Can we talk about diastasis research?

Dear Diastasis Community-Can we talk about diastasis research? 

Recently, I returned to school to pursue my DPT (a clinical doctorate in physical therapy). My middle schooler and high schooler have assured me that it can’t possibly be as hard as what they are studying, so I am not allowed any whining. Which sucks because Pharmacology is officially kicking my butt.  Though I am not here to whine, I am here to share the eye opening results of a recent assignment. I was asked to develop a question one might ask within my area of interest and develop a variety of online scientific research search strategies to locate relevant articles. I chose to look at the diastasis research.

My question: How effective are exercise programs for diastasis recti recovery?

No matter how I manipulated the search strategies I came up with only about 17-18 diastasis research articles with quite a bit of overlap between searches. Of those, only about 8-10 articles actually addressed the question in one way or another. The not as relevant articles that kept popping up included a few on the surgical procedures for diastasis. One I reviewed actually noted:

 

“..there was insufficient evidence to recommend exercise or physiotherapy

programs as a means of preventing or treating rectus diastasis.”1

Say What?

Before we get our knickers in a twist about their bias towards surgery over exercise based programs, the reality is that statement is accurate. In a systematic review by Benjamin et al (2014) published in a very pro-therapeutic exercise journal called Physiotherapy, they parsed the available literature down to 8 studies.  They indicated it was hard to draw conclusions from them because of the low quality of the studies, and the differences in measurement tools, what they measured, the specificity of the exercise program, etc. So much so their conclusion was:

 “Due to the poor quality of the current literature, current evidence suggests that non-specific exercise may or may not help to prevent or reduce DRAM during the ante- and postnatal periods.”2

 

Wow. “May or may not” is not a huge vote of confidence.

Now for those of us who have been at this for a while, this isn’t actually surprising. I mean the language is a little in your face when they put it that way, but we know that these kinds of needs are under-represented in the literature. In working toward my doctorate and heading in a new direction, I hope to be a female researcher asking questions about and for females to help fill some of those huge blind spots in the literature. However, we are a long way off.

Wait, What?

But here is the truly eye-opening part, that reveals a different kind of blind spot. Just for funsies, I googled diastasis AND exercise. I got over 950,000 results.

via GIPHY

That should stop you in your tracks. Helping women recover from pregnancy is now a big business, and loads of folks are jumping on the bandwagon. I am not here to point fingers or cast doubt. But that number is so out of proportion with the amount of research we have. It is staggering and a bit disconcerting actually.

 

I have written about misrepresentations of research before (100% of Women Have Diastasis?.…please read beyond the abstract folks) and concepts that have become urban legend and perpetuated by gurus and newbies alike ( Can We Talk About Planks? they are NOT a no-no for everyone, no matter who tells you that they are. To Brace or Not to Brace….they are NOT a yes-yes for everyone, no matter who tells you that they are. Don’t Make Me Come In There….just don’t). Please take care before you post, folks (or make an online course/product). Consider a full read of the literature (it won’t take long…it’s just 8 articles) before you tell folks how YOU recovered or how you taught your wife or a couple of friends to recover from diastasis as a blueprint for everyone else’s recovery. That’s not how this works.

Now What?

In my search there was a ray of sunshine. Recent diastasis research and clinical momentum is moving us away from measurements of the gap between the sides of the abdomen (the inter-recti distance-IRD) and towards an understanding of the role of the fascia that binds the two sides together (called the Linea Alba-LA) as our metric for successful rehab³. The ability to create tension again over the fascia helps the sides of the abdomen communicate with one another to coordinate their ability to control the trunk and pelvis during function and fitness. This return of tension can also help reduce the IRD, but the gap doesn’t always return to baseline measures. Our focus clinically now is to recreate coordinated function in the abdominal wall (through integrated relationships with Diaphragm and Pelvic Floor), tension in the fascia, and integrated control of the center in function and fitness as measures of success. The key is how well your abdomen is functioning as a part of the whole picture versus just how wide is your gap (More on that here).

