317 | Myths vs Facts about Diastasis Recti with Antony Lo

[00:00:06] Welcome to The Optimal Body Podcast. I'm Dr. Jen. And I'm Dr. Dom and we are Doctors of Physical Therapy, bringing you the body tips and physical therapy pearls of wisdom to help you begin to understand your body, relieve your pains

[00:00:17] and restrictions, and answer your questions. Along with expert guests, our goal of The Optimal Body Podcast is really to help you discover what optimal means within your own body. Let's dive in. Before we chat with Antony, we just wanted to chat with you about something real quick

[00:00:33] that everyone has a pelvic floor. Yeah, guys have pelvic floors too. And it's crazy because I don't think you'd imagine how many men and how many people in general deal with pelvic floor

[00:00:44] issues. As an athlete, I was somebody who always thought I had a really strong core, but I didn't coordinate my core very well. I didn't coordinate with my breath very well. And I didn't coordinate

[00:00:54] it with my pelvic floor very well. And after meeting Jen and doing a lot of work on my own, I have seen improvements in my pelvic floor function and some of the symptoms that I have

[00:01:03] experienced. And that's why we created the Pelvic Floor Foundations course, which is still on a discount that you can get right now. Plus for our podcast listeners, you get an extra discount if you

[00:01:14] use code optimal at checkout. So go get that extra discount right now. But we just want to create a space that you can come learn and understand what the heck this pelvic floor is because it is not

[00:01:27] just Kegels and you don't have to just live with these symptoms that people say like, oh, I had a baby. So now I'm part of the leaking club. That doesn't have to be a thing.

[00:01:36] Yeah. There are a lot of these myths that things might be common, but it doesn't have to be normal. And really what I love about this program is Jen focuses, yes, on how to become aware of your

[00:01:47] pelvic floor, how to consciously use that with your breath and other movements. But really the most important thing is integrating it into your movement and into your life. And there's so many resources in this program. You have daily resources, you have accountability,

[00:02:00] there are webinars, the calendar speaks for itself. It walks you right through this course and checks off your daily progress. So get in now. Again, it's on discount this week only, and then it goes to full price. And as being a podcast listener, you get that special discount.

[00:02:14] So go down to the link in the show notes, make sure you use code optimal at checkout to get that bonus. I'm really excited for this podcast guest, Anthony Lowe, because I am someone who have personally learned from him. I took a course

[00:02:26] a few years from him back in New York, and I've actually recently taken some webinars from him, and I continue to learn from him. So I'm really excited for what we're going to talk about on

[00:02:36] this podcast. And please, please, please, if you know anyone who has Dysarticis Recti or has been talking about it, pass this episode along because there's a lot of new information we're going to go through. Now, Anthony Lowe is a physiotherapist, educator, and podcast host from Australia who

[00:02:51] works at the junction of the musculoskeletal, ortho, sports, and pelvic health. He runs the Physio Detective Clinic, My PT Education, the Women's Health Podcast, and the Diastasis Project. He helps the general public and health and fitness professionals who struggle to progress their

[00:03:10] clients by cutting through the BS and thinking outside of the box to confidently assist people to achieve their goals. Anthony has a wife and three children and lives in the best city in the world, according to him, Sydney, Australia. Now I'm so excited. Get ready for this podcast.

[00:03:27] Anthony, thank you so much for taking the time to be here with us. I know I've taken a course from you and I've continued to learn from you ever since. And I just appreciate the information

[00:03:38] that you're putting out because I think it's very different messaging than what is very common for a lot of people to see on social media, especially when it comes to pelvic health symptoms and diastasis recti in particular. So, just thank you for being here.

[00:03:57] Thank you for having me on the show. I really appreciate the work that both of you do in raising awareness for doing things that can help improve people's situations, whether it's performance or symptoms. Yeah, absolutely. And so, I know one topic in specific

[00:04:13] you discuss a lot about and work a lot to educate the general public in is diastasis recti. And I know that this is a very common topic that gets thrown around social media, how to fix it, does

[00:04:30] it matter, what exercises can you do to get rid of your diastasis postpartum, all sorts of messages that can get really muddy for someone in the general public to kind of sift through. And it was

[00:04:45] interesting, we were on a call with our team just before this, many of which are women, and we kind of asked them questions like, oh, does anyone have specific questions about diastasis recti?

