What is a normal diastasis? One of my favorite things to do clinically is to reassure women that they don’t have a ‘diastasis’. And yes, I just used air quotes (written air quotes, but…not to be sarcastic, instead to ease women’s minds). I love telling them that yes, you have a gap, technically a ‘diastasis’. But the good news is, it is not the kind of gap that we are concerned about. Instead, I let them know that what they are exhibiting is a normal postpartum separation (a normal diastasis), and an imbalance in the way that they are using their central stability system created by the pregnancy, compensations, and habits. Their concerns about the appearance or function of their abdomen can be addressed by re-establishing balance in that system, whole abdominal wall coordination, and restoring tension in the connective tissue inside the gap if needed. In fact they actually may be displaying close to their normal pre-partum gap, but they never tested their own abdomen before pregnancy to determine what their baseline separation/diastasis was.
I have long been an advocate for creating and communicating better definitions, parameters, and messages around diastasis. So much of the challenge around clear and hopeful information is the actual word diastasis. The technical definition of diastasis is “the separation of normally joined parts”. However, the muscular sides of the abdomen are not actually normally joined. They don’t actually touch. The linea alba (LA) is the strip of connective tissue called fascia that runs between them and connects the sides of the abdomen. I tell my patients the LA helps the sides of the abdomen talk to one another during movements so they can coordinate their action. (This is also why our rehab focus is shifting to the importance of restoring tension in the fascia, not simply closing the gap).
I love this picture. It is not a picture of a variety of pathological diastases gaps. These are pictures of variations of normal, naturally occurring functional abdominal gaps.
Many women think that the presence of any abdominal gap means they have a diastasis (pathology), that there should be NO separation. Of course, internet messaging has fed this misunderstanding. Gratefully, that is not how we are designed, we have a gap between the abs, a normal diastasis, for a reason. Let’s think through why there would be a naturally occurring separation. Pregnancy is the most obvious reason…it is what allows up to grow a baby inside a closed space and not crush our organs. That’s wise planning by the Designer to create the capacity to expand out. My other favorite purpose of the gap, that crosses genders and age groups, is breathing! Your abdomen needs give in it to open and close as you breathe. We also all appreciate that gap after a Thanksgiving meal….we gotta make room for the pumpkin pie. That expansion capacity is critical for many bodily functions…be grateful for it the next time you are bloated or have gas! Can you imagine what that would feel like if your tummy stayed taut and there wasn’t a relief mechanism?
A 2009 study* looked at the variation of NORMAL width measured at 3 spots along the linea alba in women that had never had children. They noted a variation of 0-35 mm for the 150 participants.
The ranges measured at each point:
Xiphoid: 0-31 mm
3 cm superior to the navel: 1-35 mm
2 cm inferior to the navel: 0-31 mm
Please note no one had zero at every point. 9 women didn’t have a Linea Alba to measure at the measurement points at the xiphoid and 1 didn’t have a LA to measure at the 2cm below the umbilicus (therefore zeros). Most had their largest separation at about 3 cm above the navel.The fascinating thing to me about this study is that this was done, in part, to contribute to the conversation in the surgical community about whether or not surgical correction should leave some separation.
From the study introduction:
“no consensus has been reached regarding
a feasible and desirable distance of the rectus
muscles after rectus fascia plication”
So please note some gap is “normal” or natural, even up to 3 cm as noted in this study. The key at any size is how well your abdomen is functioning, and how well the sides of the abdomen are communicating wth one another through the gap and fascia. Please note, a smaller gap (≤3 cm) and associated post-partum abdominal and fascial dysfunction may still need rehabilitation. But understand that the goal of your care isn’t to get you to zero gap. Chances are your pre-pregnancy baseline fell somewhere in the study ranges above. And that’s actually great news, you aren’t far off from your normal.
Professionals! As a community we need to keep discussing how to improve both our care for women and how we communicate about “norms” to help reduce fear around the post partum tummy and recovery process.
Ladies! If you have concerns please seek help! Getting help to re-establish whole abdominal wall function and coordination, integrating it with the rest of the stability system, restoring tension in the connective tissue inside the gap, and tapping back into restorative fitness and movement patterns is always a great idea after you have had a baby! These are the goals of post-partum recovery with or without the presence of a normal diastasis.
Stay tuned for more blogs on distinguishing diastasis needs.
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*The Normal Width of the Linea Alba in Nulliparous Women. Beer GM, Schuster A, Seifert B, Manestar M, Mihic-Probst D, Weber SA. Clin. Anat. 22:706–711, 2009.