But we don’t have much diastasis research into the function of the abdominal wall with DRA within activities to help us build better programs. Until now! Cue the sunshine!! In a study by Hills et al (2018) they looked at abdominal wall function for women with and without DRA one year after their first delivery4. They used the standards set by Beer et al to set their line in the sand for who had a “diastasis” and who did not5. Women with a gap larger than 2.2 cm at two measurement points (immediately above the navel and one other point) were considered positive for DRA. The mean values for those with DRA ranged around 2.2-2.7 cm, while the non-DRA group had gaps in the range of 1.3-1.6 cm. These are not big DRAs, nor a big difference between groups, in fact both groups fall into the range found by Beer et al that exists in women that have never had children. Nonetheless they did find a significant difference in the ability of the women with DRA to generate trunk rotational torque and to perform a sit-up test.

I see rotational deficits for a strong majority of my postpartum female athletes (and those that have never had kids), so this result didn’t surprise me. However, one caveat, the non-DRA group spent 39% more time on weekly exercise than the DRA group, but the types of exercises they did weren’t specified. The authors did some statistical analysis on this time-spent-exercising variable and noted that, though there was a big difference, it didn’t impact their result statistically. However, I’d like to know more about the exercise activities the non-DRA group did to determine if it prepared them better for the rotational testing or sit ups. If everyone tested were runners, and the non-DRA group just ran for a longer time than the other group each week, then I get how that wouldn’t impact the result. But if part of what they did in their exercising was a lot of sit ups, or rotational work for 39% more time, they would have scored better on the tests.

This doesn’t necessarily negate the result. Answering that question would help us understand better what the results mean and how to apply them. Understanding what type of activity that the women in the non-DRA group engaged in will help us know if it threw off the result. OR to put a positive spin, would it show us the way towards the type of exercises that improve both DRA measures AND the function of the abdominal wall?  At the end of the day they had better FUNCTION. If we believe that exercise is part of creating that, don’t you want to know what they were doing? 

Lots to chew on, but a ray of sunshine nonetheless. Thank you Hills et al!  We are starting to ask the right types of diastasis research questions, that is the key. The deeper we dig the closer we get to understanding how best to build programs!

 

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  1. Nahabedian, Maurice. “Management Strategies for Diastasis Recti.” Seminars in Plastic Surgery, vol. 32, no. 03, 2018, pp. 147–154., doi:10.1055/s-0038-1661380.
  2. Effects of Exercise on Diastasis of the Rectus Abdominis Muscle in the Antenatal and Postnatal Periods: a Systematic Review.” Physiotherapy, vol. 100, no. 1, 2014, pp. 1–8., doi:10.1016/j.physio.2013.08.005
  3. Lee D, Hodges PW. Behavior of the Linea Alba During a Curl-up Task in Diastasis Rectus Abdominis: An Observational Study. J Orthop Sports Phys Ther. 2016; 46(7):580-9.
  4. Hills, Nicole F, et al. “Comparison of Trunk Muscle Function Between Women With and Without Diastasis Recti Abdominis at 1 Year Postpartum.” Physical Therapy, vol. 98, no. 10, 2018, pp. 891–901., doi:10.1093/ptj/pzy083.
  5. Beer, Gertrude M., et al. “The Normal Width of the Linea Alba in Nulliparous Women.” Clinical Anatomy, vol. 22, no. 6, 2009, pp. 706–711., doi:10.1002/ca.20836

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26 thoughts on “Can we talk about diastasis research?”

  1. John Ryan, PT, DPT says:

    Great information here Julie! Thank you. Dr. John Ryan, PT, DPT

    1. Julie Wiebe says:

      Thanks for stopping by! Julie

  2. Amelia says:

    Thank you for posting information we can trust! Great article

    1. Julie Wiebe says:

      Thanks for saying that, it is my goal. Julie

  3. Anshul says:

    Very Insightful!
    Take home message- How is the function!
    We as physiotherapist should base our assessment and treatment outcome on function, not on structure.
    Anshul (PT) from Canada.

    1. Julie Wiebe says:

      You nailed it! Thanks for weighing in! Julie

  4. Sheri says:

    Do you have a list of the 8 studies you deemed necessaryfor review? I’d like to be sure I’ve read them all!! 🙂

    1. Julie Wiebe says:

      Please refer to the citation list in the blog. The second study referenced (the systematic review) offers references on the 8 they looked at.

      Thanks! Julie

  5. Bethany says:

    so encouraging to know that somebody like you is getting their phd and asking the right questions to get more reliable and useful research out there on diastasis recti. I have been trying to heal my diastasis for 18 months now, with zero results after working with several different programs and a trainer on it. We need more good research for sure!

    1. Julie Wiebe says:

      We absolutely need more research. Have you pursued this with a physical therapist/physiotherapist? We do have lots of good ideas on how to help!