[00:04:56] And there were two or three of them that didn't really know what it was at all. One of them who had had a child before. So, from the sphere that we're coming from where we feel like, oh, diastasis

[00:05:07] is something that everyone knows about, like, what is diastasis recti? How would you explain that to the general public? Yeah, it's a really good question because lots of people use it in lots of different ways. Technically, the definition of a diastasis recti

[00:05:25] is the space widening between the two six-pack muscles, the rectus muscle. But often people attribute the whole front of the abdomen, your tummy stretching and looking like you're pregnant when you're not pregnant. They call that diastasis, but you might have that without a

[00:05:45] diastasis technically. So, it can mean two things. The technical medical definition is a space between the muscles, but most people are concerned about the appearance of what's going on. And then from there, there's a whole bunch made about what that means. But there's little to back

[00:06:05] up what a lot of social media is doing out there, unfortunately. So, I and quite a few others are trying to spread the message that we shouldn't be scaring people because of this, but empowering

[00:06:17] people to do the things that they want to do to achieve their goals. Taking a quick pause from the interview to talk about one of Jen and my favorite health tips. It's something that everyone

[00:06:29] should be focusing on, but not everyone takes the time to do throughout the day or remembers to do throughout the day, and that is stay hydrated. Not just with water, but making sure we are replenishing the electrolytes that we are naturally losing throughout the day, the sodium,

[00:06:44] potassium, and magnesium that our body needs on a cellular level to continue to function optimally. That is why Jen and I use Element every single day. It is our favorite electrolyte drink, and it is packed with sodium, magnesium, and potassium that we need to avoid brain fog,

[00:07:01] to sleep optimally, to make sure that our bowel movements are most optimal, to help with everything from memory to muscle cramping and beyond. That is why we use Element, and it doesn't only keep you hydrated, it also tastes incredible. Jen and I both love the raspberry

[00:07:18] and watermelon flavors, but they have so much more available. They even have a chocolate flavor that if you mix with hot water, it tastes like a delicious, rich hot chocolate that you can have in

[00:07:28] the evening, again, to wind yourself down for bed or to have in the morning so you don't need to rely on that coffee for energy. Check out the link down below. It's drinkelement.com backslash optimal. With every purchase you make, with every order you make,

[00:07:43] you get a free sample pack that helps you sample all the flavors so you know which one you like best for when you go back to order more. So, check out the link down in the show notes and

[00:07:52] make sure you get your free sample pack of Element today. And will every pregnant woman have this? Basically, the research would indicate, depending on which paper you read, two-thirds to 100% of women will have some sort of widening of the linear alba, the tissue in between the two six-pack

[00:08:12] muscles. At the moment, the technical definition is two centimeters, so it's four-fifths of an inch. So, yeah, basically 100% of women will have some degree of widening in that area. We also know from the research, the limited research that we have, that two-thirds of women by 12 months

[00:08:35] postpartum will not have a diastasis at the end of it. And so, one-third will continue to have one. So, for people who are 12 months postpartum, usually they're doing things in that 12 months

[00:08:52] to try and address it. But all the evidence that we have so far is that nothing seems to improve it quicker than leaving it alone or just getting on and doing stuff. But that's not a very sexy

[00:09:04] marketing message and it's very difficult to sell products with that. So, people just make up other reasons why people have to do their special exercises. It's hard to sell a program for money when you're just telling people, yeah, just get on and live your life.

[00:09:21] Not many people are going to pay for that message, so I totally agree with you there. I think another thing I want to cover is like, who else does this affect? And I only ask this because

[00:09:33] growing up as an athlete, myself, I had a degree of separation and I started to see this when I was in my high school and college years. And so, I know that I'm someone who has a degree of a diastasis or a separating between the

[00:09:50] two sides of that rectus abdominis muscle. And I remember when I was starting to notice it, I had a few people tell me like, oh, normally only pregnant people get that. So, who else could be affected by this? Yeah, we see this in everybody. So,

[00:10:08] in children, for example, I noticed very early on that my youngest had a diastasis and I kept an eye on it and it was about 15 years. And I noticed one year in summer

[00:10:21] that he didn't seem to have the diastasis anymore. And I did nothing to address it. I made sure that all my kids were active playing sport. I didn't even tell my wife about it because she never

[00:10:33] raised it and I just didn't want it to be another thing that somebody was worrying about. So, I just kept an eye on it surreptitiously, checked in every summer basically. And yeah,

[00:10:46] we see it in kids, we see it in adults, we see it in people who've never been pregnant. We see it in older people, we see it in younger people. It happens for many different reasons.

