The MINT Prjct

Diastasis Recti and Low Back Pain - Are They Connected?

• The MINT Prjct

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As trainers, we have all clients with low back pain.  The MINT girls specifically have all worked to help alleviate that pain from many clients, including moms.  Commonly, there has been correlations between diastasis recti and low back pain. It only makes sense that core instability would result in that kind of injury!  Right? But there's some question on that.

We at MINT are  committed to keeping up with the research and sharing what we learn with all of you. Today we’re going over a review of studies that are questioning the connection between DR and low back pain. We talk about the finds of the studies and our take on the breakdown. If you've wondered before what the harm of DR could be aside from aesthetics, this is one conversation to consider. Check out the review below to read for yourself!

Is Diastasis Recti Abdominis Associated With Low Back Pain? A Systematic Review

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To learn more about The MINT Prjct and check out our programs and courses, head to TheMINTPrjct.com and follow us on Instagram, as well as your hosts, @bets.inthewild, @_coach.cara_ and @jesscarr.fit

Speaker 1:

You're listening to the Mint Project, the podcast to elevate your knowledge on pregnancy and postpartum fitness, nutrition and more, along with parenting, business and advice to keep you living your bust light. The Mint Project is led by your expert trainers Betsy Jones, Carol Forrester and Jessica. With that said, let's do this.

Speaker 2:

I'm really annoyed by that because, first of all, we always do the things that you want to do. Most of the things we do are the things that you want to do. And then I realized she's five. She does not understand that when she's speaking in absolutes, she doesn't understand what like never.

Speaker 1:

You say no once and that means you don't let her do anything. Struggle is so real at this age.

Speaker 2:

But then my friends like well, then they say it to you at 15 and they actually know what they're talking about. And they still say it. I'm like oh yeah.

Speaker 3:

Yeah, it's just fun.

Speaker 1:

I lost it on Mila the other day and I don't remember what it was. It'll come to me, but like it was just like you know, when you get to that limit like I wasn't responding, I wasn't reacting, I was like being patient, and then it was like the last straw and I just exploded.

Speaker 3:

I felt that way about the bed the other day that I make every morning. I'm the only one who makes it. It's fine, it's okay, it matters to me, it doesn't matter to anybody else.

Speaker 1:

Oh, it matters to me yeah.

Speaker 3:

I think crew rested on the bed and left the bed and then hit. The bed was torn up and I walked into the room and what audibly went so hard. I tense my body so hard that you guys, I threw my neck out. Oh my God.

Speaker 2:

That's like.

Speaker 3:

I've hit a level. It's time to go sit in the sauna for an hour by myself.

Speaker 2:

It needs some alone time. Oh my God, that reminds me of that meme or that thing that you can add to a real sense of that lady who's like silently screaming she's like oh yeah. It's so funny. It's like me when I'm over-stimulating or something and I'm trying to be patient, she's just screaming.

Speaker 3:

Have you guys seen? I've seen memes of it and a friend of mine was like venting to me the other day about her experience with getting a car seat into the car, when you forgot that it wasn't and you're like oh God, or stuff going wrong, and then you get to put the kid in the car and remember that you had taken the car seat out, and then try to maneuver that thing that after, when you finally get it in, then you have to go find your kid.

Speaker 2:

Find the kid. Oh my God.

Speaker 3:

She said that her two-year-old during this was like climbing around in the car and went to like hit the gear shift. But it's a for some reason in that car, the gear shift would like make the car roll forward.

Speaker 2:

Oh my God, that's so scary yeah it's an out of car set, ladies, that sounds just so hard to say I'm so sorry.

Speaker 1:

It was a long road, but we're here.

Speaker 3:

Is a booster for Kaya or is she in a full-on seat still?

Speaker 2:

Yeah, and in the car we have a booster for her, and then in the truck she's still in her car seat because we don't have two boosters. Oh yeah, but yeah, she prefers riding in the car now because she wants to keep it.

Speaker 3:

Big girl. That's a whole other podcast in and of itself, just like car seat struggles Car seat.

Speaker 1:

So when you change them and what the rules are, oh my gosh, that's crazy.

Speaker 2:

It's like so overwhelming. And then you have those people all over Instagram that love to comment If you do any kind of picture video in your car. They're like that is incorrect and I'm like okay, thank you.

