Pregnancy-related diastasis rectus abdominis (DRA) describes a process where the connective tissue down the midline of the abdomen, called the linea alba, widens and thins to accommodate the growing baby. This natural physiologic process occurs in 100% of pregnant women. Beyond the linea alba, there is also stretching of the entire abdominal wall as the uterus expands. The role of the linea alba is to tension so it can transmit forces and load from your extremities through your trunk efficiently to move!
Having poor abdominal strength and a lengthened and thinned linea alba can contribute to back pain, constipation, incontinence, and more.
To the side is a picture of a typical abdominal wall and a diastasis recti. You will notice that in a diastasis recti, the linea alba is stretched out. As a result, you may notice bulging, doming, or coning present at your linea alba.
Your diastasis recti can occur in various locations of your abdomen, including
Above your umbilicus
At your umbilicus
Below your umbilicus
Along the entire length of the linea alba
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How do I know if I have a DRA?
A pelvic floor physical therapist will perform a DRA assessment. A 2-finger diastasis is a "true" diastasis.
Can DRA improve?
ABSOLUTELY! Connective tissue, fascia, and muscle can all be "molded" or "remodeled" with strength training and loading your tissues! A pelvic floor physical therapist will guide you through an exercise program to help address your DRA.
Treatment may include:
Releasing any adhesions or soft tissue restrictions in your abdominal wall. This will help optimize the function of your muscles. Almost everyone who is postpartum has abdominal wall fascial restrictions. Why is this? During pregnancy, your abdominal fascia stretches out to accommodate the baby. After you deliver your baby, the fascia just "crumbles" up together, creating tight spots in your abdominal fascia.
Strengthening your entire abdominal wall and muscles that tension or “thicken” the linea alba. Notice in the diagram below. The linea alba, which connects the two abdominal muscles on either side, must tension, to transfer load/forces throughout the body with activities.
Strengthening the following muscles:
Rectus abdominis
External oblique
Internal oblique
Transversus abdominis
Gluteal muscles (buttocks)
Adductors
Latissimus Dorsi
Check out this video to learn how to activate your transverse abdominis!
Should I do crunches or sit ups?
Yes! Crunches and sit ups actually activate and strengthen your rectus abdominis. This muscles helps DECREASE the gap! While you may not start with crunches or sit ups in the beginning of your exercise program, it is definitely an exercise you should work towards! Check out this video to learn more!
What are signs of DRA improvement?
It's not all about narrowing the gap! Remember, a DRA is defined as THINNING of the LINEA ALBA. Even before pregnancy, your abdominals are separated. But its the thinning of the abdominal wall, and the linea alba that result in that "wider gap"
So what do we look for?
Greater stiffness or tension in the linea alba
Decrease in depth of fingers
How long does it take to treat my DRA?
The timeframe of your recovery depends on many factors, including the following:
Your current strength of your abdominal muscles
The starting level of the mind-muscle connection
The starting level of abdominal distention or connective tissue laxity present
The amount of time spent on exercises
The speed at which progressive loading is done on the muscles
Other factors include sleep, nutrition, stress, etc.
Ideally, you want to give yourself at least 12-18 months for significant to full recovery.
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Not sure where to start with exercises? Check out the following videos below!
Image credits: @pelvicguru and munira hudani