[00:10:59] And you'll see it in athletes and bodybuilders. And you try telling them that their core is weak when they're at peak performance. They'll just laugh in your face, right? Yeah. We see it in everybody, but by far and away, the most common presentation that we see

[00:11:17] and probably the most distressing one for people is in that having been pregnant and postpartum population. Yeah. It's funny, I have noticed it as well in my six-month-old as he's using his core to bring his legs up and rotate. And it's just funny. It's not anything

[00:11:39] that obviously we're doing anything about. It's just I'm like, oh, that's cool. I see his tissues starting to work and form and different pressures, obviously, as his body's moving. And I think that's the thing that gets talked about the most with diastasis recti. And something that is

[00:11:58] talked about for prevention with pregnancy is that you have to understand how to manage your internal intra-abdominal pressures so that you're not putting excess pressure on the diastasis, which is going to help postpartum. So is that true? What is the findings for this?

[00:12:22] Yeah. So unfortunately, but much more fortunately, we don't experiment on pregnant people because that's just unethical. So we don't know 100% for sure. It seems reasonable that if you keep stretching tissue, just like if somebody was doing your exercises

[00:12:45] and they were going to eight to 10 out of 10 pain just to do a stretch, for example, it's going to be more likely that you might hurt yourself if you go to that degree of discomfort when you're doing something. And so we think that from scientific first principles that

[00:13:09] excessive amounts of pressure may lead to overstretching or a hernia or damage of some sort. That seems reasonable. However, it's difficult because you need pressure to stabilize. One of the main mechanisms of core stability is intra-abdominal pressure. That's how we stabilize.

[00:13:32] If you want to pick up anything that's considered heavy for you and it doesn't matter what the weight is, it just has to be heavy for you, you're likely to hold your breath at some point

[00:13:41] or manipulate your pressure because that is how you stabilize your body so you can move more load, produce more force. I'm not scared of pressure. I'm concerned about how people do things to manage their pressure. There's indications in the research, it's very,

[00:14:02] very weak but there's indications in the research that maybe having a diastasis is possibly protective for the pelvic floor. By allowing pressure to stretch you at the front of your tummy, you might be taking some pressure that's going downwards towards the pelvic organs

[00:14:24] and the pelvic floor, particularly in the early stages of the postpartum period like eight weeks where you've just had the whole area stretched out by being pregnant and then if you go vaginal birth, if you're delivered vaginally, you're going to have that area stretched as well.

[00:14:44] All of that is designed to be done, of course, through hormones and the design of the tissues. There's intra-abdominal pressure studies which show that every week postpartum, you slowly gain the ability to generate more pressure. We also see that every week postpartum, the amount of

[00:15:06] people with a diastasis decreases. I think controlling pressure is important but pressure is essential for normal function and if you want to be fit and active and do dynamic activities, then the ability to generate and control that pressure is really, really important. That's great.

[00:15:29] That's an interesting concept too that I don't think I've ever heard someone explain that a diastasis could potentially be a protective mechanism for the pelvic floor because our body would rather direct excess pressure forward than down into the pelvic floor and I think that's

[00:15:46] a really astute point there. I also appreciate how you live in this middle ground which like you mentioned earlier is not always the sexiest place to live where yeah, pressure is important

[00:16:00] but we also need to live our lives and there are points throughout our lives that we're going to need to manage pressure differently and there's not always a one standalone answer which I think is

[00:16:12] where people on social media try selling these sexy programs of fix your intra-abdominal pressure or find the one solution so you can have a balanced strong core. Are there any other, you know, from being on social media yourself, are there any other

[00:16:28] myths that really stand out for you that either annoy you to all heck or things that you just, you know, work on debunking in your own education? Yeah, 100%. We don't have long enough on this podcast to talk about them all but I'll try

[00:16:45] and get the highlights. I think one major thing is preying on people's insecurities and fears. I think that's one of the biggest ones. You know, instead of helping people focus towards a goal,

[00:16:58] whatever their goal is, even an aesthetic goal, that's fine. I don't have a problem with that. It's the fear of if you don't do this, you're going to have this problem. I have massive issues with that. I think it's unethical as health and fitness professionals, wellness professionals

[00:17:15] to prey on people's fears. And, you know, fear-based marketing is so effective that people are willing to set aside their ethics to do that. So I think it's important to recognize that. I think, you know, there is no evidence

[00:17:33] that having a diastasis is going to increase your low back pain, for example. Like there's plenty of males, for example, without diastasis who have crippling low back pain. You know, there's plenty of evidence that people with low back pain have a strong and more active