Speaker 1:

Emily, do you know what we rode in when we were kids? Because we sat in the back of a pickup truck and drove around. So it's fine, it's fine, it's a long ways.

Speaker 3:

Yes, so today we're going over a review of studies that were questioning the connection between diastasis recti and low back pain. So the hypothesis is that because rectus abdominis, which is basically your ab muscles, is considered a main contributor in lumbar and pelvic stability, that if that's having issues then you would inadvertently have low back pain. So, cara, will you just explain the anatomy of like the pelvis, abdominal wall, things like that for us really quick?

Speaker 2:

Yeah, so basically you have. There's a bunch of different layers and different muscles involved in the core and the pelvic floor, but they all work together as a team to help with stability and movement and just protect your back and all your structures in your core to help with movement and power and stuff. Your rectus abdominis are the things that you think of as your six pack abs, so they run down the length of your stomach and then they're connected. They're two halves and they're connected in the middle by a piece of fascia called the linea alba, and that piece of fascia is what thins and spreads apart as if you're pregnant, as your baby grows, and that's what creates room in your core for that growing baby. And so oftentimes that gap can get really big and just just spewing.

Speaker 2:

Another fact here If you reach 35 weeks of pregnancy, you will have some kind of a diastasis. So whatever you do or whatever you're told, there is no way that you can actually avoid that if you hit 35 weeks of pregnancy. But there's things that you can do to mitigate it. It's a whole nother topic.

Speaker 2:

But some women some women their diastasis returns, or I mean their diastasis heals on its own. Some women it doesn't, and so that's what this study is about is to really see if that diastasis being there and they define it as anything more than a two centimeter gap. Actually, there was a lot of different definitions of actually the diastasis.

Speaker 2:

Yeah, but basically, like the most easy way to say it is, if it's more than a two centimeter gap, then you're considered to have a diastasis and then does that correlate to lower back pain, because maybe your muscles are not functioning as well, they're not able to hold the tension as well, not able to distribute the pressure as well and to support your structures, because they have been compromised by being stretched and thrown out of whack by the human growing in there. So yeah, Brainers.

Speaker 1:

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Speaker 3:

Perfect. Yeah, so the study and it actually wasn't a study, it was like a literary review of multiple different studies. What they did is they looked for studies that had already discussed this correlation and looked at it. So they found a total of 207 that looked at these two things together, and then they cut that down based on their quality and relevance to 34, on a variety of different reasons for each one. So all in all, we're looking at 13 total studies here and their findings, the findings.

Speaker 3:

I'm just going to jump to those because I think there's a lot to say about the findings, or, like, when you look at one of these, there's basically a summary up at the top and then you can read all the details of how they came to that summary. So the summary and the data that was come up with, which is really what's to be? I mean, if you want to deep dive into this, like the data is what matters, but then when you start to read about it, there's a lot of like question marks that come up. So the data was and the review said that 61.5% of the studies said that there was no correlation and then 38% found correlation. So I mean, if you want it black and white.

Speaker 3:

It says that there was no correlation, but there were a ton of different things to be considered in this study. One of the first ones that I looked at was you would start seeing this trend of how very specific the field got on what they could actually review. So, for example, only 11 of the 13 studies actually even had a definition of diastasis, and throughout those, there were at least four different methods and definitions used. So there's a lot of gray area within what exactly are we calling diastasis, how are we testing it, and do we even know what we're calling it?

Speaker 2:

And the same with low back pain, like how they measured low back pain and how they defined that same thing there. Each study kind of had its own way of defining that.

Speaker 3:

Yeah.

Speaker 1:

Yeah, it almost seems like we need a new study, like a better study. That's not just, like you know, I was getting confused reading how they like weeded out some of the studies and by the time they got down to what they were actually looking at, it seemed like the sample size was so small. But if you do take a step back and look at the overall like what's the word I'm looking for? Like bigger scale of things, it seems like there's more of a correlation than what they actually came out with, because they had to weed out so much of the people involved and the studies involved.

Speaker 2:

Yeah well, and I thought it was interesting too that in the conclusion they said, or in the major conclusion at the beginning of the study they said that they found there was like 8% or eight of the studies right said there was no correlation and five said that there was. But then later in the article when they were talking in the conclusion they said that the majority of the participants so if you just didn't care about the number of studies, but more participants found that there was a correlation with low back pain and diastasis.

