DISTASIS RECTI

DEFINITION:
Seperation of the rectus abdominus muscle in the midline at the linea alba . The etiology of the pathology is unknown, but the continuity of the abdominal wall is disrupted.

INCIDENCE:
Any seperation larger than 2cm is considered significant. a) The condition is not exclusive to childbearing women but is seen frequently in this population. b) Diastasis recti possible occur in pregnancy as a result of hormonal effects on the connective tissue and the biomechanical changes of pregnancy. It causes no discomfort. c) It is relatively uncommon in the first trimester, but the incidence increases as the pregnancy progress, reaching a peak in the third trimester. d) It does not always spontaneously resolve following childbirth and may continue past the 6 weeks postpartum period. e) It can occur above, below, or at the level of the umbilicus but appear to be less common below umbilicus. f) It appears to be less common in

3. SIGNIFICANCE:

a)

The condition of diastasis recti may produce musculoskeletal complaints, such as low back pain. Possibly as a result of decreased ability of the abdominal musculature to control the pelvis and lumbar spine, subcutaneous fat, and peritoneum. The lack of abdominal support provides less protection for the fetus. b) In severe separation s, the anterior segment of the abdominal wall is composed only of skin, fascia women with good abdominal tone prior to pregnancy. c) Severe cases of diastasis recti may progress to herniation of the abdominal viscera through the separation in the abdominal wall. 4.DIASTASIS RECTI TEST: PATIENT POSITION: Hook lying ,have the patient slowly raise her head and shoulders off the floor, reaching her hands towards the knees, until the spine of the the scapula leaves the floor, The therapist places the fingers of one hand horizontally across the mid line of the abdomen at the umbilicus . If a separation exists, the fingers will sink into the gap. The number of fingers that can be placedbetween the rectus muscle bellies measures the diastasis. A diastasis can also present at a longitudinal bulge along the linea alba since a diastasis recti can occur above, below, or at the level of the umbilicus it should be tested at all these areas.

MANAGEMENT:
a) Test all pregnant clients for the presence of diastasis recti prior to performing abdominal exercises. b) HEAD LIFT: POSITION OF WOMEN: Supine hook lying with her hands crossed over midline at the diastasis to support the area. As she exhales, she lifts only her head off the floor until the point just before a bulge appears. Her hands should gently pull the rectus muscle towards midline. Then have the women lower her head slowly and relax. This exercise emphasizes the rectus abdominus muscle and minimizes the obliques.

c) HEAD LIFT WITH PELVIC TILT: POSITION OF WOMEN: supine hook lying. If diastasis recti is present, the arms are crossed over the diastasis and pulled towards mid line, she slowly lifts her head off the floor while performing a posterior pelvic tilt, Then slowly lower her head and releases, all abdominal contraction should be performed with an exhalation so that intra-abdominal pressure is minimized. Only this exercise and/or the head lift should be used until the separation is corrected to 2 cm or 2-finger width. d) LEG SLIDING: PATIENT POSITION: Hook lying with pelvis in posterior tilt. The women hold the pelvis tilt as she first slides one foot along the floor until the leg is straight. She stops sliding the foot at the point in which she can no longer hold the pelvic tilt. Slowly she lifts the leg and brings it back to the starting position, and then repeats with the other leg breathing should be coordinated with the exercise so that abdominal contractions occur with exhalation.

This exercise can be performed with both legs at the same time if abdominal muscles can maintain the pelvic tilt through the entire exercise.

e) QUADRUPED PELVIC TILT EXERCISE: PATIENT POSITION: All fours position on hands and knees. Instruct her to perform a posterior pelvic tilt. While keeping her back straight, she sucks the abdomen in and holds. Then she releases and performs a anterior tilt through partial range.