● Bottom Lift
● Bottom Lift with extension
● Short Spine – be very careful and don’t flare your ribs when going up on the lift. It’s a great exercise to work on muscle activation thru the entire body without overworking the abdominal muscles.
Stretches on the Reformer
● Standing Lunge
● Side Split
Full Body Integration on the Reformer
● Scooter: Maintain Lumbar Flexion and the C-curve of the spine. Focus on hip disassociation and pelvic stability. Avoid elevating the shoulders.
● Knee Stretch Series: The knee stretch series provides a place to use the abdominals and focus on the in phase drawing the carriage in using your abdominals. Round Back and Flat Back will help develop trunk stabilization.
● Elephant: Great for trunk stabilization.
Arm Work on the Reformer
● Arm Supine Series: Extension, Adduction, Up Circles, Down Circles, Triceps
● Shoulder Push: Engage back extensors throughout and reach elbows out to sides as they bend. Make sure to establish scapular stabilization prior to movement.
● Shoulder Push Single Arm Work: Great for scapular control working with the trunk stabilization.
Leg Work
● Hamstring Curl: Keep back extended and abdominals engaged throughout movement while maintaining hip extension.
● Single Leg Skating: a great exercise to work on pelvic and lumbar stabilization.
Lateral Flexion/Rotation
● Mermaid: To increase spinal mobility and develop oblique abdominal and shoulder control.
● Side Over on Box: When doing side overs you need to focus on keeping abdominals in and moving body on same plane. The side overs are a good place to work on lifting your pelvic floor.
Back Extension on Wunda Chair
● Swan Basic
● Swan on Floor
-Roll Down to complete workout
Conclusion:
Alyssa does Pilates 3 days a week now and her gap is almost closed. She is working extremely hard and loving every second of it. She has really noticed a change in her body, especially in her diastasis recti after doing the exercises that I have put together for her and by using the different apparatuses. Her transverse abdominals have really strengthened and she has started to heal her connective tissue. Pilates is incredible and provides a wonderful environment for rebuilding your body’s alignment and really gaining strength. The majority of diastasis Recti cases can be corrected or greatly improved through a specific and conscious exercise routine. Pilates is such an ideal program for woman experiencing Diastasis Recti due to the precise training and focus on transverses abdominis strength. Alyssa is extremely pleased and so much happier with her body now that her abdominal wall is starting to form back to the way it used to be.
Bibliography:
Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts Science International, 2013.
Isacowitz, Rael. Pilates: Your complete guide to mat work and apparatus exercises. Champagne, IL: Human Kinetics, the premier publisher for Sports & Fitness, 2006.
Johnson, Traci M.D. Webmd.com: Abdominal Separation (Diastasis Recti). September 16, 2014.
Long, Robin. Thebalancedlifeonline.com: Pilates and Diastasis Recti. September 22nd, 2014.
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