Many of us have heard of Diastasis Rectus Abdominis (DRA), or have experienced it ourselves. This is especially common during pregnancy, with incidences found between 66% of women during the third trimester [1], and, more recently, incidence has been reported as high as 100% by 35 weeks of gestation [2]. Diastasis is also very common postpartum, with the prevalence being approximately 54%, 45% and 33% at 3 months, 6 months and 12 months post-partum, respectively [3]. DRA is also found in individuals with a weak core. You might even notice it in an infant as they build their core strength!
While extremely common, there is a lot of misinformation surrounding DRA. We’ll go through a few common myths, and look at the science. But first, let’s go through what DRA means.
What is a Diastasis Rectus Abdominis (DRA), and how does the core fit in to rehabbing this condition?
A DRA is a widening of the Linea Alba, which is a band of connective tissue located between the rectus abdominis (your 6 pack muscles), and connected to your inner core via the transverse abdominis muscle. This condition may present as pain or discomfort in the abdominal region, weakness during exercise, and visible doming or sagging of the abdominal midline. The strength of the Linea Alba is determined by how well a few key muscles generate force through it, ultimately the transverse abdominis. Let’s review some functional anatomy to gain a better understanding of how strength, support and power is generated in the abdominal region.
Your abdominal strength is made up of many layers of muscles working together. The inner core unit is made up of 4 muscle groups: your transversus abdominis, pelvic floor, diaphragm and the the lumbar multifidi. These muscles work together to support your lower back and pelvis. Functions include managing intraabdominal pressures (such as during sneezing, coughing, laughing, or during pregnancy), maintaining proper posture, and providing endurance and support during activity. It is important to note that the transverse abdominis and pelvic floor work together, and, when activating in unison, help make each other stronger. Thus, pelvic floor strengthening is key in DRA rehab.
The outer unit include your rectus abdominus, obliques, erector spinae and quadratus lumborum muscles. They flex us, twist us, move us.
Due to the Linea Alba’s attachment points to both the inner and outer units of the abdominal muscle complex, targeted and gradual strengthening of both units must be done. Before we talk treatment, let’s take a deeper dive into this condition by going through some common myths.
MYTHS
Myth 1: It’s all about the gap.
Looking at the width of the gap provides only part of the story. There are very strong individuals who have a separation, who have reached their rehab goals, and can perform at the level that they need to, without any pain or weakness.
When being assessed for a DRA and during functional movements, what is more important is the ability of the Linea Alba to create tension across its fiber. Is the tissue firm or soft? Does it have endurance while performing a plank for example, or does it fatigue? Measuring the ability of the tissues to generate strength and control while performing different tasks is what will be key in creating a treatment and exercise plan. Thus, we assess the width, the depth, and the endurance of this area during functional movements to properly assess a DRA.
Myth #2: I have DRA; my abdominal muscles are injured.
This is one of the most common misconceptions out there. Having DRA does not mean your abdominals are injured. In fact, during pregnancy, the connective tissue and the muscles attached stretch to accommodate the growing baby. What has been stretched is the Linea Alba.
Myth #3: Having a DRA during pregnancy means that I am weak.
Your body’s ability to adapt to a growing baby is incredible and having a diastasis during pregnancy is another way that your body is adapting. Factors that may influence DRA incidence include [2]:
· pre-pregnancy body mass index
· weight gain during pregnancy
· baby’s birth weight, abdominal circumference during pregnancy
· general hypermobility statistics (Beighton’s Score).
While having a DRA during pregnancy is extremely common, steps can be taken to reduce the amount of widening that occurs. Postural awareness, mindful movement, muscular coordination, and appropriate prenatal strengthening can make a significant difference.
Myth #4: I should avoid abdominal exercises because it makes the DRA worse.
A common misconception with DRA is that certain exercises such as sit ups, crunches or planks can cause the separation to worsen. While this may be true depending on where you are in your rehab journey, it is important to note that these exercises may, and very likely will become a part of your individualized exercise program as your gradually strengthening. Connective tissues and muscles must be loaded in order for them to adapt and strengthen. This is where it becomes imperative to seek out a qualified specialist who is well versed in core strengthening and has a deep understanding of your physical activity and wellness goals, medical and physical history, and of your specific biopsychosocial considerations.
Myth #5: There are specific exercises that I should do to address my DRA.
There is no specific evidence stating that there is a single exercise or exercises that will address a DRA. There is, however, evidence that individualized core strengthening, and stability exercises can be effective. Challenging your core in different positions and with different exercises will be essential on your rehab journey. What is important to recognize is that each and every person’s DRA is unique and requires individualized care.
How does Pelvic Health Physiotherapy fit in?
Remember, pelvic floor muscle strengthening has been shown to increase the strength of the transversus abdominus muscle, which in turn accelerates the ability to strengthen the linea alba and reduce a DRA. Proper assessment of the pelvic floor is key to establish baseline strength and coordination in order to develop an individualized treatment plan, best suited to your current lifestyle and abilities. Proper assessment of your Diastasis Recti is also very important as it will help determine where to start treatment and which exercises would be best for you.
At Mississauga Pelvic Health, we have Pelvic Floor Physiotherapists who are trained in post-partum care to work with you on your journey to rehabbing your Diastasis Recti!
If you have any questions or would like to start your pelvic health journey, contact us to book a free 15-minute phone consultation with one of our amazing Pelvic Health Physiotherapists!
1. Boissonault J S, Blaschak M J 1988 Incidence of diastasis recti abdominis during the childbearing year. Physical Therapy 68(7):1082
2. Mota P G, Pascoal A G, Carita A I, Bo K 2014 Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther 2014; doi: http://dx.doi.org/10.1016/j.math.2014.09.002
3. Cavalli, M., Aiolfi, A., Bruni, P. G., Manfredini, L., Lombardo, F., Bonfanti, M. T., Bona, D., & Campanelli, G. (2021). Prevalence and risk factors for diastasis recti abdominis: a review and proposal of a new anatomical variation. Hernia : the journal of hernias and abdominal wall surgery, 25(4), 883–890. https://doi.org/10.1007/s10029-021-02468-8