Does diastasis recti cause lower back pain? Why your physio is likely incorrect when they say it doesn’t.

Does diastasis recti cause backpain?

A lot of healthcare professionals will say that it doesn’t but the evidence says it probably does. (And the anecdotal evidence says it almost definitely does) So how come there is such a discrepancy between the two?

Let’s begin with the definition of diastasis recti.

The strict definition of Diastasis is “Rectus abdominis diastasis (RAD; diastasis recti, divarication of the rectus abdominis, abdominal muscle separation) is an anatomic term describing a condition in which the two rectus muscles are separated by an abnormal distance ” (This distance is greater than 2.5-2.7cm if you’re curious)

And, technically, that is ALL diastasis recti is. An abnormal distance between the two rectus muscles. Anything in addition to this is not within the strict definition of diastasis recti. Definitely NOT muscle-activation or weakness.

We know that an increased distance in between the muscles alone would not necessarily lead to Lower Back Pain. It is possible to have diastasis recti AND a well functioning core.

If your core is functioning well enough, is strong enough, a wider than usual gap between the rectus muscles is not in itself enough to lead to backpain. After all most daily activities, in short bursts, are not THAT strenuous on the back and a decent core can easily help out enough for the back to not end up overworked/sore.

This has lead to a fair amount of health professionals, physios etc., saying that Diastasis Recti does not cause backpain.

So simple, that’s it sorted then….no?

TECHNICALLY they may be correct..but only technically and you have to do several things to come to that conclusion.

1; You have to follow the narrow, and in my opinion inadequate, definition of dastasis recti. I always say that diastasis recti is about more than just the gap. Muscle functionality/weakness has to be included when discussing this when you’re dealing with the public. It just makes much more sense to do so. After all, what is the point of the healthcare professional if not to make sense of this sort of stuff to the general public so that everyone understands clearly what they have to do to help themselves function as well as they can, and live a pain-free life.

Using the narrow defition also leads healthcare professionals to think that diastasis is just an aesthetic issue, when it clearly is not, and means that professional, expert help does not need to be provided by your insurer/health service. After all, aesthetics are a “you problem”.

The width of the gap, the depth of the gap AND muscle functionality/strength are all factors when it comes to diastasis recovery, and post-partum recovery generally, so it makes sense to include it when discussing DR.

2; You have to really be married to the “correlation is not causation” argument. One of the issues with research into complex things such as lower back pain in post-partum women is that causation is ridiculously hard to establish. There are a thousand different causes of lower back pain both in “normal” people and post-partum women. However the evidence all points towards a link between diastasis recti and lower back pain, even to the point that when the diastasis is healed the lower back pain diminishes.

Here are but a few of the studies that show there is a link between lower back pain and diastasis recti;

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8728546/

https://jmpas.com/admin/assets/article_issue/1638456500JMPAS_JULY-AUGUST_2021.pdf

https://watermark.silverchair.com/sjaa032.pdf?token= A study that shows the effect abdominoplasty has on lower back pain.

https://europepmc.org/article/med/28946525

https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.15568

Now, of course, it could easily be argued that most of the people with Diastasis Recti had a weak/poorly functioning core or other issues and that THAT is what likely caused the Lower Back Pain rather than “just the gap between the muscles” and that therefore it wasn’t the diastasis that caused the Lower Back Pain. I have had many chats with physios that will say that and they tend to think they’ve won the argument on this technicality. However I feel this only strengthens the argument for expanding the working definition of diastasis recti.

Especially since diastasis is still mainly viewed as an aesthetic problem that the National Health Service, and most private insurance providers, won’t actually provide help with.

Imagine knowing that a condition is linked to lower back pain and lower quality of life and arguing that, since technically it might not be the direct cause, you don’t need to provide help. This truly baffles me.

So how does healing diastasis help fix lower back-pain?

This is the tricky bit because, as I mentioned, just having a gap between the rectus muscles does not directly lead to back-pain.

If you only work on a small selection of muscles in an effort to “close the gap”, you’re inevitably going to be ignoring all the other muscles that have a very important function and you’ll not actually achieve much in the way of post-partum recovery. It does not take that much time to give someone a half-decent amount of core strength, maybe a month with a bit of focus and determination. This might of course help a bit with lower back pain but is likely to not be enough to really remedy it.

What I did when creating the HPNB program, and what every good post-partum exercise program should do, is making sure that we have a complete and holistic approach to muscle-activation and strengthening. A lot of the early exercises in the program focus on muscles that tend to be weak in post-partum women, such as the glutes and obliques. Yes of course we also get you to pay a bit of attention to your Transverse Abdonimis (TVA) and all that stuff but we don’t stop there.

As any athlete will tell you, You have to train for what your body’s purpose is.

In the case of most post-partum women this means training your body for life. Making sure that your body is strong enough to carry a tantrum throwing toddler whilst holding a travel system/bags of shopping/washing and carry a work-conversation on the phone, without your back buckling under the strain.

So, the TLDR?

We really have to widen the definition of diastasis recti as it causes many issues when women try to get help to heal their diastasis. When it comes to exercise, only focussing on your TVA, and other stomach-core muscles, is also not going to be enough to sort your lower back pain out..but it will likely help a bit. Use a holistic, well-rounded and expertly designed program (such as HPNB) and you’ll find your lower back-pain will go away as will your diastasis.

3 months free, no BS, no sales, cancel anytime you want…so why not start dealing with your diastasis and back-pain today?

Take care,

Peter