Two issues with many correlations that are much more widely spread than generally believed
The word “diastasis” comes from the ancient Greek and means “separation”. Diastasis Recti is the abdominal recti muscles’ separation, or at least, that’s the way diastasis is usually described. As a matter of fact, things are a little different – not to say more complicated. If we think about diastasis recti simply as a separation of the abdominal recti muscles, we risk forgetting some important aspects of this situation.
First of all, the separation occurs because of the thinning of the linea alba, which is a strip of connective tissue that runs from your pubic bone to your sternum and keeps all the muscles of your abdominal wall together, that is, recti muscles (a.k.a. six packs), internal oblique muscles, external oblique muscles and the transverse muscle. All these muscles (specifically their aponeurosis) make up the linea alba and enclose the recti muscles like an envelope. So diastasis recti does not only involve the recti muscles, but all the muscles of the abdominal wall and their aponeurosis.
At first sight the problem could be a physicalness matter: our belly is as swollen as during pregnancy and there are no diets or workouts that can reduce it. However, diastasis recti is an altered functional condition that can affect the whole body. It is commonly believed that only women can have diastasis, because diastasis is considered exclusively related to pregnancy. It is well-known that during pregnancy the abdominal muscles get longer and the connective tissue gets thinner and stretches, and we also know that this is a natural adaptation of the female body in order to support the growth of the belly.
However, a recent study confirmed that diastasis recti is also present in men and young people. That means that it can occur for other reasons not related to pregnancy, such as postural and muscular imbalances, intense workouts, overweight or obesity and respiratory dysfunction. That’s the reason why also men, children and nulliparous women (those who have never had a baby) can have diastasis. The study mentioned above, published in 2021 by the University or Zurich, analyzed men and women from 18 to 90 years and came to the conclusion that diastasis recti is present in 57% of the population. Based on this result, the most logical assumption is that many people have diastasis without knowing it. They just confuse the symptoms of diastasis with other issues such as bowel disorders, food intolerances, localized fat and many more.
The symptoms
The most common symptom is the bulging belly. People with diastasis recti complain of “looking pregnant”; the swelling is generally greater in the evening or after a meal. Another visible symptom is the presence of a bulge or a furrow along the midline of the abdominals when lifting up from a supine position to a sited position or while practicing “traditional” abdominal exercises or other sport activities. Other symptoms include pelvic floor dysfunction, difficulties evacuating the bowels, neck and shoulder muscle stiffness. Diastasis recti has also a negative impact on quality of life. It should not be ignored that there’s a very strictly connection between diastasis recti and body image. In fact, body image can be so negatively affected by diastasis and that it can lead to lack of self-esteem, which can even push many women into depression.
How to check for diastasis recti
Ultrasound and CT scan are the best diagnostic systems. Practical way: using hands, or more specifically fingers. Checking for the linea alba and using fingers assesses the distance between the two recti muscles and the depth of the diastasis. It can also assesses the location of the diastasis.
Healing diastasis recti without surgery
There are several non-surgical strategies and methods, many specific exercises which can be practiced and various different training programs. It is also important to learn how to manage the internal abdominal pressure (IAP) during daily life and sport activities.
The consequences of diastasis
Muscular imbalances lead to poor stability and sense of general weakness though the core. Due to muscular imbalances there could be pelvic floor dysfunction, increases in the respiratory rate and in the internal abdominal pressure. The increases in internal abdominal pressure (IAP) can cause hernias: umbilical, hiatal, epigastric and inguinal. On the other side, the consequences in response to discomfort are related to poor posture, “creative” muscular contractions in order to look thinner (such as, sucking the belly in all day long,) negative body image, lack of self-esteem and depression.
The importance of breathing
Based on professional evidence in order to repair diastasis, the first step is fixing breathing patterns and to maintain the results, breathing training has to be maintained consistently. Breathing is not only a simple act of gaseous exchange. It benefits the body by activating breathing pump – i.e. movement of diaphragm that makes intrathoracic pressure–, bringing improvement in spine mobility, fluid circulation, digestion and speaking function.
The title of the first chapter of the famous James Nestor’s ‘Breath’ writes as follows: ‘(Humans are) The worst breathers in the animal kingdom.’ The book states that a few researches discovered humans have experienced deterioration in their breathing quality evolving through the Industrial Revolution. They found 90 percent of us is breathing incorrectly and such failure in breathing generates a number of chronic diseases. Breathing is effected by a load of factors, such as perceived pressure, increased workload, poor posture, poor exercise technique, hormones, menopause/pregnancy and poor diet. Habitual incorrect breathing often eventually leads to ‘Breathing Pattern Disorders(BPDs)’.
