Year 4 of Diastasis Rectus Abdominis

When I started practicing pelvic health, I didn't realize how terrified women were of the dreaded "diastasis." Diastasis rectus abdominis is something that is most commonly seen after pregnancy and is the separation of the abdominal muscles in the middle of the belly, along that line that sometimes turns dark during pregnancy. After a few women came in to the clinic to be evaluated "just in case" with looks of terror in their eyes I realized that this was a big deal to new moms (and some not-so-new moms as well). Much of the time these women didn't even have a separation, but the horror stories on the internet freaked them out enough to want confirmation from an actual human rather than WebMD. They were scared of the idea of a hernia, a surgery, or "making it worse" while they exercised. Seems like a legitimate worry of course. After all it can be scary to feel your belly and feel like there's a big hole.

My non-pregnant belly four years after my last pregnancy. 

For me, it was something that hadn't ever really crossed my mind. I was a healthy person when I got pregnant with my son and while I carried him full term I didn't stop to think about my core for a while. The postpartum depression, nursing, and sleeplessness took precedence over my abs at that time. When I got pregnant with my twins I was too overwhelmed about, well, twins, that again I wasn't worried about it. They were born via Cesarean birth at 38 weeks and I didn't have two seconds to even think about my body. I nursed and pumped for a full year with them, so it wasn't until about 3 years ago when my body became my own again. I have my own body image issues like most women out there, but because I didn't have any pain or problems I just sort of moved past my post-baby belly. I tried to just be grateful for what my body had done for me and stop focusing on how different I looked. 

Mile 7ish of my last marathon -
March 2018

It's only been the past few months that I am experiencing the issues that an abdominal separation can create in the body. The thing is, when I check my separation, it's only 1 fingertip that can fit down in there. (There are about a million videos that "teach" you how to check for it, some are right, some are "eh").  In the world of PT, 1-2 centimeters (about 1-2 finger widths) is considered normal. It's the 3-4 finger separations that are typically more concerning. My problem is actually not the width of the separation, but the depth. It's deep y'all. And the longer I practice Pelvic Health, the more classes I take and books I read the more I realize that it's so complicated. I don't look that bad from the outside but my body is screaming otherwise. The tissues that hold muscles together, that run between muscles and connect things, my fascia, is stretched. And it's not going to just tighten back up. Over the past three years, my body has slowly started to suffer from the fact that my abdominal muscles can't work effectively and my poor pelvis isn't very stable. Up until this year it's done pretty well trying to fake it. Your body does NOT have to be perfect to work well, and up until this year my body was working just fine for the most part. I trained for two marathons (both of them after my babies were born) without any problems. But this time it was different. My body couldn't work overtime just to keep me stable anymore and I had pain every time I ran for months while training for this most recent race, my third marathon. It was a beast. I had pelvic pain and butt pain and back pain and then hamstring pain by the end. Rough. It took me three days to recover. 

Retired marathon shoes

My point here is that now I sort of understand the fear. I didn't before, partly because I felt like "but I'm a pelvic health PT, I will never have that!" I had read articles about it and books about it and learned in classes about it. I figured that since research can't find a big connection between separation and major dysfunction and since I only had about a finger width between the muscles that I was good. However, for me, I am beginning to feel the effects of my abdominal weakness. My body is done trying to compensate for it. I couldn't run another marathon like this. Marathons aren't necessarily my main fitness goal, but I know I'll want do do another one in the future and currently my body isn't going to let me. I am taking things back to basics, trying to teach my body to be strong despite the weakened fascia so that I can safely do things like run. I'll get there, and if I don't I'll look to the next step. I am lucky that I know enough to retrain myself, but probably dumb for not paying more attention to things a couple of years ago. 

Belly taped up to bring the fascia closer to the middle so my abdominals can work better. Sadly this tape doesn't stay on for 26.2 miles. 

Regardless of whether you have a really large separation or just a small little valley, if you are having pain, trouble lifting, urine leaking (no, even when you exercise it's not normal), find a PT to check you out and get you back to functioning correctly. Don't be like me and ignore it and hope for the best, at least not if you have high hopes for staying active in the years to come.  I'm starting over and showing my body the love it deserves after growing three amazing people inside of it. It's frustrating to me that I wasn't more careful and respectful with my body after my babies, but I am fortunate to be an exercise specialist, it's what we PT's do, we make movement better. So I will work on my back, my buttocks, my core, and my pelvic floor carefully, thoughtfully, and with love. If you need help with this, find a PT to help you. You owe it to your amazing body! 

Dr Lacy Kells PT, DPT

Fayetteville's "Physio Down Low"

lacykells@gmail.com
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For more info about our clinic please visit Advanced Physical Therapy Solutions at aptsnc.com