3 Steps To Self Examination of Diastasis Recti

Ask about your abdominal diastasis the next time you see a doctor for a post-pregnancy follow up. Diastasis recti, also known as abdominal or stomach muscle separation, is a common condition after pregnancy.

During pregnancy, the stomach muscle is stretched as the womb grows. After giving birth, a palpable gap can be felt between the borders of the superficial abdominal muscles, i.e. Rectus abdominis, and the stretched connective tissue of the abdominal muscle, i.e. linea alba. The likelihood of the gap closing naturally over time depends on multiple factors: age of the mother, number of pregnancy, whether it was an easy pregnancy or not, fitness condition before pregnancy, etc.

The reason why the muscles, joints, and ligaments are easily stretched during pregnancy is due to the hormone relaxin. It is produced from around 7^th to 10^th week through the rest of pregnancy. The effect of the hormone lasts 1 to 3 months after giving birth. It is during this window period that the abdominal separation is easiest to manage. After 3 months post pregnancy, trying to close the abdominal gap is much harder work either due to internal factors (muscle weakness, muscle memory, postural) or external factors  (baby getting more active, less time to do exercise)

To check your abdominal separation:

• Lie on your back, bend your knees, keep your feet on the ground
• Put your hand above the belly button with fingers pointing towards groin
• Lift your head off the ground and see how many fingers you can fit into the separation

From physiotherapy perspective, one way to reduce the abdominal diastasis (separation) is by exercise. And not just any exercise: Pelvic floor muscle (PFM) and deep abdominal muscle exercise. The PFM rarely works in an isolated way. This means that when the PFM contracts, the deep abdominal muscle is activated too.

The 2 abdominal muscles to focus on are:

• Superficial abdominal muscle, i.e. Rectus abdominis (six pack muscle)
• Deep abdominal muscle, i.e. Transverse abdominis (corset muscle)

Rectus abdominis muscle is 2 bands of fibers that run from the lower rib down towards pubic bone, and are connected to each other by soft tissue called linea alba. Due to this, rectus abdominis is easily stretched and “separated” during pregnancy to make room for the growing baby.

Transverse abdominis muscle fibers encircle the abdominal region, starting on the left of the spine and ending against the right side of the spine. If activated properly, this muscle acts like a natural corset for the body. This is also called the core muscle, which has become popular in Pilates, yoga, and fitness training industry.

The PFM and transverse abdominis usually work together, so by activating PFM the transverse abdominis will contract which supports the abdominal region and lessens the abdominal separation.

PFM exercise is more commonly known as Kegel exercises described by Arnold Kegel in 1948. (http://en.wikipedia.org/wiki/Arnold_Kegel)

To test how well your PFM is contracting on your next visit to the toilet, stop your pee mid flow. The muscle used to do this action is PFM. Or the feeling as if you want to pull your tampon in further. Try to remember this pelvic floor contraction feeling. When you are pulling the PFM up, you will notice the lower abdomen (stomach region below belly button) getting flat. If the whole abdomen is flat, or even hollow, you are probably “sucking-in” your stomach and most likely holding your breath while doing so. This is a common mistake. With some training and body awareness, you will be able to get the correct contraction.

If you think you are doing PFM contraction correctly, go back to the “checking abdominal separation” position:

• Lie on your back with feet on the ground and knees bend up
• Put your hand above the belly button with fingers pointing towards groin
• Pull your PFM up, keep breathing normally
• Lift your head up
• Your separation should be noticeably less compared to when you are not activating your PFM

If the abdominal separation is still the same, it is usually due to weak PFM or overactive rectus abdominis. If you are not sure whether you are activating your PFM correctly, visit your doctor or physiotherapist for a consultation.

