By: Dr. Allison Jones PT, DPT (Starting at Precision June 8, 2022!)
Have you ever heard of Diastasis rectus abdominis (DRA)? Or noticed that you have a small separation in your abdominal muscles when doing a sit up?
DRA is defined as the separation of the linea alba, which is the connective tissue between your rectus abdominis muscle (our 6-pack). This can occur above, at, or below the belly button. This condition most commonly occurs in in pregnant or postpartum women, however, it doesn’t discriminate! It can also occur in males, infants, and older individuals. DRA is caused by significantly increased abdominal pressure causing the abdominal muscles to separate. Specifically, during pregnancy, the connective tissue between our 6-pack softens due to hormones, Relaxin and Estrogen, in order to stretch and create space for the growing fetus. Because of this, a progressive stretch occurs through the linea alba throughout the duration of pregnancy and can even persist for months post-partum!
The most common cause of diastasis recti is pregnancy, while multiple pregnancies further increase the risk of DRA development. Other common causes of this condition include participating in heavy exercise that puts too much stress on abdomen, excess weight gain or fluctuating weight, history of abdominal surgery, family history, age, and certain medical conditions.
How do you know if you have DRA?
A true diastasis recti is determined by a 2 finger width or greater separation, but any abdominal separation that is causing pain or dysfunction is important to be treated! Diagnostic ultrasound is a more reliable way to measure inter-rectus distance, but your therapist will most likely diagnose DRA through finger width measures.
Signs and symptoms of DRA can include a visible space between your abdominal muscles or around your belly button, bulging, coning, or doming of the abdomen, palpable softness between the abdomen or around the belly button, pain or difficulty lifting objects, low back/hip/pelvic pain, urinary incontinence, constipation, and abdominal pain or pressure. In many cases DRA, is not painful at all!
To do an at home screening, lay flat on your back. Put your hands behind your head and lift your head up while keeping your shoulders down. if you notice any separation, doming, or bulging of your abdomen, you most likely have DRA. A medical professional will be extremely helpful to determine the width, severity, and treatment plan!
Why do we need to treat it?
DRA is not painful in most cases, however, it can cause a long list of complications in the future, if not treated appropriately or in a timely manner. As your abdominal muscles are stretched, they become much less effective at providing adequate core stability. This leads to poor pressure management throughout the abdomen and can result in low back pain, hip and groin pain, and/or pelvic floor dysfunction including prolapse, painful intercourse, urinary incontinence, or constipation.
If you look at your core like a soda can: the top of the can being your diaphragm, bottom of the can being your pelvic floor, and the sides of the can being your abdominal and back muscles. When the can is sealed and solid, it is able to withstand a large amount of pressure and force. If there are any punctures throughout the sides of the can, it does not work properly and affects the other parts of the can. We can apply this same concept with diastasis recti. With stretched and weak abdominal muscles, it is likely that our low back, hips, and/or pelvic floor will be affected or overloaded.
The good news is that it is easily treated through conservative management by a physical therapist!
What would PT look like for DRA?
• Education: Education will be provided on improving pressure management, breathing techniques, appropriate deep core activation and strengthening, and avoiding activities that could potentially make the DRA worse
• Strengthening: A specific progression of deep core activation and strengthening will be implemented to improve the separation and increased stabilization throughout the trunk with a focus on returning the patient to activities they love! And no, we aren’t talking about sit ups or crunches! We are looking to particularly focus in on the deep core muscles called your transversus abdominis, multifidi, and your pelvic floor. We will show you how to properly activate your deep core muscles and put them to use during functional and recreational activity. Exercises that target these muscles help prevent or decrease DRA!
• Management of potential complications that may have occurred in conjunction with DRA: We can provide treatment for the whole body to correct any dysfunction that may also be occurring. A pelvic floor evaluation can also be performed, if warranted!
• Taping or binders if necessary to approximate abdomen and improve separation (only to be performed in conjunction with regular core strengthening!)
At Precision PT, we can screen patients for DRA and help patients with this condition to manage symptoms that may be associated with the condition, strengthening, and safely return to activities.