Diastasis Recti

On July 23, 2012, in Lumbar Spine / Core, swimming, by jcubos

Here’s a subtle case of “Diastasis Recti” found in a male swimmer.

He presented with ongoing low back pain, aggravated mostly in the morning upon waking. Aside from pain, he reports stiffness in the low back.

Multisegmental Flexion as per SFMA was FP, Multisegmental Extension was DP, Multisegmental Rotation was FN bilaterally. All other top tier tests were FN aside from the Deep Squat which I did not assess.

SFMA breakouts led me to SMCD findings (primarily with SLR) and DNS IAP tests led me to this subtle, but in my mind significant, finding.

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The summer swim season has now come to a close and OUR goal for the next six weeks is to normalize his SMCD.

The significance of the above finding, especially in this population (male, young adult, athlete) is generally under appreciated as this finding is most commonly found in young babies and post-partum women. Although some will receive surgical intervention, the current thought process is that correction is largely cosmetic.

Not so subtle

In Prague and in the clinics of many practitioners who are DNS-trained, the prevalence of such findings are likely higher. This in my mind, is due to more astute and investigative clinical testing. While I have yet to see any published studies that show a correlative or causative relationship between diastasis recti and low back dysfunction, the Prague School seems correct in their observed relationships between such presentation and acquired spondylolistheses, especially in older, more overweight men.

Notice it once, notice it again and again...

Their rationale, inadequate cylindrical intra-abdominal pressure.

www.rehabps.com

Remember, this athlete is a swimmer and spends much of his time in a relative prone position. And while it may likely be inappropriate to rid him of (hyper)extension, achieving stability motor control in all positions, directions, and movements is a must. I will probably never see the end result 50 years from now, but my goal is for this swimmer to not become a statistic.

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4 Responses to Diastasis Recti

  1. Very interesting. I have observed this in an older, overweight man, but frankly couldn’t quite figure out if it was relevant to his problem (forgetting what it was now).

    I know you addressed this is in a sentence or two, but do you see this as a sign of an underlying pathology, or as a part of the pathology itself?

  2. jcubos says:

    No scientific evidence to back this response up but I think a lack of reflexive, instantaneous, involuntary IAP / stability motor control is an “underlying pathology” in itself. It’s a dysfunction that certainly may not always manifest into a clinical condition but faulty nonetheless.

  3. Andrew Greer says:

    How do you treat a small diastasis? Can you consciously draw in the linea alba while maintaining IAP? Is it impossible to achieve a normal IAP/SMC until this separation of connective tissue is healed?

  4. jcubos says:

    I’m not a fan of drawing but when optimal IAP is established, the DR minimizes. Then you would have to challenge the individual to maintain this IAP with tasks.

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