17.01.25
Split abdominal muscles
Rectus diastasis is the Latin term for divided abdominal muscles. An “unnatural” division of our rectus abdominis muscles, i.e. an increased distance of the connective tissue that brings our rectus abdominis muscles together in the midline. The separation occurs in the connective tissue strip called the linea alba, the white vertical line that surrounds and holds our abdominal muscles together in the midline, from the sternum to the pubic bone.
Who typically gets split abs and how many people have them?
Split abdominal muscles are most often a condition that occurs in connection with pregnancy.
This is a completely normal adaptation of the tissue to make room for the baby and the growing belly. The increased pressure on the abdominal wall causes the linea alba to give way to the sides, becoming thinner and weaker in structure. All pregnant women have split abs by the end of the last trimester.
After pregnancy, the connective tissue will in most cases contract and try to return to its original shape, strength and stabilizing function.
In most women, the tissue will spontaneously contract, but up to 33% may still have split abdominal muscles 1 year after giving birth. However, this does not necessarily cause symptoms, and it is not serious.
The body and connective tissue reorganize their fibers for up to 2 years after pregnancy, but often the greatest spontaneous progress will occur during the first 6 months.
Detection of split abdominal muscles – the one with that distance
When determining divided abdominal muscles, the distance is most often measured in the midline of the abdomen. It is measured either in centimeters or finger widths. In reality, however, the distance says nothing about the condition and thickness of the connective tissue, or about the function of the trunk in general. It also says nothing about symptoms or discomfort that one might experience.
The distance is no indication of whether the connective tissue is strong or not, that is, the ability of the connective tissue to tighten, stabilize and “bridge” between the abdominal muscles on each side.
For example, you can measure a distance of 2-3 cm, where the connective tissue hangs like a soft “hammock” between the abdominal muscles. Conversely, you can have a distance of 3-4 cm with strong connective tissue that stretches like a sail, can transfer tension between the muscles, and stabilize as it should.
The most important thing is that the connective tissue and core work together in a functional context so that the core is strong for the demands placed on it.
And even more importantly – whether you feel bothered by the condition, or whether you feel fine in and with your body. If you have no discomfort and feel strong, there is no reason to get measured or to worry about the condition.
Symptoms of split abs
Split abs can be experienced in many ways, and we have no definitive list of symptoms that can be concluded to be caused by split abs.
The clearest indicator of whether you have split abs is the classic “toblerone” in the middle, for example when you bend backwards while standing, get up from a lying position, do sit-ups, stand in a plank or similar.
Some people with divided abdominal muscles may also experience a hernia at a weak point in the midline, e.g. an umbilical hernia.
Many women with problems related to split abs describe the following:
- You can feel and see a depression between the muscles in the abdomen, both in a relaxed and tense state.
- Feeling of lack of contact with the abdominal muscles and weakness in the core.
- Discomfort in and around the stomach.
- Discomfort and nausea when wearing tight-fitting clothing, especially pants.
- The stomach becomes bloated when you eat, and not just because of what you eat.
- The feeling of still looking pregnant, long after giving birth.
- You can see organs moving under the skin in your abdomen when you relax.
- Soreness in the lower back during activities/movements that are done “too much”, for example when carrying a baby.
- Impaired quality of life.
Can I make the condition worse?
Split abs are not dangerous, and most people get the best core and body stimulation by staying physically active, both during pregnancy and after birth. You shouldn’t worry about moving or doing anything wrong if you just listen to your body and proceed sensibly.
It’s far better to move than to be limited by worry about making something worse.
Split abs have historically been a condition characterized by many limitations and outdated restrictive advice that we have now learned is not true.
Previously, it was believed that split abdominal muscles were a condition where the tissue needed to be “protected” in order for it to “heal.” This was done, among other things, by using special abdominal belts.
Treatment of split abdominal muscles
With split abdominal muscles, movement and stimuli are essential to give strength back to the connective tissue. Therefore, if you don’t move, you won’t get the necessary stimuli and strength. Therefore, you shouldn’t be afraid to use your body.
