Understanding the bulge
Diastisis Recti (DR)is the stretching of the connective tissue, Linea Alba, that runs down the centre of the abdominals, clearly discernible on the torso of well honed, Thor-like folk. Regardless of whether or not you can see it with the naked eye, it is there on all of us; a band of strong, yet stretchy, fibrous connective tissue. It acts as an attachment site for all of the abdominals; the rectus abdominals (six pack), oblique muscles in your side and the unsung hero of this blog – the Transverse Abdominals muscles.
Although DR is a very common condition in post-partum women, it is also pretty prevalent in men too. Who knew that men could get separation of the abdominals? The rest of this blog is focussed on men presenting with DR although much of the information will still be relevant to females with the condition.
What does it look like?
The most common DR presentation I see in my classes and one-to-one sessions, is the ‘Beer Belly’. An extended abdominal area, often very hard to the touch and out of proportion with the rest of the body – or indeed the amount of beer being consumed. When lying on the mat, there is often a clear doming/coning of the abdominals, which is accentuated when intra-abdominal pressure is increased i.e. when doing a sit up or crunch. In some cases it almost looks like an Alien film – a large rugby ball shaped trench, with a very definite something protruding from it.
What causes DR in men?
DR is caused by too much pressure on the abdominal wall, causing the connective tissue of the linea alba to stretch to the point it can’t return, thus allowing the abdominal walls to separate.
Obesity is one of the leading causes of DR as the excess fat deposits put additional pressure on the abdominals making them stretch farther and farther – if the pressure becomes too great the linea alba, which is weaker than the muscle tissue itself, becomes the path of least resistance and may become compromised, unable to do its job of providing stability to the torso and spine and compressing the organs of the abdominal cavity.
Poor exercise technique is also another major contributor to DR in men. In order to understand this you need to delve a little bit deeper into the anatomy of the abdominals. You have four abdominal muscles, the most superficial muscle is the rectus abdominal muscle, often referred to as the six-pack muscle and very often, the most over worked muscle of anyone trying to get a toned, flat stomach. On the side of the body there are the external obliques and under them, the internal obliques. The deepest abdominal muscle is called Transverse Abdominal (TVA) and is the muscle that we really focus on in Pilates. This muscles connects the breast bine, under the ribs, to the pelvis, around the waist and attaches onto the fascia of the lumbar spine. It is big and powerful and is crucial in providing a stable core. If the very centre I weak, nothing else can be strong.
The TVA muscle contracts to help create intra-abdominal pressure (think pneumatic suspension on a Landrover Discovery), which can be very useful when we need to stabilise the spine or pelvis etc, however, if there is too much intra-abdominal pressure on a regular basis, this will push outwards onto the abdominal wall, gradually causing a separation of the muscles. If the wrong exercise techniques are used, such as during crunches (you should exhale as you curl up), sit ups, planks and push ups, the pressure may increase to the point that more harm than good is being done. This links quite closely with another cause of DR…
Poor posture. The body isn’t designed to sit, slumped at a desk or in a car for most of the day. This forward slouching position can lead to muscular changes that can have a greater than expected impact on the body. I really could go on for hours about how slumping at a desk leads to tight hip flexors, which in turn leads to weak gluteal muscles, which leads to lumbar spine and knee issues, which can cause lasting detrimental changes to our skeleton, however, I will save that lecture for another day. Needless to say, posture also plays a vital role in staying healthy.
Symptoms
· A visible or palpable gap, wider than two fingers width along the centre line of the abdominals.
· A bulge may be visible from the gap, particularly when intra-abdominal pressure is increased – i.e. during a crunch.
· The bulge may even be apparent when coughing, sneezing or going to the loo.
· Constipation and urinary incontinence can also be a symptom.
· Balance may be compromised due to the lack of core stability.
· Strain on other parts of the body, which will be straining to make up for the lack of core strength.
· Lumbar and mid back are common complaints and pelvis/sacroiliac joint pain.
Now what?
Firstly, make sure you’re not doing anything to make it worse. Stop all crunches, sit ups, planks and push ups or anything that causes increased abdominal pressure, further stretching the connective tissue between the tummy muscles.
I would always advise seeking the advice a of your doctor or a professional such as a physiotherapist before you go any further.
If this isn’t an option for you here are a few exercises you can try at home. They’re not the most exciting but they are focussing on the very deepest abdominal muscle, the TVA.
Exercise 1
Lie on the floor with you knees bent, heels under your knees, Try and establish a ‘neutral spine’, you might need a pillow to keep your neck neutral, rather than having your chin poking up to the ceiling, Take a deep breath and on the exhale, try and draw the pelvic floor muscle up towards the belly button, whilst pulling the tummy button down towards the spine. Exhale fully whilst drawing in and down with pelvic floor and TVA muscle. You are aiming to feel quite a deep, intense contraction predominantly around the belly button area.
Exercise 2
Once you have found this connection, you can use this muscle for this next move. Still lying on your back, draw the abdominals down and the pelvic floor up, take your arms up to 90 degrees so your figures are pointing at the ceiling. Take an inhale here and on your exhale, gently lower the arms behind you, only so far as you can go without your ribcage lifting away from your hips, back ribs lifting off of the mat and the spine extending. In short, your arms are trying to make your spine move and your TVA muscle is contracting strongly to prevent any movement. Ensure your breath matches your movement, inhale to prepare and exhale as the arms go back (most people get their arms to their ears, not all the way to the floor.
If you are still unsure, please give me a shout and we can have a chat, or you can book a one-to-one with me via the bookings page of my website.
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