Using Pilates to Correct Diastasis Recti in Men

Doris Joukhadar

October 14, 2016

Course year: 2015

Pasadena, CA

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Abstract Diasrasis Recti, a condition mostly known to affect postpartum women, is a problem that

can affect anyone including men, children and even newborn.

A diastasis recti is the separation of the outer abdominal muscles, the Rectus Abdominus.

These muscles support the back and organs. When the RA separates, the connective

tissue, Linea Alba, is stretched out and becomes thinner.

These weak muscles reduce the support of organs, back and trunk stability and cause

many problems including a gap in the mid-abdomen, a bulging pooch, low back pain and

poor posture.

The majority of cases can be corrected or greatly improved through a specific and

conscientious exercise routine. Pilates is a great approach due to its abdominal focus. The

Basi repertoire offers a variety of core strengthening exercises targeting the rectus

abdominus and trunk stability in an effective and safe manner, avoiding movements and

actions that cause the stomach to protrude forward.

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Table of contents

Abstract................................................................................................... 2 Anatomy of abdominal muscles.............................................................. 4 Case Study.............................................................................................. 5 The block system……………………………………………………….7 Conclusion.............................................................................................10 Bibliography...........................................................................................11

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Anatomy of abdominal muscles

Rectus Abdominis: the “6 pack muscles” that run along the top of belly.

Transverse Abdominis: deep core stabilizing muscles acting as a corset around waist and spine.

Linea Alba: white fibrous band that runs vertically along the center of the anterior abdominal wall and receives the attachments of the oblique and transverse abdominal muscles.

Diastasis Recti: vertical separation of the rectus abdominus/connective tissue – Figure A

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Case Study:

• Client is a 68-year-old man, Leonard.

• He’s slightly overweight. He used to exercise 4 to 5 times a week (walking and

weight-lifting).

• Diastasis Recti (separation about 4 fingers) and abdominal hernia that bulges out

when in flexion and muscles are contracted.

• He wanted to try Pilates to minimize the separation and prevent surgery.

Diastasis recti is a condition that can affect anyone not only postpartum women. In

women, the most common cause of diastasis recti is pregnancy. The growing fetus and

uterus put pressure on the abdominal muscles causing them to stretch and separate.

In men, it can be caused by rapid weight gain, weightlifting, or some wrong abdominal

exercises.

When someone suffers from diastasis recti, the rectus abdominus is separated

sideways (gap of 2 or more fingers) causing the joining tissues (Linea Alba) to thin out

and stretch. The most notable symptom is a bulge in the stomach. This bulge is caused by

weakness and separation of RA, and it is more noticeable when you strain or contract the

abdominal muscles (when in flexion). In advanced cases, this condition might cause

abdominal hernias, lower back pain and poor posture.

My client Leonard’s DR was caused by his rapid weight gain. The gap started about

2 fingers wide but his heavy incorrect weightlifting aggravated his condition, caused a

bigger separation and even caused a hernia. He wanted to prevent surgery, and was

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cleared by his physician to start Pilates.

It was crucial to make sure he does the exercises correctly and avoid the movements that

cause his stomach and hernia to bulge forward such as:

• Forward flexion of the upper torso

• Upper body flexion with rotation

• Extreme back extension

I also had to modify some of the exercises and use some accessories such as the

large ball, resistance band, arc barrel and a wide band around the belly.

Another important aspect we focused on was his breathing. He learned the

difference between the regular diaphragmatic and the Pilates lateral breathing. This

helped him maintain his abdominal muscles contraction during the exercises, which in

turns help with the stabilization of the trunk.

We avoided the Roll-Down the first few sessions. Around the 4th session, I modified

by having his back to the wall, feet apart with bent knees, focusing on coordinating his

breath to the movement, and actively pulling the abs in. Around the 10th session he was

able to perform regular roll-down.

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The Comprehensive Block System:

I used the Basi repertoire (mat and different apparatus) and followed the block system

combining exercises from the fundamental and intermediate levels. Here’s an example of

some of the appropriate exercises that I used:

• Warm up:

- Pelvic curl (we modified and performed it standing against the wall the first

few sessions)

- Spine Twist Supine: using the large ball under his knees to give him more

support.

