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PilatesforDiastasisRecti

ClaudiaSurgison

Date20202019/2020

CapeTown,SouthAfrica

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Abstract

Diastasisrectiisthepartialorcompleteseparationoftherectusabdominismuscles,which

areapairofflat,longmusclesrunningverticallydowneachsidesoftheabdomen.These

musclesarevitalinsupportingthebody’sinternalorgansandstabilisingthecore.During

pregnancythebellyexpandsandtheconnectivetissue(lineaalba)stretchesandbecomes

morerelaxedtoaccommodatethegrowingbaby.Afterbirth,thetissuehealsandthe

musclesrealign.Ifnot,themostnoticeablesymptomisabulge(orpooch)intheabdominal

area.FurthersymptomsassociatedwithDiastasisRectiareconstipation,lowerbackpain,

poorpostureandurineleaking.Theconditionisnotonlylimitedtopregnancyandcanalso

beasaresultofliftingheavyweightsincorrectlyorperformingexcessiveorunsafe

abdominalexercises.

MyclientwasdiagnosedwithDiastasisRectipost-partum.IwilldiscussthePilates

repertoireIdevelopedtorehabilitateandstrengthenedherweakcoreandimproveher

overallfitness.

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TableofContentsAbstract Page2TableofContents Page3AnatomicalDescriptionofDiastasisRecti Page4-5 CaseStudy Page6BASIBlockSystemConditioningProgram Page7-10Conclusion Page11Bibliography Page12

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AnatomicalDescriptionofDiastasisRectiTheseparationoftherightandleftrectusabdominismusclesalongthelineaalbaiscalled

DiastasisRecti.Therectusabdominismuscle,alsoknownastheabdominalmuscle,isa

pairedmusclerunningverticallyoneachsideoftheanteriorwalloftheabdomen.Thereare

twoparallelmuscles,separatedbyamidlinebandofconnectivetissue(lineaalba).It

extendsfromthepubicsymphysis,pubiccrestandpubictubercleinferiorly,tothexiphoid

processandcostalcartilagesofribsVtoVIIsuperiorly.Theproximalattachmentsarethe

pubiccrestandthepubicsymphysis.Itattachesdistallyatthecostalcartilagesofribs5-7

andthexiphoidprocessofthesternum.

Figure1

Thefunctionoftherectusabdominismuscleistoflexthespine,tensetheanterior

abdominalwall,assistincompressingtheabdominalcontentsandprovidesupporttothe

backandorgans.Inpregnantwomen,DiastasisRectiiscausedbythegrowinguterus

pushingagainstthesemusclesandseparatingthem.Hormonesduringpregnancycanalso

causetheconnectivetissuetoweaken.Separatedmusclescannotfunctioncorrectlyto

supportthebackandorgans.

TocheckforDiastasisRecti(Figure2),placetheclientinthepelviccurlposition.Placeyour

fingersjustbelowthenavel,applyinggentlepressurewhilstinstructingtheclienttoliftthe

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headandchestgentlywhileengagingtheabdominals.Moveyourfingerstocheckthebelly

buttonandslightlyaboveaswell.Ifthereisagapofmorethan2fingerswidthapart,thatis

DiastasisRecti.DiastasisRectiusuallyhealsnaturallywithin6monthsofgivingbirth,butcan

persistlongafter.

Figure2

Diastasisrectireducestheintegrityandfunctionalstrengthoftheabdominalwallandcan

aggravatelowerbackpainandpelvicinstability.Manyabdominalexercises,suchas

crunchesandtrunkflexioncannegativelyimpacttheseparation.Theytendtomakethose

musclestighter,pushingthemfurtherapartandstretchingtheconnectivetissueevenmore,

makingitthinnerandweaker.Thefocusshouldratherbeonisometriccontractionofthe

transverseabdominis,whichisourdeepestabdominalmuscle.Thetransverseabdominis

(TVA)muscleactsasastabiliserforourentirebackandcoremusclesorinshorterterms,

ourbody’snaturalgirdle.

