Is Diastasis a Disaster?

Grainne Donnelly, a physiotherapist in Northern Ireland specialising in Pelvic Health talks Diastasis with Antony Lo (Physiodetective) on a recent podcast and what role a physiotherapist can play in managing this condition. 

Characteristics of Diastasis are becoming more widely discussed and presented in the media, social media and internet, which is great for improving awareness in the post-natal population, but potentially does feed the fear of the dreaded ‘tummy gap’, ‘ab separation’ or ‘how many fingers fit in the gap.’  

That fear is an overwhelming presenting factor in clinic for most women, however it is important to recognise that it is a completely normal and in fact, necessary effect of pregnancy. Research does tell us that it occurs in 100% of women by 35 weeks’ gestation (put simply – to make room for baby)! It is only an issue if it doesn’t resolve after giving birth and if it compromises the function of the abdominal wall.  

It’s not just about the gap – it’s much more important that we assess the function of the abdominal wall and the tension across the linea alba (the connective tissue between the two sides of the Rectus Abdominus). If a client is able to transfer load across the linea alba without doming or sinking or relying on compensatory strategies then we must question whether the gap is even significant.  

We should be cautious of finding exercises online that promise to ‘close the gap’ or ‘get rid of mummy tummy’ because they will be general exercises that are directed at a population who cannot be generalised. Each pregnancy, birth experience, post-natal recovery is different. Each woman will have been at a very different level of fitness, strength and body awareness before, during and after their pregnancy. They may have just had their first baby, addressing the diastasis immediately after giving birth, or have had multiple pregnancies and be many years post-natal. They will be at different stages of life at the time that they are pregnant. You see where this is going... each woman should be addressing their recovery with an approach that is very specific to them. 

What is the value of physiotherapy in this case? 

There are many videos, instructions, pictures etc available online which you can follow to measure your own diastasis. There is nothing wrong with measuring that gap yourself, although it is very important to recognise that the position you are in when measuring the gap does make a big difference to what you will feel. A physiotherapy assessment can identify whether the diastasis is significant functionally.  

You may have a gap which is functioning perfectly well, and therefore an assessment can ease your anxieties and save you time, effort and anxiety trying to solve a problem which doesn’t exist. If you do have some reduced function, a physiotherapist can also direct you towards suitable exercise rehabilitation to improve the function, address other musculoskeletal factors which may be contributing to the diastasis (eg. Scar tissue release, breathe pattern, pelvic floor function), and advise you with what activities you should be avoiding to ensure you don’t worsen the condition while you work to rehabilitate it.  

There are lots of exercise options, and fantastic exercise professionals out there that can be of great benefit to resolving the condition, and as your physiotherapist I will work with you and with other fitness professionals to ensure you are returning to exercise in the safest way possible, while being considerate of what your goals are – whether that be to simply recover well in the post-natal period and return to day to day activities, or to return to a high level of fitness.  

Often post-natal care is best approached holistically, taking into account your way of life, your goals and what we find clinically. This may involve referring you to other professionals, such as exercise professionals, nutritionists, masseurs... etc if this helps you to improve your recovery. It is important to remember that these approaches can all have a positive influence on improving DR – and often the best results are from a combination of interventions.  

NB: Grainne Donnelly, Emma Brockwell & Tom Goom are currently working on producing the first guidelines for returning to running after birth, of which the first recommendation is that all women should seek a pelvic assessment from a physiotherapist before beginning running training post-natally.