Dia- whaaaat?

If you’re following any pregnancy or postpartum fitness professionals on social media, it seems as though there is talk about diastasis rectus abdominis (DRA) everywhere. Many people have heard of DRA, but aren’t really sure what it is, if they should be worried about it, or how to go about addressing it. Let’s clear some things up. 

What is diastasis rectus abdominis (DRA)? 

First, we need to talk a bit about the anatomy of the core. We’ve got several layers of abdominal muscles: 

  1. Rectus abdominis or “six-pack” muscles on each side of our midline 

  1. Internal and external obliques that run diagonally along the sides 

  1. Transverse abdominis that wraps horizontally around our trunk like a built-in “corset”  

Along the middle of our abdominals, we have our linea alba, which is connective tissue that connects the two sides of our rectus abdominis or “six-pack” muscles. The connective tissue of the linea alba allows for some flexibility of the core – very important if you’re growing a human! As the abdomen expands, the linea alba will widen to allow more space, creating a separation between the two muscle bellies of the rectus abdominis. This often presents in the second or third trimester of pregnancy. Research has shown that by the 35th week of pregnancy, 100% of pregnant individuals will develop a DRA.  

Read that again. By the end of pregnancy, nearly everyone develops a separation of their abdominals muscles. So, a diastasis rectus abdominis during pregnancy and in the early postpartum period is normal. It means that your body did its job in ensuring that you had enough space for your baby to grow.  

Other people, including men, can develop a DRA due to other reasons, including weakness, suboptimal body mechanics, or after abdominal surgeries. In many cases, the diastasis rectus abdominis resolves on its own over the first three months postpartum. Some people will find that it sticks around longer.

How do I know if I have a diastasis rectus abdominis (DRA)? 

Some people will notice a separation of their abdominals above or below their umbilicus, or belly button. They may feel a space between the sides of their rectus abdominis or a change in what their stomach looks like. Others may notice weakness through their core as they ease back into exercise or activity.  

One test for DRA involves observing and feeling the abdominals as someone does a small abdominal crunch. There may be “tenting” or “doming” through their abdominals, with the abdominal muscles sticking out, rather than staying relatively flat. This can also occur with exercising, sitting up, rolling over, getting out of bed, or lifting. Alternatively, they may notice a “sinking” or divot through the middle of their abdominals with similar activities. 

Some patients have an abdominal separation with no symptoms. Others experience low back, hip, pelvic, or abdominal pain, or have issues with continence or leaking.  

OH NO! I think I have a DRA! What do I do about it?! 

First of all, remember that it is normal to develop a diastasis rectus abdominis (DRA) while pregnant and that in many cases, it resolves on its own within the first three months postpartum. That being said, there are a lot of things that we can do either while a patient is pregnant or postpartum to try to treat some of the underlying factors that are contributing to the separation, address symptoms, and minimize the potential for long term issues. 

If there is tenting, doming, or sinking of the abdominals with activities, issues with continence, or weakness or pain through the abdominals, hip, back, or pelvis, a patient should be assessed by a trained physical therapist to determine whether the DRA is contributing to their symptoms and if it needs to be addressed. In physical therapy, we take a look at the whole patient and try to determine what factors are contributing to the current symptoms.  

Often basic activities -- how patients stand, move, breathe, or use their abdominals for exercise and other daily activities (including lifting and carrying your child!) can contribute to a persistent separation of the abdominal muscles. Learning to use the muscles more efficiently may reduce the separation and decrease other symptoms.  

Soooo...what does a PT do for DRA? 

It depends! Many different factors can contribute to an abdominal separation or DRA. Treatment will look a little bit different for each patient depending on what we see when we are examining a patient. Learning how to decrease the amount of pressure placed on the abdominals can help reduce the tension on the linea alba and reduce the gap between the abdominals.  

 Treatment may include: 

  1. Soft tissue massage 

  1. Postural education 

  1. Education in proper use of the abdominals to avoid doming or sinking with activities or exercise 

  1. Adjusting body mechanics for exercise and daily activities – including caring for a baby 

  1. Breathing 

  1. Stretching 

  1. Strengthening 

  1. Scar mobilization 

This article was authored by one of our expert physical therapists, Lauren Hogan, PT, DPT, OCS, ATC, FAAOMPT. You can schedule with her by calling 414-224-8219 or learn more about Lauren at laurenhoganpt.com

 

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