Figure3

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PilatesisaperfectwaytostrengthentheTVAmuscle,howevertherearecertainexercises

thatarecontraindicatedfordiastasisrecti.Theseincludeflexion,rotation,backextension,

flaringtheribsoranyexerciseswhichcouldstretchthediastasisrecti.Oncethediastasis

rectihashealed,theseexercisescanbeintroducedintherepertoireaslongasthe

transverseabdominiscanbeactivatedandthereisnobulgingorpoochingoftherectus

abdominis

CaseStudy

Name:LisaPrzybojewski

Age:43

Limitations:Noflexion,rotation,extremebackextension,ribflaringandnoexercisesthat

couldstretchthediastasisrectiandleftshoulderbursitis.

Symptoms:4fingergapanddomelikebulgeinthecentreoftheabdominals,weakcore,

limitedleftsiderotation,stiffthoracicspine,tighthamstrings.

Lifestyle:Lisaisa43yearoldmotherof3children(8,11and13),playsleagueTouchRugby

andworks3daysaweekinherfamilybusiness,whichisofficebound.Sheisofslender,

petitebuild,generallyfitandactive,runsonaregularbasisandplaysleagueTouchRugby.

Lisawasdiagnosedwithdiastasisrectiafterherthirdbabyin2012.Lisawantedastructured

Pilatesrepertoiretohealherdiastasisrectiandimproveoverallstrengthandflexibility.

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ConditioningProgram

Warmup(Mat)

• Breathingcontractions–lyinginthepelviccurlposition,inhalefor5countsand

exhalewhilstcontractingtheabdominalmusclesfor5counts.Thisbreathing

exerciseisolatestheTAmuscleswithoutanystrain.

• Pelviccurl–startwithonlytiltingthepelvis.Tiltthepelvistowardsthenaval,

activatingtheabdominalmusclestopressthelowerbackintothematandthenback

toneutralposition.Followintoafullpelviccurl,concentratingonpelviclumbar

stabilisationandkeepingthebackneutralinsteadofarticulatingonthedownward

phase.

• Spinetwistsupine–engagingtheTA,smallmovementswithnoflaringoftheribs.

• Chestlift–emphasisonengagingtheTAandpelviclumbarstabilisation.

• Chestliftwithrotation–engageTAandpelviclumbarstabilisation.

Week1-5

FootworkontheWundaChair FootworkontheReformer

• Parallelheels Parallelheels

• Paralleltoes Paralleltoes

• Vpositiontoes Vpositiontoes

• OpenVheels OpenVheels

• OpenVtoes OpenVtoes

• Calfraises Prances

• Singleheels Singleheels

• Singletoes Singletoes

FootworkontheWundaChairishelpfulwithhealingdiastasisrectiasitpromotestheco-

contractionbetweenabdominalmusclesandbackextensorsandworkingintheuprightor

seatedpositionputstheleastamountofstrainondiastasisrecti.

Abdominalwork

Forthefirst5weeksIdidn’tfocusontheabdominalblockasmostabdominalexercisesput

toomuchpressureonthelineaalba.Fortunately,allPilatesexercisesinvolvecontracting

thetransverseabdominis,whichindirectlytickstheabdominalblock.

HipworkontheReformer

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• Frog

• Circlesupanddown

• Openings

• Extendedfrog

• Extendedfrogreverse

Boththefundamentalandintermediatehipworkonthereformerareidealforhipstrength

andflexibilityandpelvicstabilisation.

SpinalArticulationontheReformer

• Bottomlift

• Bottomliftwithextension

Focusonnotflaringtheribsandcorrectbreathing.