[00:17:56] cause than people without low back pain. So it's not about a lot of these things, you know. There's no association with increasing rates of pelvic floor disorders with having a diastasis. I think sometimes the reaction to the diastasis may be the issue there because, you know,

[00:18:22] if you don't like how you look or you do feel weak or you hear that you've got to turn your core on all the time, that does generate pressure. And if you're trying to keep your tummy flat,

[00:18:34] for whatever reason, there's no judgment. You want it to look flat? Cool. You know, you want it because you think you're weak? Okay. But when you do that and you don't allow the pressure to move through your system more evenly and you start bearing down on your pelvic

[00:18:51] floor and your pelvic organs, then you may develop issues that way. And not everybody will. Don't get me wrong. I'm not saying this is the reason why. I just want people to think about

[00:19:04] the consequences of their advice because I see people all the time in my limited, you know, I can't see 7 billion people. You know, people will bear down when they do things to try and improve their posture or activate their core. They will have this subtle bearing down pressure.

[00:19:26] And when you start loading that up, you know, it's what if that's the issue because they're scared of hurting their back or developing an issue? You know, we've got to think about the

[00:19:38] consequences of our advice and no matter how well-meaning it is, you know, the saying is that the path, what is it? The path to hell is littered with good intentions. Like, you know,

[00:19:53] I know that you mean well, everybody means well, but even I mean well and we can have negative consequences with our actions. So I think it's important to be circumspect, to have that degree

[00:20:07] of uncertainty and to be intellectually honest about what we do know. And, you know, results simply don't prove reasoning. Results are just results. I think it's so important to mention the aesthetic goal that a lot of people have and I think that's

[00:20:23] why people are reaching out to these programs on social media because it's, well, if you can get me the flat stomach, if you can get rid of my mom pooch finally, if, you know, and sometimes there is

[00:20:36] more skin and more tissue in the area now and especially if you have a little bit more of the widening of the diastasis. So a lot of people run to these programs is, you know, at what degree

[00:20:52] would we be able to say you can train for aesthetics or it's probably not as realistic? Well, it's difficult. Diastasis again in its definition is to do with the space between the muscles. It doesn't include the skin and the subcutaneous fat, the fats that's between the

[00:21:11] muscle and the skin. So, you know, I don't know how people can in good conscience say that you're going to have a flat tummy when your skin may have been stretched to a point where it's not

[00:21:24] going to come back to how it used to be. And if that is a concern for you, we should live in a society where you don't have to feel like you justify having cosmetic surgery because you want

[00:21:38] to deal with that. Do you know what I mean? Like I think a lot of the times that people, including surgeons by the way, try to make more of diastasis than what it is. It's because if

[00:21:52] you can say that having a diastasis is bad for you and that's the reason why I'm having a tummy tuck, well then I think you can turn up to a party and say that and not feel as judged as, hey, you know,

[00:22:08] I don't like how things are looking at the moment and, you know, I'm going to have surgery next week to take care of that. Like I think it's just easier for people to say, oh, it's bad for me

[00:22:21] therefore I'm going to have the surgery because it's important. I want to be healthy for my kids. Do you know what I mean? And that's sad that we live in a society where people have to justify that.

[00:22:34] So, let's dive a little into the meat and potatoes of exercise too because you've kind of alluded already to there might not be any specific magic sauce when it comes to exercise and diastasis. So, to what degree or is all exercise safe for people with diastasis or is

[00:22:56] there a level of diastasis maybe combined with other symptoms that people are experiencing that are pelvic or core pressure related where they should seek out a different type of exercise or a different type of professional to help them out with that? Yeah. It's a difficult question

[00:23:16] to answer. In general, getting up from a chair, just a regular dining room chair, not even a low set lounge sofa, like getting up from a chair has got more pressure than on average than most

[00:23:33] Pilates exercise whether it's on a reformer or on the mat for example and a lot of the exercises for diastasis are lying down. So, in terms of safety, what does that actually mean?