Definitions of BPD
Many researchers suggest different definitions of BPD, and among the best ones is Dr. Jessica Rowley’s. She defines BPD as ‘inappropriate breathing which is persistent enough to cause symptoms, with no apparent organic cause’. Symptoms may not affect daily life but may disrupt specific performances, e.g. elite athletes and their performance, singers and voice production, or the child playing Saturday morning sport.
Types of BPD
Below are the classifications of breathing pattern disorders suggested by Boulding et Al (2016).
Hyperventilation syndrome : Related to respiratory alkalosis or independent of hypocapnia
Periodic deep sighing : Usually associated with an irregular breathing pattern
Thoracic dominant breathing : Can manifest more often in somatic diseases
Forced abdominal expiration : Evident when there is inappropriate and excessive abdominal muscle contraction during expiration
Thoracoabdominal asynchrony : characterized by delay between intercostal and abdominal contraction, causing ineffective effective respiratory mechanics
Impacts of breathing pattern disorders on overall health
The best known in BPD is hyperventilation syndrome(HVS), which refers to excessive increases in breathing volume during rest or in exercise and stress situations. HVS causes respiratory alkalosis, which prevents oxygen from releasing into the tissue, it also causes coronary arteries to contract and affects brain blood flow reduction. This inefficient breathing causes the sympathetic nervous system to increase, affecting psychological problems such as anxiety and panic disorder.
In addition, patients with BPD commonly have a thoracic dominant breathing pattern, a characteristic of which inhibits the use of the diaphragm, the main muscle of breathing, and causes excessive tension in the accessory breathing muscles. This causes neck and shoulder pain, and also reduces the mobility and stability of the spine, resulting in back pain.
As mentioned above, BPD can affect the entire body, i.e., biomechanical, biochemical, and psychophysiological, causing a variety of medically problematic diseases, resulting in poor quality of life.
This article is the result of the cooperation and professional dialogue between Chiara De Benedetti and Yusung Kim about the correlation between diastasis recti and breathing disorders.
References:
James Nestor, Breath. Chapter 1. The worst breathers in the animal kingdom. Riverhead Books New York, 2020
Rowley J. The role of asthma, stress and posture as etiological factors in breathing pattern
disorders. 2002, unpublished.
Leon C, Diana B, Christopher G. 2014. Recognizing and treating breathing disorders: a
multidisciplinary approach
Lais Silva V, Celso Ricardo F,, Alex H, Mandy J. Dysfunctional breathing: what do we know? Journal Brasileiro de P.2019;45(1):e20170347
https://www.scielo.br/j/jbpneu/a/NBZcwpX45rBKS5gDbHFLNXr/? lang=en
Gardner WN. The pathophysiology of hyperventilation disorders. Chest. 1996; 109(2): 516-34.
http://doi.org/10.1378/chest.109.2.516
Boulding R, Stacey R, Niven R, Fowler SJ. Dysfunctional breathing : a review of the literature and proposal for classification. Eur Respir J. 2016; 25(141): 287 -94.
Tania C, Janet R. Breathing pattern disorders and physiotherapy: inspiratory for our profession.
W. S. Maney & Son Ltd 2011 DOI 10.1179/1743288X10Y.000000025
Rosalba C, Kenneth M, Marc C,. 2011. Relationships between measures of dysfunctional
breathing in a population with concern about their breathing. Journal of Bodywork & Movement Therapies doi:10.1016/j.jbmt.2010.06.004
Mike T, Anne B, 2014. Breathing exercises for asthma. DOI: 10.1183/20734735.008414
Connections Between Perceived Social Support and The Body Image in the Group of Women With Diastasis Recti Abdominis – Bernadetta Izydorczyk et al. 2021
Women’s experiences of their pregnancy and postpartum body image: a systematic review and meta-synthesis – Emma L Hodgkinson1 , Debbie M Smith2 and Anja Wittkowski1,3* – 2014
Stability, continence and breathing: The role of fascia following pregnancy and delivery D.G.Lee et al 2008 – Butt gripping and chest gripping
Kaufmann RL, Reiner CS, Dietz UA, Clavien PA, Vonlanthen R, Käser SA. Normal width of the linea alba, prevalence, and risk factors for diastasis recti abdominis in adults, a cross-sectional study. Hernia. 2022 Apr;26(2):609-618. doi: 10.1007/s10029-021-02493-7. Epub 2021 Oct 5. PMID: 34609664; PMCID: PMC9012734