- Chest lift sitting on foam roller or box (avoiding chest lift with rotation)

- Leg lifts/ leg changes

• Footwork:

- Parallel heels/ toes, V position toes, Open V heels/ toes, Calf raises and

Prances.

- Single leg heel and toes.

- When using the Reformer and Cadillac, I had him use a wide band across his

abdomen. I helped him connect the movement to the breath by pulling on it

with every exhale, actively pulling his RA closer together.

- Footwork on the Wanda chair is very beneficial because it emphasizes more

trunk stabilization in addition to focusing on the hamstrings and quadriceps.

• Abdominal work:

- Reformer Short box series: round back/ flat back Tilt and Twist

- These exercises help strengthen the abdominal muscles while he’s in a sitting

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position and avoiding excessive flexing.

- Chest lift and Reach on Spine Corrector.

• Hip work:

- Reformer: frog, circle up/down, openings

- Cadillac single leg Supine series (frog, circles down/up, hip extension and

bicycle) was also very useful in helping him focus on his pelvic lumbar

stabilization and coordination.

• Spinal Articulation:

- Bottom lift on the reformer (after about 10th sessions)

- Mat spine stretch

- Pelvic curl on Wanda Chair.

• Stretches:

- We just used a resistance band to help him stretch his hamstrings and

eventually moved on to the standing lunge on the reformer.

- Shoulder stretch 1 and 2

• Full Body Integration:

- Scooter (Knee stretch group)

- Up stretch 1

- Elephant

• Arm Work:

- Reformer Arm sitting series (chest expansion, Biceps, Rhomboids, Hug-a tree

and Salute)

- Cadillac arms standing series and the Ped-a-pul arms standing/ sitting series

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are practical and help avoid extended supine positions.

• Full Body Integration:

- After 10th sessions, I started adding more FBI exercises such as Sitting

Forward and Side Reach on Cadillac.

• Leg Work:

- Leg press standing (Wanda chair)

- Magic circle sitting series: Ankles, below knees and above knees.

- Gluteals kneeling series: hip extension bent knee/ straight leg and hip

abduction bent knee.

• Lateral Flexion/ Rotation:

- Side lift on Spine Corrector.

- Side over prep on Step Barrel.

- Side Stretch and Spine Twist (Pole series sitting on large ball)

- I avoided giving him Obliques strengthening exercises and focused more on

stretching and releasing them.

• Back Extension:

- Mat: Back Extension and/or Cat Stretch

- Reformer: Breaststroke prep (long box).

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Conclusion:

After working with Leonard for more than 6 months, with two sessions every week

he noticed a big improvement and the gap was reduced to less than 3 fingers. His

Diastasis Recti did not heal completely because his case was severe and advanced but he

was able to avoid surgery. Pilates also helped him learn how to engage the right muscles

not only during his workout but with his daily activities as well.

The Basi Pilates method offers a variety of exercises that focus on strengthening the

Rectus Abdominis minimizing the separation and easing lower back pain.

The vast repertoire offers many exercises that put emphasis on the abdominals even

if the focus in footwork, hip work or arms.

I was very luck to have the opportunity to work with my client at the Basi studio in

Costa Mesa and was able to utilize the variety of equipments available. The Wanda

Chair, Cadillac and Avalon system provide different options to effectively focus on our

goal, avoiding the contraindications (such as upper body flexion and extreme back

extension). And even if you don’t have access to all these apparatus, the Mat and

Reformer repertoire offers numerous choices as well.

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Bibliography:

- Rael Izacowitz, Pilates –Complete guide to mat work and apparatus exercises,

1995 second Edition.

- Rael Izacowitz, Study Guide Comprehensive course.

- Katy Bowman, Diastasis Recti: The Whole-Body Solution to Abdominal

Weakness and Separation, USA 2016, copyright @KatyBowman 2016,

Forward @Christane Northrup 2016

- New Health Advisor, Diastasis Recti in men, 2014,

WWW.NEWHEALTHADVISOR.COM

- Elizabeth Connor, What You Should Know About Diastasis Recti, Healthline,

Copyright © 2005 - 2016 Healthline Media.