[00:23:49] I think that there's lots of things that we do in everyday life that produce more pressure and use more effort and if you get weaker because you're doing less strength work then it's going to be

[00:24:02] more effortful to go upstairs and you may not be able to avoid that. It's going to be more effortful to carry things. You might have to run suddenly and scoop up your kid and all of a sudden

[00:24:18] because you haven't trained for it, you may be hitting your limits a lot earlier than if you were training for such a thing. So, safe and unsafe, I have issues with. I don't think there's

[00:24:32] any such thing as an unsafe exercise. I think there are just some exercises that are higher risk of injury but it depends on the person themselves and then we go from there to

[00:24:43] well, how do I know that it's okay for me? One simple thing that I like to teach clients is to be able to teach them how to feel for bearing down. How am I pushing

[00:24:58] pressure through my pelvis and if they are, they still get to choose because some people it's more important to do the things they want to do than it is for their pelvic health. So, I make

[00:25:09] sure that they make a fully informed decision. The same with the tummy and like with a diastasis for example, lots of people see movement in the midline and they freak out and they stop doing

[00:25:23] things. So, I've got lots of consults on the diastasis project which I'll be able to release soon and you can just see the fear in these people and how it's not necessary. It just doesn't make sense to me that we're concerned. If you take

[00:25:44] say a towel, a hand towel say and you are going to try tear it in half and I told you that you had to keep that towel slack so it wasn't on maximum tension and then I told you you had

[00:26:02] to tear it without getting to maximum tension, you'd think that I was nuts. You can't do that, you've got to get it to maximum tension before the fabric breaks and if you're concerned about

[00:26:12] your diastasis and your midline is soft just because it moves, a slack hand towel will move. Just because your midline moves doesn't mean that you're on the verge of doing a hernia but that tissue has to get very, very hard. It's got to stretch quite firmly first. So,

[00:26:34] I think a lot of things that people say are unsafe are actually quite fine. I think most people are underloaded. We know from the research that most people don't meet the physical activity guidelines for example. So, I think that the safe-unsafe argument,

[00:26:55] it leaves a lot to be desired. Do I give people two weeks postpartum double leg lift and lowers? Not necessarily but I might if they were demonstrating how strong they were and

[00:27:10] they gave me a really good reason like, hey in eight weeks I've been paid already to perform, I need to be able to do this move. It's like, do you understand the risks? Yes, I do. Okay,

[00:27:20] let's do this as best we can. It's still up to the person. It's not up to me. I'm not the gatekeeper. That is a patriarchal medical model and I'm not a fan. Yeah. Totally. I think that's such a good point and being able to go to a provider,

[00:27:39] I mean either like yourself to be able to continue to learn or another hopefully professional who's not going to create fear in someone to be able to move and load and lift. I mean,

[00:27:52] I remember seeing a meme of, oh a woman wants to go and work out but doesn't want to lift, is afraid to lift more than 10 pounds but yet she's going to pick up her 30-pound child and

[00:28:04] carry groceries at the same time. And it is crazy to think of the load that many mothers are having to do on an everyday life but then afraid to do more or been told they couldn't do more in exercise.

[00:28:19] I think it's a very sad consequence of this fear that gets brought up when we talk about diastasis recti and being able to identify the difference and the soft doming and the hard

[00:28:32] doming that I know you talk about. I know that's going to sound like over a lot of people's head, me just saying that. But understanding the difference in your body and how it moves

[00:28:42] and being able to be guided by a professional I think is so incredibly beneficial. And there is a lot of talk as well in the muscles that contribute to closing the gap or what you need

[00:28:58] to be paying attention to to help close the gap. And for many years it has been talked about that it is the transverse of your inner core, essentially your transverse abdominus and your pelvic floor really helping to control that diastasis. And I know that you have

[00:29:17] stumbled upon some differences that you've seen. Can you talk about that? Sure. Well, the first thing is that it never made sense to me that transversus or obliques or any of them,

[00:29:29] there are no muscles that directly close that gap. The only muscle that can do that is rectus abdominis because all the other muscles pull outwards. So it confuses me when people, especially people who've done anatomy at university like physical therapists tell me that transversus

[00:29:51] closes gaps. It's like, explain how because I can't figure it out. And yeah, I think what we're doing is we're loading tissue and tissue adapts. The diastasis that people get is not damage, it's not

[00:30:07] an injury, it's an adaptation to a situation that was created by whatever reason in pregnancy and postpartum. It's by being pregnant usually and having that stretch on your belly. And so, it's a positive adaptation. If you didn't have that ability to widen there,

[00:30:30] it might be a very, very more painful pregnancy, more uncomfortable pregnancy. Your baby's growth might be hindered because you can't stretch in that way. So it's a positive adaptation. And at the end of the day, if you want that to change, well then we should adapt

[00:30:51] the body as best we can to it. And that means loading the tissue. If we said to any medical professional or athlete that, hey, you've got a tendon injury and what we're going to do

[00:31:07] is just put you in a boot. So let's say it's the Achilles, put you in a boot so you cannot use your Achilles and we're going to wait until your pain goes away and then we'll send you back

[00:31:17] on the field. People would go nuts. You should get sued if that's the way that you're helping people with an Achilles problem because that's not right. And you need to reload. It may be right to immobilize. They may have really, really bad issues. Cool, immobilize and then reload.

