You may have heard of diastasis rectus abdominis (DRA) because it has been getting a lot of press in the past couple of years. In fact, the Today Show highlighted it in a special Modern Motherhood video: “What Really Happens to Your Pelvic Floor:”
My pelvic health physical therapy colleagues and I are seeing more self-referred postpartum patients because of this increased awareness.
Diastasis rectus abdominis occurs when the normal distance between the two sides of the rectus abdominis, or “6-pack muscle,” widens. Women may notice it’s more difficult to get out of bed and notice “tenting” of the abdomen.
The distance between the the right and left sides of the rectus abdominis isn’t the only aspect of diastasis recti abdominis we evaluate. We also want to note if the fascial integrity at the linea alba is compromised. When you have a baby, your pressure systems in the abdomen change immediately and you can’t find where your center is. Your core control has been shifted completely.
Diastasis rectus abdominis can occur:
- during pregnancy
- after abdominal surgery
- in children before they gain abdominal wall strength; it may remain through the lifetime
- in men too!
How do I know if I have a diastasis rectus abdominis?
Oftentimes the women I see in the clinic seek treatment because
- they have felt a gap
- their midwife has tested them for diastasis
- their core feels weak
- they are frustrated that their belly doesn’t look the way it did pre-pregnancy
- they have an abdominal bulge that they notice when getting out of bed or during exercise
What exactly is diastasis rectus abdominis?
As physical therapists, we look at a two things: what’s happening at your linea alba and how is force transmitted through your pelvic girdle.
The linea alba is a fascial band between the two sides of the rectus abdominals or “6-pack muscle.”
During pregnancy (and sometimes after) you will see the linea alba widen and the two sides of the rectus pull away from your midline. As physical therapists, we look at the full length of the rectus distance (the “gap”) from the ribs at the top to the pubic bone at the bottom of the abdomen.
To test the gap, we look at the distance between the right and left rectus bellies during a crunch sit-up. Can we pull them wider apart with gentle pressure? What happens when we pre-engage transverse abdominals?
Recent research shows that even though the distance between the rectus bellies might widen with a curl up, the distortion at the linea alba might improve because of activation of the transverse abdominal muscles.
Therefore, when we look at rehabbing someone with a diastasis rectus abdominis, we take into consideration both the gap as well as the fascial integrity of the linea alba.
We evaluate the ability of the tissue at the linea alba to generate force tension, which is accomplished if there is good fascial integrity by noting how easy it is to press into midline and if there is tension underneath our fingers.
Diastasis rectus abdominis aside, we also want to make sure you are able to optimally transfer load through your ribs, abdomen and pelvis.
Common compensatory patterns during load transfer may include puffing your abdomen up or holding your breath. This is important because we want our deepest stabilizing muscles to be in charge of the load for optimal core strength.
Transmitting load through your pelvic girdle
Women often are disappointed or suffer from embarrassment postpartum because they have looser skin, tenting down the center line, and might even be asked by people if they are pregnant.
Beyond how you feel about the way your belly looks, does it matter?
Physically, yes. Our abdominal wall is critical in transferring load across the center of our body. Strength in this part of our core helps prevent back pain, hip pain, and incontinence.
We want our abdominal wall to be as strong as possible, throughout the entire lifespan.
How does an optimal abdominal wall function?
We have four different abdominal muscle groups:
- Rectus abdominis
- External oblique
- Internal oblique
- Transversus abdominis