Skip to main content

Why Surgery Isn’t the Answer for Diastasis Recti Abdominus

My latest contribution to the Core Expectations blog:

Surgery is often suggested to repair a Diastasis Recti (separation of the rectus abdominal muscles). My clients often ask me if they are candidates for surgery, and there is both a short and a long answer to this question. The short answer is “unlikely.” In my experience, surgery for a Diastasis is a rare case scenario. 

What determines the small percentage of women who require surgery to repair a Diastasis Recti?

The inability to create any tension in the linea alba with proper core cueing may be a surgical situation – with no functional core support the system is weak and vulnerable to injury – but it is still a long process to say that definitively. 

Here’s the long answer.

If after teaching a client effective cues to recruit the core 4 muscles (diaphragm, pelvic floor, transverse abdominis and multifidi), she is unable to generate tension in the linea alba, more work is prescribed as homework in the hopes that with practice this will improve. Upon reassessment if she is still unable to generate tension with any of the cues provided it is time to insist on a visit to a rostered pelvic floor physiotherapist.

An internal assessment is the most definitive way to assess tone, strength and function of the pelvic floor muscle. A weak pelvic floor muscle will inhibit the ability of the transverse to effectively recruit and create tension in the abdominal wall. A pelvic floor physiotherapist can release any trigger points or scarring that may be causing hypertonicity in the pelvic floor, assess any degree of pelvic organ prolapse, as well as determine which cue truly is best for any particular client. The client is sent back to the trainer, with a follow-up scheduled to assess progress.

Cued dynamic movements may be introduced prior to stationary core 4 movements being mastered, in an attempt to “tap into” any automation that may be happening. A pelvic floor physiotherapist may ask for a year of exercise to say definitively that absolutely no tension is being created in the connective tissue. If tension does improve, the client is able to strengthen the muscles, although this may take a lot of time and effort. Choosing to avoid the commitment to exercise rehabilitation does not make a client “surgical” in my opinion.

The goal of core rehabilitation is to create a functional core: one with both the strength to create and the endurance to sustain myofascial tension that supports everyday movements, as well as exercise. A core may be “functional” with a small diastasis still present. If a client considers surgery at this point, it is often aesthetic and unnecessary from a strength and fitness perspective.

For that small percentage of surgical cases, I feel a tremendous amount of empathy. Surgery is a last resort as by its very nature it can inhibit optimal core recruitment forever. It is not a “fix;” but in rare cases it is the only viable option. Abdominoplasty is a major surgery resulting in scarring and myofascial immobilization. It’s invasive, mentally taxing, expensive, and the recovery is long. A surgically reinforced core is not “strong” by fitness standards; surgeries can fail and pre/post-op core 4 exercise is still a must. You don’t ever avoid the work of core rehab if you truly want to be strong.
The “S” word is a last resort.

Comments

Popular posts from this blog

I don’t have a Diastasis- Why is my abdomen still distended postpartum?

I get asked this question all the time! Here is my answer:
Research has shown that 100% of pregnant women will develop some degree of diastasis recti. A diastasis is a lateral separation in the abdominal wall between the recti or “six pack”, due to a stretching of the midline connective tissue or “linea alba”. Although some diastasis will heal postpartum, in many cases a separation will remain without restorative exercise.
Distention from DR will present as a doming in the midline. Women who heal a diastasis spontaneously or through restorative exercise may still find that their abdomens are distended, particularly after a meal and/or at the end of the day. If there is no diastasis, why is this?
This abdominal distention does not occur in the midline, but rather across the entire abdominal wall. This is due to a weakened hypotonic TVA- transverse abdominis muscle. The TVA is the deepest anterior abdominal muscle, wrapping around the midsection like a girdle, with a left and right side. T…

Day 3 Carb Flush- Ketosis

I am on Day 3 of my pre race carb flush. Here is my food plan for today:
Wednesday:
- Coffee & Banana
<--- Left was my mid day post client meal- chicken chunks, red cabbage and spinach in a white sauce, quinoa.

---> Right was my dinner- raw veggies with homemade mayo, bacon (mmmmm), 2 perogies, edamame.

Tonight I had 1/2 pear, cheddar cheese chunks and 3 thick crackers. O yes and this......

Sangria FTW! :)

I am wrapping up the 3rd and last day of my carb flush. Tomorrow I begin to replenish, Friday is the big homemade pasta dinner we have planned, then Saturday is bean salad and regular program pre-race day. I have completely avoided refined sugar even in my coffee (favouring extra milk over sugar). I will continue this until race day and beyond, now seemingly hyper-mindful of glycemic indexes and performance (from race day to every day!).

The Mississauga Half Marathon Clinic at the Winston Park Dr. Running Room store had its last clinic meet on Tuesday. I loved running with …

Challenges and Strategies with Bodybuilding

It's been 4 months of a solid push 1-2x week in the gym weights to max with my buddy. A few weeks ago I wrote this blog post on the challenges of recovering from the workouts. I am doing my best to keep up with demands of calories and rest to support this program. I am not suffering the extreme symptoms as I was a few weeks ago, although the post workout fatigue on the following day is pretty noticeable.


I have noticed some tendon soreness post workout. My elbows feel as if they have been struck- tender to the touch. I mentioned it to a body building client of mine and she suggested wrapping to provide support as the tendons strengthen with the muscle growth. The only way to make these big improvements is to push the envelope, but I want to train smart, as always! Here is my gimpy exhibition in the gym- wrapped and pushing hard.

I've been able to max at 100lbs once. 90lbs is my new consistent max, with increasing ROM. I tend to cheat to get the reps, and form nazi that I am …