[00:31:37] And we know that loading tendons helps them. If you want a healthy tendon, you've got to load the tendon. And so, the linear alba is made of very similar materials. You have to load it if you

[00:31:49] want to adapt it and if you don't, if you don't load it, it's not going to adapt. If you keep offloading it as much as you can, how does it get stronger? I don't understand this.

[00:32:02] You know, everything in our body responds to load. We don't want to overload it. I think everybody's on board with that but I certainly think, again, we underload people. They're not doing enough often. I want to be careful because obviously, there are people

[00:32:18] that are doing too much. Yeah. And that's the most difficult thing, I think, especially about this podcast format is that everyone out there is in a different place and there are people who could probably definitely

[00:32:31] use more load and increase training versus other people that might be doing too much. That's just the challenge of trying to speak to all of those 7 billion people who potentially could listen to this at once. Exactly. So, we've kind of established the core, okay, specifically training transverse abdominis,

[00:32:53] specifically training your obliques, not specifically the thing that's going to help close the gap. So, what is safe? Another hard question that isn't going to have one single answer coming up but what is the best way to start approaching core training? Is it safe to

[00:33:13] do sit-ups and planks? What can people start to do to become a little bit more conscious and associated with how they're managing their pressures in their core and abdomen? Yeah. Yeah. You know, at this point, usually I would say go find a suitably qualified health or

[00:33:33] fitness professional to help you. Yeah. You know, I would feel confident saying, yeah, go see Doc Jim, go see Doc Don. But yeah, it's difficult to say because there are lots of people that were taught the older way of being fearful.

[00:33:49] So, you know, I think if you think about your natural movements, I think this is where it's going to be at. So, I think it's natural to be able to sit up and get out of bed. I don't think

[00:34:04] you should have to roll over forever unless you want to, right? But if you want to just get up quick, then you should be able to do that without fear. And we train people for that. So,

[00:34:18] you know, even a head lift will generate more load than lying there doing nothing. If you crawl around and play with your kid, you shouldn't be made to feel guilty that you're in

[00:34:29] a four-point position. Now, do I think that trying to achieve two minutes of planking at eight weeks postpartum is going to be good for you? I suspect that there are other things that might be worth

[00:34:40] your time, but it really depends on your goals. Maybe you're the planking champion of the world and you want to keep your title this year, even though you were pregnant and gave birth. So,

[00:34:53] in general, just being upright is a lot of load on the belly. People ask me, should I wear a support or not? It's like, well, I don't know because you need to be able to learn what hard feels like. So, Jen, you mentioned hard and soft doming. Yeah.

[00:35:13] So, you know, when you push in that midline, if it feels soft and you can push in and you can feel your muscles on the sides of your fingers, that's how far you can push in, you're unlikely to be

[00:35:24] doing damage. If when you do an exercise, especially like a plank, for example, and you push on the midline and it feels like it's working as hard as the muscles that are working next to it,

[00:35:38] like when you're really bracing your abs, then that might be considered hard doming without being able to see, right? It's difficult to say. So, I tell people if the midline feels as hard as when you push your finger into your tummy, into the muscles, well then maybe back

[00:35:58] off a little bit. Bring your knees in more or go down to your knees, bring your hands back a bit more, sit your bum back a bit over your knees. Find that spot where it's working hard but not

[00:36:12] so hard that we could be stretching it wider because you told me that you didn't want it to go wider. If you do want it to go wider, we know that if you do transversus exercises, it probably

[00:36:24] will. It doesn't mean that you get a lack of function, that's the thing. It just sits wider. That's just how it is. Yeah. And I know there is, I guess the hard thing with determining is it hard, is it soft,

[00:36:43] what am I feeling for? Obviously, seeing a professional to help guide you is going to be the best way. And there's also understanding, how do I say it? When you're doing ab exercises,

[00:37:00] you're told to search for firmness but making sure that it's not raised in that doming position or that coning position. So, is it okay to feel for firmness when you're doing exercises as long as

[00:37:16] it's not coning or doming or is that still putting too much excess pressure on the tissue? Well, no. In fact, pressure is pressure and tension is tension. And if the goal is to adapt your

