Diastasis Recti Abdominis. Why THE GAP isn't the problem?!...

Diastasis Recti Abdominis.

Why THE GAP isn't the problem?!...

One of the biggest myths around diastasis recti abdominis (DRA) is that it only occurs in postpartum women. DRA is an issue that can impact women, men, children and athletes.

What Is Diastasis Recti?

Diastasis recti abdominis (DRA) is the separation of the right and left rectus abdominis muscle, and the thinning of the connective tissue, called the linea alba, that runs along the midline of the abdomen.  

DRA is most common in women during pregnancy or postpartum.

DRA is most common during pregnancy and “all women have a variable amount of separation of the recti by 35 weeks of pregnancy” (Lee 2017). The stretch/strain that a growing fetus puts on the abdominal fascia and muscles can cause a natural separation of the connective tissue along the centre line of the abdomen, called the linea alba.

How can DRA occur in non-pregnant women, men, kids and athletes?

DRA is heavily influenced by the inability to regulate intra-abdominal pressure (IAP) during activity. Excessive IAP leads to increased pressure through the abdomen, which over time can contribute to separation of the central abdominal muscle and a thinning of the connective tissue in between, called the linea alba, creating a gap in the midline of your abdomen. Poor regulation of IAP can happen with non-optimal movement strategies and strength deficits, potentially leading to DRA with men or women of all ages and athletic level.  

How to diagnose DRA using a self assessment:

1.      lie on your back with your knees bent and your feet flat on the floor

2.      place one hand on your belly 3 fingers above your umbilicus (belly button) with fingers pointing straight down 

3.      lift your head up off the ground and press down with your fingers into the centre line of your abdomen to palpate for the presence of a gap between your muscles (normally there should be no gap)

4.      repeat this placing one hand on your belly 3 fingers below your umbilicus (belly button) with fingers pointing straight down

If you feel a gap, do not get alarmed. Up to 25% of women continue to have some level of DRA at 1 year postpartum (Dufour 2019) and a Pelvic Trained Physiotherapist can help. As each person’s contributing factors and presentation of DRA is unique, assessment by a Pelvic Trained Physiotherapist is important to develop a program that will benefit you the most.

How a Pelvic Trained Physiotherapist can help.

While many people affected by DRA worry about the look of the separation, the ultimate goal of seeing a Pelvic Trained Physiotherapist is to optimize the function of your abdominal muscles as well as ensure that you can participate in activities safely. Our goal is that your abdominal muscles and fascia can hold tension and stabilize your core, leading to what we call ‘functional DRA’, and to allow you to return to sport and activities at your pre-pregnancy level.

Preventing or recovering from DRA isn't necessary about avoiding certain exercises, it is more about understanding that your current movement strategies, strength and connective tissue health may not be optimal. Continuing to move the same way if you are demonstrating signs of tissue failure and poor regulation of the IAP may lead to further disfunction and worsening of your DRA.

Your Pelvic Trained Physiotherapist will be able to diagnose DRA and educate you on appropriate strategies to reduce and prevent DRA. The ability to properly regulate IAP and effectively recruit your deep core muscle tension is called ‘force closure’. Without proper force closure, which is also known as ‘non-functional DRA’, you may be at risk for non-healing or worsening of your DRA , pelvic floor disfunction, incontinence, pelvic organ prolapse (POP) and other disorders.

How to identify if you have poor regulation of IAP during exercises?

1.      presence of a visible doming/tenting /gapping of the abdominal muscle/fascia during movement or exercises (ie. supine curl up, supine straight leg raises, standing leg lift)

2.      sensation of a pelvic bulge/pressure/dragging during movement and exercises - which is often a sign of a POP

3.      presence of a urinary or fecal incontinence

4.      pelvic floor pain which may also refer pain to your hip, groin, or lower back 

How to restore abdominal function/treat DRA?

When considering DRA, it is most important to address and restore function of your deep and superficial abdominal muscle systems so they can efficiently regulate IAP during activity. Restoration of this muscle function leads to effective force closure and will allow you to return to activities that are important to you.

Professional evaluation is very important with DRA to ensure you obtain the most effective plan of care. A Pelvic Trained Physiotherapist can diagnose and treat DRA, identify muscle weakness and faulty movement strategies, as well as evaluate the function of your pelvic floor, pelvis and lumbar spine. A thorough evaluation of all these systems will ensure you return to your pre-pregnancy functional level as quickly as possible, as well as ensure that DRA does not recur in the future.

Yours in health 

Beata.