Talofa Samoa and welcome back to your weekly Physiotherapy column! Today's column is written by PhysioChoice in Australia – enjoy!

Abdominal separation is an issue that’s usually thought of as something that happens to women after their abdominal wall has been stretched by carrying a child, but it is something we see in people who have not carried children. It is possible, and not uncommon, to find smaller degrees of abdominal separation in young, fit, healthy men, for example. It is also common to find more significant separations in perhaps less active men.

What is abdominal separation? 

If you think of your six-pack muscles—your rectus abdominus—the tissue that runs down the centre and divides the right side from the left side is called the linea alba. Normally there is about a finger width of space between the right three-pack and the left three-pack, and that centre divide, the linea alba, is so firm most people don’t even know it’s there.

An abdominal muscle separation happens when the space that runs down the middle gets wider. The linea alba gets stretched wider, and there is increased space between the right and left sides of your rectus abdominus. In all genders, our physios have seen this separation range from two finger widths apart to being so wide the therapist can put their entire hand in the space. It’s common postnatally, but it can also be seen in people who haven’t carried children. 

For example, Alexander Skarsgard can be seen in the Tarzan posters with an increased inter-recti distance (i.e. an abdominal separation). Even though his abs may look enviable, this separation can contribute to back pain. Separation of the abdominal muscles can also be seen in people who are not as fit as Skarsgard was when he was playing Tarzan.

What causes abdominal separation? 

Every person’s situation is different, but some common causes include:

• Significant abdominal wall stretch, e.g., pregnancy.
• Poor core strength
• Muscle imbalances
• Poor coordination of abdominal muscles (i.e., inefficient strategies in how you use your tummy muscles)
• Reduced fitness
• Excessive focus on abdominal muscles in exercise—particularly with increased oblique bias in training programmes.
• Altered breathing strategies.
• Restrictions within the ribcage and/or diaphragm.
• Bracing strategies (e.g., when you go to do a heavier movement and you push your belly out)

What does it mean if I have an abdominal separation? 

Again, every person’s situation is different, and the degree to which abdominal muscle separation impacts them varies, but it significantly increases the risk of back and pelvic pain, breakdown of spinal discs, development of hernias, and deterioration of continence mechanisms. Basically, if not appropriately managed, abdominal separations can lead to disc issues in your back, and hernias and, in women, commonly contribute to the leaking of urine during exercise. It also can impact the way your stomach looks. Lots of men complain of feeling barrel-chested or larger in the stomach than they feel they should be.

Do abdominal separations mean I have an increased risk of back pain?

If you were to do a little sit-up or a crunch, the tissue that runs down the middle of your six-pack, the linea alba, should feel firm—like a t-shirt pulled tight—when you touch it. Commonly because of a core muscle imbalance associated with abdominal separation, the middle feels softer when people do this little sit-up or crunch. Sometimes it’s pretty squishy, and you can barely feel it. 

The linea alba is really important to help transfer force around your body. If you were to play tennis, for example, and you went to hit the ball, you need the forces generated in your legs and torso to transfer well through your body so you’re not just creating the power in your shot from your arm and shoulder muscles. If your core isn’t great and your linea alba is softer than it should be, those forces will travel up your legs, heading up to try and help you hit the tennis ball, but instead of travelling across your body through your stomach muscles, it just stops.  

When it stops, that load and force disperse to the lower back and the pelvis. In other words, your lower back and pelvis cop all the load because your stomach muscles aren’t working correctly. This happens throughout the day with big tasks and small tasks, and slowly, your joints and discs start to complain. 

If your stomach muscles aren’t coordinated and strong, this also leaves your back vulnerable. How do I check if I have abdominal separation? 

What does abdominal separation look like? 

Abdominal separation symptoms may include a visible bulge or gap in the midline of the abdomen, along with potential lower back pain and weakened core muscles. If you do a little sit-up or a crunch, does anything push out the middle where your six-pack should keep things flatter?  

If you do a little sit-up of a crunch and gently feel your stomach, is there a gap in the middle where there should be muscle? 

The best course of action is to get an expert physio to check it for you. Roughly 50 per cent of the time, patients don’t realise they have an abdominal separation, even if it’s large because they’re unsure what to look or feel for. So, if you have back pain, we suggest you get an awesome physio to do a thorough check for you. 

• Eliana Viali is a Physiotherapist by profession and can be contacted at the following email address [email protected]