[00:37:30] linear alba, then having tension in a dome or a cone or an arch is still tension. And if it's relatively soft, if you can push that dome back in, like the raised midline back in, and I've got

[00:37:45] videos on my Instagram highlights that show this. If you can push it back in, that's you're not under too much tension. I often ask people to take their middle finger or like take one of their fingers and push it backwards, pull it backwards until they feel a

[00:38:06] gentle stretch and feel the tendon in the palm of their hand, like it'll harden up. And if they, you can just push it against the edge of a desk if you want. And then the more they do,

[00:38:17] the more they feel, oh, that really feels like I shouldn't be doing that. And they'll feel that the tendon will get harder and harder and harder until self-preservation kicks in and you go, I'm not doing any more of that. So people listening, please don't hurt yourself.

[00:38:32] Please be careful. But to say that I'm at risk of tearing my tendon when my hand is relaxed and it's soft, that's what people are saying when they see that it's just a slack being taken up by the

[00:38:49] pressure. We call it the toe region in the stress strain curve. I'm not sure if you remember your physiology from back in the day, but it's the toe region. You're just taking up tension and it just

[00:39:02] pops up into a little cone, dome, whatever name you want to give it. And it seems to be fine for me. And people just, if they just keep training and getting stronger, things adapt. And sometimes

[00:39:16] they don't. I've seen people do lots of different programs and still end up wanting surgery because nothing worked, including working with me. And that's okay. We don't have enough information to predict who these people are. There's some risk factors, but it's pretty general.

[00:39:38] It doesn't predict who's going to get better after they've had a diastasis. And I appreciate the full truth in that, especially nowadays when we have so much to say, this is what it's going to be. And if you do this, then this will be the result.

[00:39:54] Where the reality is we just don't know and every person is so uniquely different, which is amazing. And we as clinicians get to continue to learn from other people as well.

[00:40:05] And I love too, I remember being at your course and there was someone who had a five-finger gap and yet they're doing CrossFit and they're incredibly functional and so strong. And aesthetically, someone might say, that's not what I want to look like, but functionally,

[00:40:26] so strong, able to do so much. And I think that's hopefully the message that people are able to see and understand is that just because you have this doesn't mean that you can't be strong,

[00:40:39] doesn't mean that you shouldn't do exercise. It's just understanding how to work with it for your body. A hundred percent. And function is very different to aesthetics. The difference is training for say CrossFit, you mentioned CrossFit. I'm sitting here in Madison at the

[00:40:57] moment for the CrossFit games, powerlifting, Olympic weightlifting, training for that is very different to training for bodybuilding. The training program that you might give a fashion model or a sports model is going to be a bit different to the training that you give somebody

[00:41:15] who's a professional field of sport athlete. We give people different programs because they have different goals. And if your goal is aesthetic, I will train you in an aesthetic way. But if you think that because you have a diastasis, you cannot have good function until you,

[00:41:34] in inverted commas, heal your diastasis, well, that's just not true. It's simply not true. Yeah. And I think we see example after example that disproves that. People being very strong, doing very high level activity, exercise that have that degree of separation or a significant

[00:41:56] degree of separation with no additional symptoms other than the aesthetic symptom of the diastasis, the visual diastasis. And I think it's funny because when Jen was taking your course,

[00:42:11] I think it was in New York. It was one of the first trips she and I had ever taken together. And I actually stopped by and I'm ashamed to say that I got a little free education from you

[00:42:23] kind of standing on the side of the gym, listening into one of the ends of the sessions. And I think one thing that stood out to me that I really still appreciate that you always say is,

[00:42:36] okay, how did that feel? Okay. Process that. Now do something different. And I think that that's so valuable. You've given a few examples here and there throughout this chat of, okay, if you feel a certain way when you're doing an activity, do something different and then assess

[00:42:53] how that felt and do something different and find a way that you can make yourself feel different within that movement, within your body, and then try to train into that. And I think doing that

[00:43:05] self-exploration can be one of the most valuable things for people to do if they're just trying to feel something different in their body. A hundred percent. And I call it the red slide. And the summary of the red slide is find the difference. So, different with an S,

[00:43:23] find the difference that make a difference. Yeah. You know, that's all we're doing as certainly as PTs. That's all we're doing. We go, okay, what's currently going on? Show me how you do it. And then nobody ever goes, just keep doing that.