Gita Go, BSc (Hons) Physiotherapy (Hong Kong Polytechnic University), Registered Physiotherapist下次做產後檢查時，問問您的醫生有關”腹部直肌分離”吧！”腹部直肌分離”，又稱為腹部或胃部肌肉分離，是一種懷孕後常見的情況。

懷孕時，腹部的肌肉因為子宮生長而拉伸。分娩後，淺層腹部肌肉（即腹直肌）的邊緣和腹部肌肉被拉伸的結締組織（即臍白線）之間會出現一條明顯的間隙。隨著時間，該間隙的自然癒合取決於以下因素，包括年齡、懷孕次數、懷孕是否容易、健康情況等等。

肌肉、關節和韌帶在懷孕期間容易拉伸的原因是由於鬆弛激素的作用。鬆弛激素在大約懷孕第七至十週產生。它的作用在分娩後持續一至三個月。腹直肌分離在這段窗口期是最容易調理的。在產後三個月後嘗試去收復腹部的間隙會更加困難，一是因為內在因素（肌肉軟弱無力、肌肉記憶、姿勢），又或是因為外在因素（寶寶變得越來越活躍，更少時間做運動）。

要檢查你的腹直肌分離：

• 仰卧，彎曲妳的膝蓋，保持妳的腳在地面上。
• 把妳的手放在肚臍的上方，手指指向腹股溝。
• 抬起妳的頭，看看妳能有多少隻手指可以放入間隙。

從物理治療的角度來說，減少腹部直肌分離的其中一個方法是做運動，但不是任何運動，而是盆骨底肌肉(PFM)運動和深層腹部肌肉運動。盆骨底肌肉很少單獨運作，即是當盆骨底肌肉收縮時，深層腹部肌肉同時運動。

我們要留意的兩種腹部肌肉是：

• 淺層腹部肌肉，即腹直肌（六塊肌）
• 深層腹部肌肉，即腹横肌（胸肌）

腹直肌是由下肋骨延伸到恥骨的兩組肌肉纖維，並且由稱為臍白線的軟組織連結在一起。基於這個原因，在懷孕時腹直肌很容易拉伸和「分離」，以騰出空間給胎兒生長。

腹横肌包圍腹部範圍，由脊柱的左側延伸到右側。如果正常運動，它就像一個身體的自然束腹帶。它也被稱為核心肌肉，在彼拉提斯，瑜伽，健身訓練行業中經常會聽到個名字。

PFM和腹横肌經常一同運作，所以激活PFM會令腹横肌收縮，幫助支持腹部範圍和減輕腹直肌分離。

PFM運動通常被稱為凱格爾運動，由阿諾•凱格爾於1948年公布。(http://en.wikipedia.org/wiki/Arnold_Kegel)

要測試妳的PFM的收縮情況，下次如廁時，在小便中作停頓。作出這個動作的肌肉就是PFM。這感覺就像妳將月經棉塞往內塞一樣。儘量記住這個骨盆底部收縮的感覺。當妳拉扯PFM時，妳會注意到小腹（肚臍下方的腹部）會變得平服。如果整個腹部都是平服的，甚至凹陷的，妳可能正在「吸吮」胃部，這很大可能是因為妳在做這動作時正在屏住呼吸。這是一個常見的錯誤。當妳接受了一些訓練和對身體有了意識後，妳就可以做到正確的收縮動作。

如果妳覺得妳可以正確做到收縮PFM的動作，請回到「檢查腹直肌分離」的部分：

• 仰卧，彎曲妳的膝蓋，腳保持在地面上
• 把妳的手放在肚臍的上方，手指指向腹股溝
• 拉扯妳的PFM，保持正常呼吸
• 抬起妳的頭
• 妳的腹直肌分離應該比PFM沒有運動時明顯地減少了

如果妳仍然有腹直肌分離，通常是因為PFM太弱或腹直肌的過度活躍。如果妳不肯定妳是否正確地激活妳的PFM，請向妳的醫生或物理治療師諮詢。

Gita Go，香港理工大學物理治療（榮譽）學士，註冊物理治療師