Episode #50: Diastasis Recti & Hernias: What you need to know to lift heavy weight even if you have these!
Diastasis Recti and Hernias are common abdominal concerns that personal trainers, lifters and doctors are concerned about when it comes to lifting weight. However, it’s safe to continue barbell training or powerlifting even if you’ve been diagnosed with either of these.
Though commonly believed to be a tearing of the midline fascia, Diastasis Recti is the separation or widening and weakening of the fascial connection between the two rectus abdominis muscles. This commonly occurs in nearly all pregnancies and during abdominal expansion, for example with a “beer gut,” or a hard, round belly. Because there is no tearing of the linea alba, or fascia connection between the two rectus abdominis muscles, diastasis recti is both manageable and reversible.Thus, it is possible to continue to barbell train if managing intra abdominal pressure and barbell training fatigue and technique appropriately.
A hernia is a disruption to connective tissue that maintains our organs in the abdominal and pelvic cavities. These disruptions are most commonly found in the inguinal or groin region and around the belly button. Because of the disrupted tissue, internal organs displace into the inguinal canal or umbilicus to varying degrees. There can be pain and discomfort or none at all associated with hernias as well as damage to the displaced organ. Based on the level of pain and potential damage to organ tissue, surgical intervention is more commonly associated with hernias than diastasis recti.
However, in most cases, symptoms and progression can be minimized with proper internal pressure, technique and fatigue management in barbell training thus making it safe to continue to barbell train or powerlift even with a hernia in some cases.
In this episode of the PRS podcast, Dr. Breanne Maruca, PT, PRSCC, CLT, WCS and Dr. Rori Alter, PT, PRSCC, SSC discuss:
How Diastasis Recti and Hernias are not the same thing
The varying degrees of Diastasis Recti and Hernias
When to consider physical therapy or surgical management
How pressure management is the key to barbell training with diastasis recti and hernias
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Dr. Rori Alter, PT, PRSCC, SSC: [00:00:34] Welcome back to the Progressive Rehab & Strength podcast. I'm your host, Dr. Rori Alter, Head clinical coach here at Progressive Rehab & Strength, with my lovely co-host for this month, Dr. Breanne Maruca, our pelvic health specialist and a clinical coach here at Progressive Rehab & Strength Physical Therapist as well all those good things that we all are at Progressive Rehab & Strength. So this episode we are going to be focusing on hernias and diastasis recti Am I saying that right? I feel like people say it.
Dr. Breanne, Maruca, PT, PRSCC, CLT, WCS: [00:01:14] Tomato. Tomato.
Dr. Rori Alter, PT, PRSCC, SSC: [00:01:15] Yeah. Okay. So just making sure.
Dr. Breanne, Maruca, PT, PRSCC, CLT, WCS: [00:01:18] So diastasis or Diastasis.
Dr. Rori Alter, PT, PRSCC, SSC: [00:01:21] Yeah, it doesn't. It doesn't matter. Whatever you want to say, as long as it's one of those. Or you can just go with a DR. Yeah, Most people will know what you're talking about if you say you have a DR. But there's this whole month with all of these things that we're talking about related to the core and the pelvic floor. These are things that people experience outside of training that you might have totally unrelated to training, but you can still train with them and you might I would say DR and hernias are not usually a result of training, but there are things that people have and we need to be cognizant of them and figure out how to train with them because we shouldn't shy away from training just because we have these things, because most of the time they're nonsurgical. And so we just have to learn how to manage them.
Dr. Breanne, Maruca, PT, PRSCC, CLT, WCS: [00:02:15] So manage and also learn how to prevent exacerbation and how to improve even these diagnoses or these symptoms because it's definitely, again, we're biased because we see how much what we do actually affects these symptoms and how much it improves these symptoms. So even how training can actually help treat what exacerbates these symptoms.
Dr. Rori Alter, PT, PRSCC, SSC: [00:02:43] So before we even dive into that, sometimes I feel like people think that DRs and hernias are the same thing which they're not, correct? So and you can have a DR, and you can have an umbilical hernia. So they're definitely not the same thing. So I think that we should first and foremost discuss what the difference is between the two, even though they do fall under the same category of a failure in connective tissue and a pressure management issue, they're definitely not the same thing. So let's go ahead and define first what a hernia is, who they affect and where they can be found. And then what a diastasis recti is who they affect because I think that there's a common misconception that they're only found in women and only develop during pregnancy.
Dr. Breanne, Maruca, PT, PRSCC, CLT, WCS: [00:03:43] Yes and yes.
Dr. Rori Alter, PT, PRSCC, SSC: [00:03:44] And then exactly what that is.
Dr. Breanne, Maruca, PT, PRSCC, CLT, WCS: [00:03:46] Yeah. So first thing with hernias, I would say that they definitely fall under the failure of connective tissue kind of category. And I think that's something that really makes hernias stand apart from diastasis recti because with a hernia you actually have a disruption in your connective tissue. So that means and I don't want to say that you have a hole in your connective tissue, but I mean, yes, essentially you have a disruption in that tissue and you may or may not have abdominal contents kind of pushing through that opening. Obviously, you still have skin, so they're not actually coming out of your body. But essentially they're not; the abdominal contents have more of a chance of actually leaving their home in your abdominal cavity and pressing through that disruption or that hole in that tissue. Now, Diastasis recti is different, where it's not really a failure in the tissue you might have. So going back to our functional anatomy, we have that linea alba that is separating or the hamburger or the hot dog in between the bun, in between your six pack muscles or your rectus abdominus muscles. So that is the connective tissue that connects those two abdominal muscles. So when we have diastasis recti, it's not really that the connective tissue has failed and something is wrong with it, that that's what's causing what symptoms you may experience or that visible. What we describe I guess as diastasis recti. So when we and let me back up, I guess when we assess or I guess when we name Diastasis recti, we're naming it based on our assessment, what we physically assess and what we visually see. So the two main things that people see and assess to then say you have done. Diastasis recti or to diagnose someone with diastasis recti usually is a finger width distance so the distance between those two abdominal rectus abdominus muscles, that distance is bigger than normal and when we assess, normal is considered 1 to 2 fingers. And we'll get into that in a little bit more in a second. But and then visibly what you see is like coning or doming or a bulge in the abdomen when you're doing some sort of any sort of resistance resistive movement function, something that requires force to achieve.