[00:43:42] Like we always find something to pick on, change the technique in some way, optimize this, adjust that. And that's all it is. We're just trying to find the different things that they can do

[00:43:55] that will make a difference for them towards their goals. And when we lose sight of that, when we start going for dogma, you must be this way because that's how I was taught everybody should be like, and you don't fit that mold. Therefore, you're wrong.

[00:44:11] You know, your body's wrong. You're broken. Like I have massive issues with that. Yeah. Being able to do something different and explore that whether it's with a therapist or a trainer or a coach or whomever,

[00:44:24] your friend, or just at home on your own, being able to gently explore and find the edges of your fence. I think that's where the magic happens when we stress the body a bit. We know that from

[00:44:37] the research that you have to stress the body if you want the body to change. And if you have an aesthetic goal, you have to stress the body to attain that. And even then you may need surgery

[00:44:50] because we can't affect the skin and the fat that's there. It just doesn't work like that. Unfortunately, I wish I did because I'd be a lot richer. I'm very blessed. But yes. Yeah. I mean, I think it's so important to remember and things can be easily manipulated.

[00:45:10] I remember a couple of years ago, someone was coming out saying, you know, there's a person using my photo of the surgery I got on my stomach to try to sell their diastasis recti program. And

[00:45:24] it's just so sad that we just don't know. We don't know the marketing. We don't know the things that people are saying and showing. And so remembering that you're not broken. There's ways that we could still create function and live your life in a way that is fulfilling.

[00:45:44] And I think that's so incredibly important. And we can get out of pain and you can be strong and you might still need surgery and that's okay. So I love the message that you continue to preach the things that you're sharing and showing people.

[00:46:02] Where can people learn about some of the projects that you have coming up? Yeah, thanks. AnthonyLowe.com is the easiest way to find what I do. I see people both online and in person. I teach both online and in person. I have remote, like online only education.

[00:46:25] And I have the diastasis project, which I think is the most relevant for all of this. It's diastasis.info. And the plan is to get, I've got over, I must have over 70 consults by now.

[00:46:39] And I've just recently, because I haven't been able to get to them and I haven't got enough volunteers helping me edit video. The idea is to put these consults out so that people with

[00:46:50] diastasis can learn from watching the consult of somebody else who's volunteered this consult to be watched by the public. And I don't want financial barriers to be a barrier for them to get

[00:47:03] information. So it's all at the cost of a donation. If it's $1, it's $1. It's still going to be cheaper than seeing anybody really. And certainly cheaper than buying a program. So hopefully people find

[00:47:16] that valuable and useful and can learn from watching that. I hope to have some written content and programs and exercise demonstrations again, all just part of that donation. And if people want to support that work, I'd love that. So yeah, hopefully that will be available completely for the

[00:47:37] public. Anything that I do diastasis related, whether it's my paid courses or webinars, all of that goes to fund the project, which has been going since 2019. But it's all done off the spare time that I have and the spare time of the other volunteers as well.

[00:47:57] So it's been slow going, unfortunately. The wealth of spare time that I'm sure you have to devote to that. No, that sounds like an incredible project. And I think those consults are going to

[00:48:09] be massively impactful for certain people because sometimes you just need to feel seen in a way by seeing someone else who's going through the same thing as you. And with so many consults, I feel like a lot of people are going to resonate with certain consults in there

[00:48:26] and get incredible value out of that. So of course, we will have all of Antony's information linked up down in the show notes. If you haven't, you should go check him out on Instagram

[00:48:35] at physiodetective. Always trying to find the best ways to bring the education to the masses. Antony, thanks so much for the work you do and for spending some time with us today to chat diastasis.

[00:48:48] Thank you very much to you both for having me on the show. And I am happy for people to reach out and I'm happy to answer any questions that people have. So yeah, thank you again for this opportunity

[00:49:00] to share this message and the work of many others that are in this area as well. And thank you for the work that you both do in spreading a positive functional message out there. Thank you. Absolutely.

[00:49:15] So much so appreciate that message and that conversation with Antony, educating and continuing to help people do something different, to feel something different in their bodies. That's what Jenna and I preach all the time. And we love the message that Antony brings when it comes to

[00:49:29] diastasis, educating on the core and on the pelvic floor. And we thought that this interview would be so relevant because we just launched the Pelvic Floor Foundation's course and it is still discounted

[00:49:40] this week only until Friday. You can get a discount on the course and our podcast guests only get an extra discount when you use code optimal. So make sure you go down to the link in the show notes.

[00:49:50] It's just Jen.health backslash pelvic floor. Use code optimal at checkout and get into that course. And of course, we will see you next time on the optimal body podcast.