      Thanks for weighing in! Julie

  6. Lorraine Scapens says:

    Hi Julie this is fantastic, there are just so many businesses jumping on the ‘fix you’ bandwagon that they seem to have made Diastasis a much bigger issue then what I believe it actually is. Over the past 24 months, I see 15 new mums every 5 weeks, I get to assess them all.
    Regardless of birth, exercise and postnatal posture I only see approx 20% of women (around 4-6 weeks postpartum) with a Diastasis greater than 3 fingers and with a depth past the first knuckle. Second-time mums it is only slightly different.
    Yet because women don’t have a DR they are tending to miss out (as they don’t think they need) the essential basic core activations, this is where I feel the problem is.

    1. Julie Wiebe says:

      YESSSSS! One of my favorite things to tell patients is that they don’t have a diastasis.They just need better strategies for how they use their center. If you need back up information about that for clients I have a blog that elucidates the Beer study answering “What is a Normal Diastasis?”, you can send them here:https://www.juliewiebept.com/diastasis/what-is-a-normal-diastasis/ . You and I have been around the social media block for a long time….things have really changed.

      Take it easy Lorraine! Julie

  7. Erin says:

    We will all benefit from your return to academia- appreciate you sharing your research here! Thank you!

    1. Julie Wiebe says:

      Thanks! It’s an exciting new direction for me! Julie

  8. Melissa says:

    Great article! I love the way you write and explain things!

    1. Julie Wiebe says:

      Thank you! Julie

  9. Jennifer Miller says:

    Great post, friend! I’m knee deep in analysis like this myself! Keep up the good work!

    1. Julie Wiebe says:

      DPT buddies! High five from here! Finishing my Pharmacology reading as we speak…or more accurately struggling to stay focused and thought I would check my emails so here I am!

      Take it easy! Julie

  10. Margy Verba says:

    Julie, One of your many talents: thank you for being an amazing bridge between the research world through folks like me (practitioners) all the way to clients/patients — as in your blog is written in such a way it is accessible to all! And thank you for sharing not just the specifics of the research, but also a glimpse into the research world (what gets studied, how it gets studied, how reliably, etc.). Invaluable! I refer everyone to you…I think my colleagues and clients almost groan: oh no, she’s going to tell us again to check out Julie Wiebe:-).

    1. Julie Wiebe says:

      Thanks Margy…I want to be a good reader of research, but also as I enter into trying to do research I am aware how hard it is. Grateful for folks taking the time to help we clinicians do our best for the folks we care for! Thanks as always for your encouragement! Julie

  11. Angie says:

    can you tell me what a rotational deficit is? Is there a quick way to see this deficit?

    1. Julie Wiebe says:

      Hi there,

      Simplified a rotational deficit means that when they do a crunch, for example, they can’t generate as much strength when they do it diagonally (across the body toward one of their hips). So that might be one way to see it or test for it. Thanks for helping me clarify that!

      Hope that helps! Julie

  12. Emily Wannenburg says:

    So much more going on with Postpartum women than just “closing the gap” and I am so appreciative of the light that you shed in each of your blog posts. Ten years ago, I also was on the band wagon of “Close the Diastasis” and all will be well (or at least better)… And, now we know better…That perhaps things were never UN-well in the first place and a great deal of fear was instilled or perhaps things are Unwell inspite of a closed-by-measurement-bu-unsupported DR adn the moms can’t figure out what’s going on with their bodies! In my line of work, my emphasis is on education — help the moms know more about their PP bodies and who to go see if they need more help. So grateful to the many like you, Julie, who help folks like me to better help my clients.

    1. Julie Wiebe says:

      Thanks for chiming in Emily! We are all learning and evolving in our understanding of all this. Just grateful researchers are starting to turn their attention to it. Keep up the good work educating and helping mamas!

      Julie

  13. Stephanie says:

    Thank you for continuing to dig! I’m a mother runner recovering from DR (6 years too late!) and struggle with weird abdominal cramping when turning up the intensity on my runs. No one can figure me out! I follow you and am thankful you keep looking for more information.

    1. Julie Wiebe says:

      6 years isn’t too late!! Your body is resilient! I’m always happy to consult with a local clinician if you need some new eyes on the issues…or if you fancy a trip to LA you can stop by for a consult to see if I can help!

      Take care! Julie

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