As with all training, we recommend that you listen to your body and build up your training gradually and sensibly. There is nothing you can’t do, but it makes good sense not to do training that causes symptoms such as drip, discomfort or pain.
We also do not recommend that you continuously “cultivate” the tobleron – i.e. consciously train directly into it, but that you instead adapt the training and activate the deep part of the core, in order to stabilize the front side as best as possible during training.
If you want to work more specifically on strengthening the midline of the abdomen by dividing the abdominal muscles, current research in the field has not shown one specific exercise or training program with a convincing effect.
However, there is now quite a bit of research on connective tissue, which is the tissue that makes up the midline of the stomach, the linea alba. To strengthen connective tissue, mechanical stimuli are required – that is, a load on the tissue to stimulate growth and strength. To target the connective tissue in the midline, the muscles that are connected to the tissue must be activated and provide that load.
This applies especially to the deep core muscles, where the transversus abdominus muscle in particular has transverse fibers directly to the linea alba.
In order for connective tissue to become stronger and thicker in structure over time, it needs frequent mechanical stimuli, preferably with gradually increased load and challenge.
In addition to the deep core muscles in the abdomen, it is also important to train the outer layer of abdominal muscles, preferably integrated into full-body exercises, as all connective tissue and muscles are connected in the body.
Training split abs doesn’t necessarily require hours of hard training sessions on the exercise mat. There is a lot of potential for getting core and connective tissue stimulated and trained in everyday movements, spending time with the kids, or doing daily chores around the house.
Connective tissue takes time to respond to training. Retraining split abs is not a quick fix. However, many will experience improvements in core and connective tissue strength after just a few months of training.
The physiotherapists at the Women’s Body Clinic have developed an online training program specifically targeted at women with split abdominal muscles.
If there are specific symptoms related to split abdominal muscles or the postpartum body, consider whether an individual assessment and guidance from an osteopath or specialized physiotherapist could be relevant for you.
Is it ever too late to train split abs?
There’s not just a small window where you can train your abs, core, and connective tissue after giving birth, after which it’s too late. You can pretty much always train tissues like muscles, tendons, connective tissue, and bones.
Tissue is malleable and responsive to the stresses placed on it.
However, there may be factors that influence how the tissue responds, including hormonal, specific diseases and age-related factors. This does not mean that the tissue cannot be positively influenced.
We know, for example, that older people benefit immensely from strength training.
For some, it may be easier to resume focusing on strengthening the body when the children are not quite young, and when energy and sleep is better.
When can surgery be considered?
It is not in all cases that rehabilitation of split abdominal muscles is sufficient for the woman to feel accomplished. Considerations regarding surgery for split abdominal muscles can be many and are an individual matter. There may be both symptomatic and cosmetic considerations that apply.
We know that many women experience improved quality of life in the long term after surgery, and that part is worth taking into account.
There are no clear guidelines for when to operate. Neither in relation to time nor symptoms. Therefore, it will not be possible to say in advance whether the public sector will recommend surgery or not. Many women end up in private care and pay for it themselves.
The following are considerations that would make sense to look at if you are considering surgery:
- Initially, you should only consider surgery if you are bothered by the condition, physically, mentally/cosmetically. And both are perfectly fine.
- You should wait until you are done having children. And preferably 2-3 years after your last child, so that the tissue has had plenty of time to recover, and the children reach an age where you don’t have to carry too much on them.
- You are no longer breastfeeding and your hormones have stabilized.
- You should have tried continuous training for at least 12 months, preferably with a physiotherapist specializing in split abdominal muscles.
- Surgery may be considered if progress in a rehabilitation program stagnates. Or if the prognosis indicates that surgery may not be the solution for the woman to feel she is getting the improvement she wants.
- It should be clear that surgery is not a quick fix. The muscles are tightened, but not strong, and for many women the healing phase and rehabilitation take longer than expected.
- You usually get quite far with targeted rehabilitation, and it will never be wasted, even if you end up with surgery.
- We do not focus on time or symptoms regarding the individual woman’s considerations, but leave it up to the individual. However, we will always recommend targeted training prior to surgery.
