Diastasis Recti Abdominis (DRA)
definition:
Diastasis Recti Abdominis (DRA) is a stretching and widening of the connective tissue between the right and left Rectus Abdominis muscles (the ‘six-pack'). DRA is graded by the distance between the two muscles in finger-breadths. When the distance is ≥2 fingerbreadths either 4.5 cm above, at or 4.5 cm below the umbilicus, this is a diastasis.
cause(s):
DRA is caused by the over-stretching of the linea alba – (connective tissue that joins the 6- pack muscle at the midline, named for it’s white appearance) that happens during pregnancy. It can also happen when there is an excessive of fatty tissues around the organs in the abdomen (“beer belly” or protruding abdomens) causes stretching of the muscles. It becomes more prominent with straining and often disappears when the abdominal muscles relax
incidence:
It is VERY common in pregnant and postpartum women. Some statistics: 45% of mothers at 6-mos postpartum and 33% of mothers at 12-mos postpartum had significant DRA
the problem:
Research has shown that DRA size diminishes in the early postpartum period but when not treated it will not naturally continue to improve significantly after 8 weeks to one year postpartum. This change in the fascia of the abdomen alters the pull force that can be achieved throughout the abdominals which significantly impacts the way our entire core, including the pelvic floor, system functions! This means that in some women, the entire core system is vulnerable for at least 1 year after delivery.
when the problem persists:
Continued use of non-optimal strategies, such inappropriate core strengthening exercises (or just LIFE activities), with an underlying deep core muscle problems will just reinforce the non-optimal patterns. Left untreated, this can lead to tissue break down and pain (low back pain or even remote pain such as knee pain, plantar fasciitis or even shoulder pain), everything ultimately connects to your core!
why physical therapy?
Returning to an Active and Healthy Life After Pregnancy Requires an Optimally Functioning Trunk! Research has shown that even specific stabilizing exercises is not enough to get the deeper layers of the system optimized to a point that prevents dysfunction.
So what does it take to restore a functional abdominal wall and trunk after pregnancy? A customized core strengthening program, that includes both core training exercises and core strengthening exercises that focus on the entire core and system is the solution. This type of program when designed specifically for each person will address the entire spine and ribs, the pulmonary diaphragm and breathing patterns, posture, the pelvis and pelvic floor muscle function (and belief patterns too!). A well designed (and faithfully practiced) physical therapy based program that builds tension in the core can bring the abdominal muscles closer together and restore proper abdominal and core mechanics and allow for a safe return to activity and exercise
the take home:
It is strongly recommended that all postpartum women should be checked for abdominal and pelvic floor muscle function, especially prior to returning to sport or exercise!