What is Diastasis Recti Abdominis? (DRA)
“This is just what happens when you have kids.” Words that make every pelvic floor PT cringe. Urinary leakage, pelvic pain, and weaker abdominals are not conditions you need to suffer through after child birth. Even conditions like abdominal separation or Diastasis Recti can be treated with physical therapy.
What is Diastasis Recti Abdominis?
A common complication of pregnancy is Diastasis Recti Abdominis or DRA. Diastasis is a seperation of the left and right rectus abdominis (think six pack muscles). The connective tissue, called your linea alba, holding these two strips of muscle together is stretched out (Keeler, et al, 2012).
Diastasis affects 60% of postpartum women but you don’t have to be female or have experienced pregnancy to develop a diastasis (Keeler, et al, 2012). However, the expanding abdomen and hormonal changes that cause tissue laxity increase the risk for this separation in pregnancy.
Why does it matter?
Diastasis is not a cosmetic issue. A separation in our abdominal muscles can alter how we generate tension through our core. Our ability to appropriately regulate the tension in our core provides us with spinal and pelvic stability, as well as intra-abdominal pressure control. When we cannot maintain the stability or pressures of our body we are more at risk for low back pain and even urinary incontinence.
How do I know if I have DRA?
Lie down with your knees bent. Place two fingers perpendicular to the abdominal wall. Then, lift your head and shoulders off the surface you are lying on. With a moderate amount of pressure, feel above, below and at the belly button. You are noting the width between the two strips of abdominal muscles and the depth that your fingers sink in.
If you are not sure what you are feeling, consult with your physical therapist. A width greater than 2 finger widths is considered a DRA. However, depth is important to consider as well. Depth may provide us with additional information on how we are generating tension through the abdominal wall.
What can I do about it?
While increasing core control is important for the management of diastasis, it is imperative to be cautious with certain abdominal exercises. Crunching and twisting when performed incorrectly can actually further distort the linea alba (Lee & Hodges, 2016).
Consult with your physical therapists to create a treatment plan that is appropriate for you. Your physical therapist can examine many factors that may be contributing to your diastasis. Manual therapy techniques may be used to release restriction in other muscles that pull on the linea alba. Taping and support techniques can be implemented to help approximate the separated strips of muscles. Most importantly, physical therapy will teach you how to use your own body mechanics to reduce the separation. With proper pelvic floor, transverse abdominis, and breathing mechanics the functional limitations that are correlated with DRA can significantly improve (Sandra, et al., 2018).
Keeler, Jessica & Albrecht, Melissa & Eberhardt, Lauren & Horn, Laura & Donnelly, Chantal & Lowe, Deborah. (2012). Diastasis Recti Abdominis. Journal of Womenʼs Health Physical Therapy. 36. 131-142. 10.1097/JWH.0b013e318276f35f.
Lee D, Hodges PW. Behavior of the Linea Alba During a Curl-up Task in Diastasis Rectus Abdominis: An Observational Study. J Orthop Sports Phys Ther. 2016 Jul;46(7):580-9. doi: 10.2519/jospt.2016.6536. PMID: 27363572.
Sandra L Gluppe, Gunvor Hilde, Merete K Tennfjord, Marie E Engh, Kari Bø, Effect of a Postpartum Training Program on the Prevalence of Diastasis Recti Abdominis in Postpartum Primiparous Women: A Randomized Controlled Trial, Physical Therapy, Volume 98, Issue 4, April 2018, Pages 260–268, https://doi.org/10.1093/ptj/pzy008