Q&A with Tom: Linea Alba Separation

A reader asks:

Do you or your team have any experience with linea alba / deep abdominal fascia separation? Can it heal? Can separations be strengthened?

Tom replies:

A bit hard to answer generalities – depends on how large and open the diastasis (abdominal hernia of the linea alba) is.  Also different responses happen to different treatments in different types of people.  Many of these separations happen after childbirth (although I had a mild one myself a few years ago via bad Pilates teaching) and wearing a bit of a corset or wrapping the body in a bandage right after can be helpful, but is not so helpful later after the diastasis is well-established.

If you can’t fit three fingertips into it (couple of inches, 4 cm), I leave it alone.  If you can get more than three fingers into the opening, it’s more serious, or could be.  Even the bigger ones, if it ain’t bothering function or health, I generally leave alone.  If it is bothersome, surgery is the one sure way to get the two halves together again for good; simple procedure, but it is of course invasive.

The middle way I use is to lie on a largish physioball face down, hands and toes on the ground, and to do a long contraction of the transversus abdominis in this position.  This means:  gently and slowly but increasingly firmly pulling the navel toward the spine as the breath is expelled very slowly against resistance – like a hiss, or closing the throat until the breath sounds, what the yogis call an Ujjayi breath.

Later, once tone is increasing in the TA, this exercise can be done without the ball – for those living in urban environments, I suggest that at every red light they slowly bring the navel to the spine, as if playing a clarinet, until it turns green.  Maybe you have another cue?

Make sure not to flex the trunk while doing this – the ribs should not be pulled toward the pubes during the breath, just the navel pulled back, away from the ball, so to speak, toward the spine.  Sit-ups, crunches, and other tough belly exercises are definitely counter-productive and can exacerbate the problem.  So can a slump or a job moving pianos.

The best time for a full ‘healing’ is right after it happens, with a corset-ish bandage and these exercises together.  Afterward, we’re going for ‘good enough’..  I have seen these exercises strengthen the belly wall against the problem.  Without surgery, there will probably always be a weakness, a tendency to open there again if circumstances dictate.  With surgery, there will be a ‘fixed’ point that will need stretching, or it could tear somewhere near the scar in strenuous activity, like those pianos – have you got them moved yet?

Also, follow the work of Canadian physiotherapist Diane Lee – whatever she says to do about this will be backed up with research and clinical practice.

Hope that helps


P.S. Check out the video below for footage of linea alba separation dissected.