Diastasis Rectus Abdominus (DRA or DR)
Questions:
The causes and symptoms of diastasis recti
How diastasis recti should be treated
How diastasis recti can be avoided
The safety of exercising with diastasis recti and how best to do it if so
Any exercises/movements to avoid with diastasis recti
Warning signs to watch out for and what to do
Diastasis Rectus Abdominus (DRA or DR) is a condition where the rectus abdominus muscles separate due to weakening or stretching of the connective tissue that joins these muscles at the center of the abdomen. This connective tissue structure is called the linea alba. Most commonly, this occurs due to growth and stretching of the abdomen during pregnancy, but can also happen as a result of a large abdomen or weak muscles, making it possible to occur in both men and women. It is common during pregnancy due to the relatively quick growth of the abdomen as the baby grows in the uterus. This is a very normal part of late pregnancy, but something to be aware of and addressed postpartum. Many women have a gradual return of normal rectus function and distance, but should always be aware of proper core activation and strengthening postpartum to help the abdominal muscles return to optimal function.
Symptoms of DR are a bulging or doming at the central vertical line of the abdomen with increased abdominal pressure. You may notice this doming while attempting to sit up in bed or any time the abdominal muscles are working. Some women report that as the day progresses, their abdomen bulges out almost as if they were pregnant. The stretching of the connective tissue and separation of the muscles can cause abdominal weakness, which may lead to other symptoms such as lower back pain, pelvic girdle pain, stress incontinence and abdominal pain. The disruption of the pressure system in the abdomen and core can cause compensatory muscle imbalances.
Treatment for DR depends on the severity. Most often, specifically performed exercises guided by a physiotherapist will help restore connective tissue integrity and muscle strength, and full function will return. Early intervention is best, however it is never too late to address DR if you have it. If you notice any symptoms, do mention this to your OB/Gyn or seek help from a physio as soon as you are able. In rare cases surgery is required, but the vast majority of women can recover with proper exercise.
The best way to avoid DR is through prevention. Maintaining good abdominal, pelvic floor, hip and back strength and mobility can set you up for success postpartum. Exercising throughout pregnancy will help your body and your muscles recover more quickly after delivery. If you are expecting, you want to work on core strength throughout your pregnancy. Not only will it help you support your changing body during pregnancy, but will allow easier return to exercise postpartum.
If you have a DR, there are a few things to be aware of during exercise and daily movement. The first rule is never hold your breath! Always breathe through movement. Your diaphragm and pelvic floor work in tandem with the abdominals to stabilize the spine and pelvis, and if you are not moving your breath you are not able to correctly engage and may be pushing out against the muscles, adding stress to the DR. Exhale as you pull in, activating the deep abdominals and pelvic floor. This can help create stability at the linea alba and rectus muscles by engaging the deep core. Try this with functional movements such as lifting, moving out of bed or getting up from a chair. Another rule to be aware of is activating the deepest layer of abdominal muscle, which is called the transverse abdominus. You can do this by drawing your belly button towards your spine, as if you are zipping up a tight pair of pants. This helps create stability at the midline of the abdomen to protect the healing connective tissue.
If you cannot maintain a deep core contraction and move your breath during exercise, you will need to modify until you can perform it with these actions in place. The biggest mistake postpartum women make when it comes to DR is doing too much abdominal work too soon. Slow and controlled movements with mindful deep core activation are best, and start basic. You should avoid sit ups or crunches, especially if you see the doming as mentioned earlier. Working on leg and arm movements with a neutral spine in supine, quadruped or standing, maintaining good breath movement and core activation. Once you can do this with good control, you can increase the difficulty and do more challenging core work with the goal of returning to your preferred form of exercise. Seeking help from a physical therapist is very important if you are not sure where to start or how to progress. Your therapist can help design a program that is specific for your needs and help you reach your fitness or functional goals safely and quickly.