Linea Alba: Abdominal Link, Anatomy and Role in Diastasis Recti
The Linea Alba (White line in Latin) is a fibrous line that travels vertically down the abdominal wall’s midline that connects the rectus sheath to the rectus abdominus. The alba line from the xiphoid process (sternum) ends at the pubic symphysis. This structure can easily be seen in the athletic population due it the deep depression that separates the “six-pack”. The line darkens with extra melanin during pregnancy and then is named Linea Nigra (black line).
The Linea Alba is a crucial structure functionally by acting like a zipper on the front of the abdominal wall.
Structures that blend into the linea alba:
- External Oblique
- Internal Oblique
- Transversus Abdominus (TVA)
- Xiphoid process
- Pubic symphysis
- Fundiform ligament of the penis (attachment site)
- Pyramidalis muscles
- Parietal peritoneum
- Scarpa’s fascia
- Camper’s fascia
Diastasis Recti and Pregnancy
The linea alba is stretched and weakened during pregnancy and is the most common cause of injury and abdominal separation between the two sides of the rectus abdominus muscle. This separation is known as diastasis recti.
Diastastis Recti in Men
Men can also develop injury to the linea alba due to:
- Weak obliques
- Poor connection between TVA and pelvic floor
- Inadequate diaphragmatic depression during inhalation (breathing in) to create intraabdominal pressure
- Over-reliance on lumbar paraspinal muscles and rectus abdominus muscle during core and spinal stabilization (rib flare)
Injury to the linea alba occurs due to the considerable strength of the erector spinae muscles and poor strength/endurance of the core system, lumbar extension, and rib flare during power-based movements such as the back squat and bench press. Over time, this Rib flare due to back extension (like pregnancy) weakens the linea alba until diastasis recti occur. This posture is known as the scissor position and is part of a lower cross syndrome.
Treatment
Linea alba injuries during pregnancy are prevented by complete body movements that don’t rely on the core muscles. Getting out of bed is the most common way to cause this injury. Exercises are the same for men and women, but women with uncomplicated pregnancies should wait 2-3 weeks before beginning exercises.
Step 1- Breath retraining
Step 2- Retraining the synergy of the core muscles contraction to integrate the entire system, not just the rectus abdominus.
Log roll
Step 3- Increase capacity by using long lever arms (movement) with longer lever arms (arm/leg movement)
Dead bug
Step 4- Add in variation to exercise starting from on back (supine), moving to side-lying, quadruped to standing.
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