Speaker 2:

recti then did not, and so it's not really about like. I would take it more as like how the number of people rather than the number of studies, because some of those studies had more people in them than others.

Speaker 3:

Yeah, yeah, yeah. So there were 2,820 patients overall within all the studies and the 9 1989 of those were in the studies that found correlation and only 831 in the ones with no correlation was the data that it quoted there, and even at the end of end of that paragraph where it points that out, it says this might weren't further investigation and then later on says it seems that the correlation appears to be real. So it's funny because you know, I don't know the process of how these, especially why I don't know the process of the studies work, but even these reviews, it seems the author is saying I mean, kind of seems like there is something there.

Speaker 1:

Right, but we got to do more research, right. It's like they they can't tell you a hundred percent, but yeah, well, and it's interesting. I mean they talk about, they do talk about. Obviously this affects mainly postpartum women or pregnant postpartum women. And then they give some other areas where, like Core instability I know we're gonna talk about this a little bit but like core instability would also affect low back pain and those things are obviously very similar, like if you're dealing with Diastasis, you likely your core is not fully where it should be in terms of strength.

Speaker 1:

I Also be really curious to like how long have these people been dealing with the diastasis and how long have they been dealing with low back pain and, as they've started to work on, hey, we could start. We should start working on core strength, because that should help with low back pain, which I know.

Speaker 1:

All of us have seen that in the gym with like assessing people, 70 to 99% of people that I see in the gym who have low back pain. It stems from their war, or maybe yeah a core instability. I mean that's that's the first place you go, typically is like let's work on your core.

Speaker 3:

Yeah, there might be a time where their hips are out of whack. Yeah, they're hamstring. Yeah, exactly, they don't have them.

Speaker 1:

They don't have the mobility to like the range of motion and so it starts impacting their low back. But yeah, to me it seems like it's a it should be a pretty conclusive, like that makes sense type of situation.

Speaker 2:

Yeah well, even in the study it says that an excessive skin and laxity of the fascia, so that oh yeah, alba, that stretches out In the abdominal region of those with diastasis have been shown to strain the lower the lumbar back region, thus creating pain. So, and there's also a decreased contractile function of the transverse abdominus, which is kind of like that natural muscle belt In your body that can last for up to at least four months post delivery. So that's interesting too, that just goes back to you know.

Speaker 2:

When you're coming back, make sure that you're taking the time to train your core or reconnect your body with those muscles, retrain your deep core so that you're building a strong foundation For whatever fitness or lifestyle that you want to do.

Speaker 1:

Yeah, that's such a good point, kara, that a lot of the times we think, oh, I have diastasis, I blow back pain. Okay, well, yeah, what can we do to address it postpartum? That's why it's, like you said, so important to follow something or at least be working with someone who can help you reconnect to your core. Your body has just gone through so much and if we're just jumping back in, our core is not ready for the training that we were doing before. It's Likely weaker, it's likely we aren't connecting to it as much because we lost some of that while it made room for the baby. And so Following something where you can progress back and build that core strength back is gonna help you, probably help you avoid some of that, that low back pain.

Speaker 1:

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Speaker 3:

It was interesting when I read that it said that how to improve that motor control and some of the exercises that could be done would be low threshold stabilizing exercises, isometric and dynamic exercises, which is exactly, and, kara, I'll let you speak to this, but that's what a lot of the six phase program is written around.

Speaker 2:

Yeah, it definitely starts you in those stabilization and deep core things, learning how to breathe and reconnect you to your core and then slowly building in other dynamic things as you go and more compound movements as you go.

Speaker 3:

Yeah, building that foundation. Kara, can you because I know a lot of people out here maybe would think like oh, breathing exercises and core work are different things, which I mean. Depending on how you look at them, they are different or they are the same. But can you explain the differentiating things between those isometric, why those isometric breathing exercises are important and why they're different than what you may see as ab exercises?

Speaker 2:

Yeah, so it's really about putting the two things together. You can train abs and core all day, but if you are not getting those deep muscles involved and the way that you do that is through proper breathing mechanics even oftentimes we think, okay, train the core, I'm going to train my rectus abdominis, those muscles that I talked about, the six pack abs. You want to train the full core as a team. That includes your back, that includes some of your lats, that includes your pelvic floor, to work with all those muscles as a team. Then that full team is being engaged and is being strengthened, strengthening that deep core, which will then the effects will go out from there.

