Diastasis Recti: Why Visceral Manipulation should be part of your treatment plan

Diastasis Recti (DRA) is one of the most common concerns I hear about from my pregnant and postpartum patients. There is a ton of scary misinformation on the internet and social media about what you “should” or “shouldn’t” be doing if you have diastasis, ways to prevent diastasis, and whether or not it is too late to “fix”.

The truth is, we don’t have significant evidence suggesting that there are things you can be doing during pregnancy to prevent DRA. In fact, some studies have shown that up to 100% of participants have DRA by 9 months pregnant. This midline separation is a normal compensation as your baby grows. Some trainers and therapists suggest avoiding activities that strain the midline during pregnancy, however we don’t have sufficient evidence to suggest that avoiding those activities will reduce the risk or severity of DRA postpartum, especially in higher level athletes.

From a clinical standpoint, what I’ve observed is that some women do “all the right things” and still have DRA postpartum, while other women come in to see me at 4 weeks postpartum with a very minimal gap left in their midline. I think the risk of significant DRA is multifactorial (age, genetics, lifestyle, etc), but that doesn’t mean we can’t improve DRA if it is present.

I also think it is important to note that evidence has not clearly shown links between DRA and other orthopedic or pelvic health dysfunction, including back pain, urinary or bowel dysfunction, or sexual dysfunction. However, again from a clinical standpoint, many pelvic floor therapists will tell you that we see patients who have pelvic health or orthopedic dysfunction alongside DRA. In my opinion, this is likely because underlying factors (such as pelvic floor muscle dysfunction, poor pressure management strategies, generalized weakness, etc) are at play in both DRA and these other syndromes.

Does diastasis recti need “fixed”?

This is an interesting question, but I think ultimately the answer needs to be individualized and there are a few things to consider.

1) Does it matter to the patient? For many of my patients, DRA is bothersome and something they want to work on. If it is important to them to address, it is important to me.
2) Do they have other symptoms? As I mentioned above, oftentimes we see patients who have DRA and other symptoms, but there are certainly women who come to see me for DRA that don’t have any other symptoms. Either way, we can likely work on whatever they have going on alongside improving their DRA, since both likely have pressure management, strength, and nervous system components contributing to them
3) What is their linea alba tension like? When looking at DRA, traditionally most people look at the “gap”, or the distance between the two sides of the linea alba. However, it is also important to assess the strength of the linea alba. The linea alba is connective tissue, and although it may remain lengthened postpartum, it can still get stronger. Good tension in the linea alba is really important for overall core strength and function.

What can I do about diastasis recti?

First, it is important to establish good pressure management strategies and improve strength. Check out this blog post to learn more about exercises for diastasis recti.

What I want to dive into more in this blog post is why visceral manipulation should also be a part of your treatment plan. I was lucky enough to take VM1-3 through the Barral Institute with instructor Brandi Kirk. Brandi is both a pelvic floor therapist and an expert in Visceral Manipulation, and has combined these skillsets to study the effects of visceral treatment on diastasis recti.

In this study released in 2020 conducted by Brandi and her colleague Teresa Elliott-Burke, they took a retrospectrive look at 3 patients who presented with DRA and assessed the effects of VM on the gap in their linea alba. The study showed that all 3 participants had improvements in their DRA, as well as reduced pain and improvement in pelvic health symptoms, following 4 visceral manipulation treatments that lasted for 6-16 months.

Although the study did have some limitations (such as a small sample size, using finger width measurements vs ultrasound, and the patients receiving additional treatment after the first 4 sessions that may have helped hold the DRA improvements), it is a great starting point for understanding how reducing tension in the small intestine and mesenteric root can help reduce strain on the linea alba that may be contributing to DRA.

I have personally been using these techniques for several years in my practice now, and I consistently see immediate and lasting improvements in my patient’s linea alba following treatment. Visceral Manipulation is very gentle, and can improve many other symptoms such as back pain, constipation, urinary dysfunction, and more!

If you have diastasis recti, I highly recommend finding a Barral trained provider and trying a few sessions of visceral manipulation alongside your exercise or pelvic floor therapy program! If you are local to the Memphis area, you can schedule an in-office appointment with me here.

Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS, PCES