StretchesonReformer

• Standinglunge

• Poleseries–Shoulderstretch,Overheadstretch,Sidestretch,Spinetwist

Fullbodyintegration

• Upstretch1–Reformer

• Elephant–Reformer

• Thighstretchwithrollupbar–Cadillac

ArmWorkontheReformer

• Armssittingseries–Chestexpansion,Biceps,Rhomboids,Hug-a-tree,Salute

• Armskneelingseries–Chestexpansion,Circlesup,Circlesdown

• Shoulderpush

• Shoulderpushsinglearm

LegWork

• Singlelegskating-Reformer

• Sittingseries(Magiccircle)–Ankles,Belowknees,Aboveknees

• Adductorsqueeze–magiccircle

• Glutealsidelyingseries–Sideleglift,Forwardandlift,Forwardwithdrops

• Legpressstanding–WundaChair

• Lungeforward–WundaChair

• Backwardstepdown–WundaChair

• Hamstringcurl–WundaChair

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• HipOpener–WundaChair

LateralFlexion

• Mermaid-Reformer

• Sidelifts-Mat

• SpineTwist–Mat

BackExtension

Iavoidedanyvigorousbackextensionforthefirst5weeksdoingonlylightBackExtension

andCatStretchonthemat.

Week6–10

FootworkontheCadillac

• Parallelheels

• Paralleltoes

• Vpositiontoes

• OpenVheels

• OpenVtoes

• Calfraises

• Prances

• Singlelegheel

• Singlelegtoes

AbdominalWork

• Standingpike–WundaChair

• Standingpikereverse–WundaChair

• Hundredsprep–Reformer

• Shortboxseries-Reformer:Roundback,Flatback,Tilt,Twist

HipWorkontheCadillac

• Basiclegsprings–Frog,Circlesdownandup,Walking,Bicycles

• Singlelegsupine–Frog,Circlesdownandup,Hipextension,Bicycle

SpinalArticulation

• Monkeyoriginal–Cadillac

• PelvicCurl–WundaChair

Stretches

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• Kneelinglunge

• Sidesplit

ArmWork

• Armsupineseries–Reformer:Extension,Adduction,Upcircles,Downcircles,

Triceps

• Armkneelingseries–Reformer:Chestexpansion,Upcircles,Downcircles,Triceps,

Biceps

FullBodyIntegration

• Scooter-Reformer

• Roundback–Reformer

• FlatBack–Reformer

LegWork

• Hamstringcurl–Reformer

• Frogfont–WundaChair

• Singlelegsideseries–Cadillac:Changes,Scissors,Circlesforwardandback,

LateralFlexion

• Sidestretch–WundaChair

• Sidekneelingstretch–WundaChair

• Sidelift-Cadillac

BackExtension

• Breaststrokeprep–Reformer

• Pullingstraps1–Reformer

• Pullingstraps2–Reformer

• Prone1-Cadillac

• Swanbasic–WundaChair

• Backextensionsinglearm–WundaChair

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Conclusion

After10weeksofbi-weeklyPilatessessions,Lisa’sabdominalseparationwasreducedto2

fingerswideandheroverallstrengthandflexibilityimproved.Herabdominalmusclesareno

longerpainfulaftersherunsandhercardioperformanceatTouchRugbyhasimproved

tremendously.Theisometriccontractionofthetransverseabdominisusedthroughoutthe

repertoireisparticularlyusefultoimprovethiscondition.Initiallyclientsshouldavoid

flexion,rotation,backextension,flaringtheribsoranyexerciseswhichcouldstretchthe

diastasisrecti.Theseexercisescanbereintroducedoncethetransverseabdominisactivated

withoutpoochingorbulgingoftherectusabdominis.Manywomenfollowexerciseregimes

post-partumthatdeterioratestheirDiastasisRecti.Ifuntreateditcouldrequiresurgeryor

leadtofurtherproblemslikeconstipation,lowerbackpain,poorpostureandurineleaking.

Diastasisisnotonlycausedbypregnancybutalsofromunsafeabdominalexercisesorlifting

heavyweightsincorrectly.TheconsistentpractiseofPilateshasprovidedasafeand

effectivewaytorehabilitateDiastasisRectiandimproveoverallwellness.

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