Speaker 1:

Yeah, it's not the sexiest things that you're working on in that early postpartum era, but it's the things that get you back to the sexy movements without the pain, which is, I think, frustrating for people. We actually had a client recently at the gym that joined very early postpartum. We were taking her through those really early and she just wanted to do other things and didn't want to keep going.

Speaker 3:

I get it. It sucks.

Speaker 1:

I'm like and there was no talking her into it because she had done that with her last baby it's like, well, okay, now we got it more stressed, because now this is your second or third baby. Just give it a chance, you'll get there.

Speaker 2:

Yeah, I think it's hard too, like what you're saying, it's not sexy because it's not going to get you losing the baby weight. Learning how to breathe properly, learning how to engage your deep core that's really what we should be saying when we say breathe properly, it's not going to do all of that stuff. What it is, it's a protective longevity, it's like a prehab thing. None of that stuff is fun to do. No one loves to do prehab. No one loves to do mobility.

Speaker 3:

Nobody likes to warm up. At Waterploo says there's a warm up club apparel line. I know, I feel like I'm. I know, I feel like I'm yeah.

Speaker 2:

I feel like I'm getting more into specifically warming up just from some shoulder and upper neck and back things that I've had going on. I'm like, okay, I used to just do a few barbells and start working out.

Speaker 3:

Sorry, girl, you're getting old with these old teams.

Speaker 1:

I know I just made a post about how I now have to actually warm up because, yeah, you have to. I'm specific to what you're doing. Yeah, exactly, I'm specific to what I'm doing. Just do a quick general warm up.

Speaker 2:

Yeah, quick, but yeah, and I think too there are those people that can jump back into it and they're fine, or maybe they seem fine In my mind. I would personally rather take the slow route so that I can be strong later, rather than speed through everything now and then have problems later on. So that's what.

Speaker 2:

I'm talking about when I'm saying to train for longevity, do the prehab. Yeah, and I always tell my clients these first few weeks are going to be pretty boring. Yeah, and I do do some stuff with them. Get their heart rate up. Let's do some rowing, let's do some biking, so that they leave feeling like, ooh, that was a good workout, without compromising their core, their pelvic floor, while they're still learning and still really healing that area.

Speaker 1:

Yeah, that's a good point. You can add in little things that will help you feel that kind of sweaty or, you know, getting your heart rate up type of workout, while still really prioritizing the things that are important early postpartum and, yeah, it's, you have to think long term and, like you said, yeah, some maybe you can jump right back in and be totally fine, but maybe not. So why don't we just be better safe than sorry? I think my other rant around this to what I've seen a lot in not really I guess, yeah, kind of the fitness industry or health industry, and this isn't really necessary necessarily related to diastasis.

Speaker 1:

But in working on things, when you have some sort of like mobility issue or some like limitation, like diastasis, or maybe that's a mobility limitation and it's impacting how you feel or giving you, causing you pain, it's this like, hey, just go get a massage or just ice it or just take ibuprofen and then you'll be fine. When really, it's about addressing these root issues with which is the same as this, addressing the root issue of why we have the diastasis and how, because, like you said, all pregnant women will have a diastasis at some point. So let's work on the root issue instead of just trying to put a bandaid on it.

Speaker 2:

Yeah, so I yeah in conclusion about the study. So I'm just going to kind of read what it said at the end. It says from our review, most studies did not find an association between the diastasis and low back pain, but there was a positive association in three quarters of patients in the included studies.

Speaker 2:

So it says two different things and then, based on the quality of the studies included in our review, better studies are warranted to understand the association. So basically it's saying there could be an association and there's studies are interesting. I think oftentimes we think like, oh, it's in a study, it's science, that's how it is science is fact.

Speaker 2:

But there's a lot of different ways that you can manipulate studies like that's he was talking about earlier. The way that you define things, the way that you measure things, all that kind of stuff can kind of make a difference. So really, just if you are wondering, you know, should I take the time to work on healing my diastasis? There's just some facts for you. You can think about them. But really I think the thing that stood out to me in the study was that the core structure is compromised during pregnancy and could really benefit from rehab postpartum All right, guys, so we will put the link to that study in the show notes, per usual.

Speaker 3:

Yeah, we'll see you next time.

Speaker 1:

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