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.
The core and pelvic floor are often forgotten areas of the body when it comes to addressing injuries and issues in powerlifting. This area of the body is not visible and symptoms associated with dysfunction of the inner core and pelvic floor can present themselves as poor training progress or injuries in the back or limb before a direct issue presents itself.
There is a strong relationship between the structures of the neck and head with balance and performance in barbell training and powerlifting. This is why we coach people to maintain a neutral neck posture in line with the rest of their spine and to focus their eyes on a specific point close to their bodies while executing the powerlifts.
Not considering and adhering to sound technique in the cervical spine may lead to neck pain, headaches, dizziness, or injuries in barbell training. This may lead you to seek out the care of a chiropractor for manipulation or adjustment of the cervical spine for neck pain or other disorders of the head and neck. But is chiropractic adjustment of the cervical spine safe and what you need?
There are many other treatments that can provide the same benefit in a safer capacity
One of the iIssue with traditional chiropractors is they market themselves as the only way to fix symptoms and make someone healthier.
The narrative and language used by traditional chiropractors scares people into believing they need adjustments forever and it is the only way to feel well
Chiropractic manipulation isn’t doing what it says it’s doing because…
Bad palpation skills
a. Not adjusting the level we think we are adjusting
b. Bones don’t move
c. Medical Subluxation & Chiropractic Subluxation are different confusing people about the mechanism of their pain
Contraindications to manipulating the cervical spine and when WOULD she recommend and use cervical spine manipulation?
How are the neck, ears, jaw, and eyes connected to dizziness and balance
How might movement of the neck while lifting cause dizziness or fainting
Is there truly bad posture and how does that influence neck pain?
Types of headaches stemming from our traps and how they are different from migraines
a. Cervicogenic headaches
b. Tension headaches
Where does botox fit into the treatment of cervicogenic and tension headaches?
Some of Taylor’s Educational Articles:
Connect with Taylor @theyhypermobilechiro on Instagram
Need help with an injury or programming? Book a free consultation call with one of the PRS Clinical Coaches here!
Interested in attending some of the free PRS community events and getting early access to PRS Podcast episodes? Sign up for our weekly newsletter here!
Join our Facebook Community for free form checks, live Q&As & more: https://www.facebook.com/groups/PRS.Barbell.Mastery
Got questions or guests you'd like to hear on the show? Submit them here: https://forms.gle/7Vu2HmgHoeQY9xM59
Check out the Clinical Barbell Coaching Institute to learn more about the PRS education opportunities! https://bit.ly/43VjRFz
Email: podcast@progressiverehabandstrength.com
Rori IG: @rorimegan_prs
Alyssa IG: @alyssahope_prs
Bre IG: @breannejulia_prs
In this episode of the PRS Podcast, Clinical Coaches Drs. Rori Alter, PT and Alyssa Haveson, PT connect with PRS remote rehab coaching client, Dr. Matthew DiPaola, MD, orthopedic surgeon, who has utilized barbell training as his own form of rehabilitation and physical therapy after having two hip surgeries on the same side.
