One very common dysfunction that can often trigger fears of exercise is Diastasis Rectus Abdominis, or simply DRA. Diastasis Rectus Abdominis essentially means abdominal stretching in between the six pack muscles (rectus abdominis). It can affect men and women of all ages and is a very common physiological change seen during pregnancy and postpartum. In fact, 100% of women will have some extent of abdominal separation at week 35 of pregnancy (baby does have to go somewhere). Of those, 39% of women will have a DRA at 6 months postpartum.
Exercise after giving birth can help moms feel their best (physically AND mentally) and allows for a healthy recovery. When a client states that they have been avoiding all exercise (whether it be due to something they read, or someone telling them they shouldn’t), the first thing I do is reassure them. Then I teach them how to incorporate their physical activity goals in a safe way while building resilience and tolerance to increasing demands. I’ve had clients (with no symptoms) who’ve stopped running during pregnancy because they were told it was “bad for them.” Or clients postpartum tell me that they read online or have been told by others that they shouldn’t exercise (at all!) or else their symptoms will get worse. I think part of being a physiotherapist is to help reassure and decrease fears, to educate and guide, and to help others progressively return to any activity that they want to do.
So, what causes this to happen??
First, it’s important to understand why and how it happens. As mentioned above, all pregnant women will have some form of abdominal stretching. As the baby grows, the rectus abdominis muscles widen and the linea alba (a connective tissue that connects the abdominal muscles in the midline from the xiphoid process to the pubic symphysis) lengthens and thins to accommodate the growing baby. The main function of this linea alba is to transfer loads/force from one side of the abdominal wall to the other – similar to a bridge. When you think of crossing a bridge, you don’t necessarily focus on the length of the bridge (to a certain extent), but more importantly how STRONG the bridge is when crossing over. That’s the same principle of the linea alba – we want a strong tissue that can transfer our loads when needed. Laxity in this tissue can create dysfunction and the linea alba does not transfer these loads properly.
When assessing for DRA, the tension of the linea alba is a fundamental component. However, numerous online programs focus on “closing the gap” – but is this really what we are looking for? Diane Lee and Paul Hodges (2009) assessed the effects of a curl-up task on the linea alba. They found that engaging the deep core muscle transversus abdominis (TrA) does not actually “close” or narrow the gap (it can actually widen the gap!), but instead increases tension through the linea alba – which is our main goal. This means that we should not solely focus on narrowing the gap, as this type of strategy creates less tension through the linea alba.
- There are no safe/unsafe exercises for DRA, my goal as a physiotherapist is to help guide you to reach your goals
- The strength of the midline connective tissue (linea alba) is more important that the width (We want a STRONG bridge, not a short rickety one)
- DRA is a common physiological change during pregnancy and can be addressed afterward, even if it is many months or years after.
Stay tuned for Part 2, where we will look at some Frequently Asked Questions related to DRA.
Written by Sarah Trottier, Physiotherapist.
Sarah has a clinical focus in Women’s & Pelvic Health, as well as Orthopaedics. She currently lives and works in Ottawa, Ontario, Canada.
Disclaimer – Everything shared is for informative purposes only. It is not intended for assessment, diagnosis or treatment purposes. If you feel there needs to be further investigation, please seek out a qualified health care professional for a proper assessment