I’m sure at some point, you’ve heard someone mention diastasis recti or DRA, but you might still be wondering just what it is. Well, let’s start with a quick anatomy review. Diastasis recti is a separation of the connective tissue in the middle of the large abdominal muscles known as the rectus abdominis (6 pack abs). The rectus abdominis runs from the sternum to the pubic bone, and therefore diastasis can occur anywhere along that length of the connective tissue (the linea alba). Oftentimes, the linea alba becomes softened and stretched during pregnancy due to hormonal changes and increased pressure in the abdomen from the developing fetus.
How it happens
When these tissues are softened and stretched, they become less efficient, and thus more easily injured with various activities. This is especially true with activities that increase pressure in the abdomen or require forward flexion of our trunk as this is the primary function of the rectus abdominis. This can include certain core exercises during the second and third trimesters of pregnancy or early postpartum, excessive pressure with pushing during delivery, excessive straining due to chronic constipation, poor pressure management or breath holding with exercise, or poor pressure management with lifting during daily activities.
It can also occur in the early postpartum phases from returning to activity too rapidly, especially high intensity activity like running, HIIT classes, Crossfit, or powerlifting. Other risk factors for diastasis recti include:
Women who have had multiple births, especially those women who have become pregnant again within 18 months of delivery.
Women who are pregnant with multiples.
High birth rate of the baby.
Genetics – women whose mothers had DRA are more likely to develop DRA.
How to help prevent it
While several of these risk factors are outside of your control, there are still ways to help prevent diastasis and/or lessen the severity of it. First, let’s review how to perform a self screen to see if you have diastasis. This can be done lying on your back, with your knees bent and feet on the flow. Without activating your abs, lift your head off the floor like you’re performing a chin tuck. Then take your fingertips and gently press along the midline of your abdomen. If you get a nice springy resistance, and your fingers do not sink in, then it is likely your tissues are completely intact. If there is little to no resistance and your fingers sink in at least to the first knuckle, chances are you have some level of diastasis.
Common signs and symptoms
If you’re still unsure, here are some common signs and symptoms that are often associated with diastasis recti:
- Feeling of inability to activate your abs or feeling extremely weak (especially when you previously had good core strength and endurance).
- Pulling or stretching sensation in the middle of your abdomen with crunches, planks, or other high level core exercises.
- Doming or conning (pictured below) with lifting during daily activities or exercise, with core/ab exercises, or with bowel movements.
Seeing a PT can help
Seeing a pelvic PT can also help! We can:
Help assess for potential diastasis.
Give specific modifications that fit your personal lifestyle.
Assess the strength, motor control and endurance of your deep core.
Help you prepare for childbirth by educating you on the proper breathing and pushing techniques during delivery.
Provide treatment to any weakened or tightened tissues that may increase your risk of diastasis.
If you are certain you have diastasis, don’t be alarmed. There are treatment options available.
Noninvasive treatment options
Pelvic PT is a great, noninvasive way to help improve diastasis recti. A pelvic PT can help educate you on proper breathing techniques to ensure you are not breath holding with activity, and are properly engaging your deep core and pelvic floor to help support the DRA with activity. We can also assess your muscles and connective tissues for tightness, and treat those restrictions with manual techniques.
In some instances, the patient may require surgical intervention. This is typically if the patient has a DRA that has not improved in depth or width with PT, they are at least 1 year postpartum and not planning on having anymore children, or if they develop a hernia that is causing significant pain. In those cases, the patient should consult a plastic surgeon to discuss their treatment options.
Are you currently pregnant or planning to conceive? If so, make sure to download my FREE resource — 5 Myths We’ve Been Told About Pregnant Bodies! I correct common pregnancy myths and give you tons of tips to help you feel strong and healthy for 40 weeks and beyond.
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