Diastasis Rectus Abdominis: DRA Part 2

Diastasis Rectus Abdominis 

How do I correct DRA during the postpartum period? In our previous blog, we discussed that a diastasis recti abdominis is an inevitable physiological change the body makes in order to accommodate the growing baby. Frequently asked questions we get are: 

What happens when the diastasis doesn’t go away post-birth? 

What can we do to build proper tension through the linea alba?

DRA: What is a “normal” gap?

It’s important to remember that our six pack muscles are not fused together in the midline, the “gap” that gives the appearance of 6-pack abs. They are connected by our linea alba, which means that everyone has a separation between their rectus abdominis muscles. There is confusion when it comes to a specific measurement that defines a DRA. However, there is no consensus on desirable distance between our abdominal muscles, as long as the linea alba can generate tension. 

For instance, one person may present with 2cm -4cm separation but may be able to produce great tension through the linea alba. This is very functional!

DRA: What exercises are we supposed to avoid?

There isn’t a cookie cutter recipe for someone presenting with a DRA. You may have found many exercises online that you should “avoid” with a DRA. It’s imperative to understand that every person’s body is different, and may need different dynamic exercises to see functional changes. 

Not everyone needs to be avoiding planks and sit-ups, there is no evidence to support this! There may be exercises that YOU aren’t ready to presently perform because they might create too much load through your linea alba. 

Load and pressure through the linea alba are not a bad thing for short periods of time. It’s the sustained pressure over long periods that lead to stretching. Pressure over a shorter time period with exercises like sit ups or planks won’t make things worse, it just may not necessarily help you improve either. 

We need to find the limit to which your linea alba can be loaded to its functional capacity and build good tension. Our goal is to build synergy between all abdominal muscles, with various different exercises.

DRA: What should I be looking out for?

Pressure

Our intra-abdominal pressure (IAP) is the natural pressure system that we have within our abdominal and pelvic cavity. When we exercise, the IAP naturally increases, and our core system manages this change. 

Within the core system, we have the pelvic floor making up the bottom. The diaphragm is up top, and the transverse abdominis muscle is located in the front. Lastly, the multifidus muscles make up the back. 

With excessive abdominal pressure and an improperly managed IAP, the pressure is insufficiently distributed to the weaker areas. 

For instance: When there is laxity in the linea alba, IAP may move outwards to that space. This causes coning or doming in the midline of the abdomen. Similarly to individuals with pelvic floor issues, pressure may descend against pelvic floor. It can cause dysfunctions such as incontinence or pelvic organ prolapse. 

Adding in non-optimal postural strategies can create more pressure and strain through the linea alba and core system. (Ie: Carrying baby with upper back slouched and pelvis rotated)

Breath can also impact IAP

Holding breath means that the diaphragm does not move to its full capacity. This can present difficulty in managing IAP. I always teach clients to “exhale on exertion”, which allows the diaphragm, abdominal wall and pelvic floor to reconnect as a system. It also increases tension through the abdominal fascia 1.

Diet is another component

Some women will experience the additional sensation of bloating with a DRA . Inflammation or swelling of the digestive system (i.e. caused by food sensitivities, like gluten or dairy) can create more bloating and thus more pressure on the abdominal wall. Referral to a registered Holistic Nutritionist or Naturopathic Doctor is important to discuss possibilities of anti-inflammatory diet, and discussion of other digestive issues.

 How do I check for DRA myself?

Lay on your back, knees bent, and place your fingers horizontally in the midline of the abdomen. Perform a gentle curl-up task, where your head and shoulders come off the ground. 

You can check for two things during this task: 

How many fingers are between your two abdominal muscles? Remembering that different finger sizes may slightly impact results.

What kind of tension is the linea alba creating under your fingers? Does it feel hard, or soft like a balloon? 

I typically assess for diastasis in different positions and with different activities. Often times, there may not be a DRA with a curl up, but may be present with a more difficult task, such as a plank. Additionally, if we only assess a client laying down, this won’t measure visceral loads the way a standing position would. 

Therefore, we want to see how the body is working in different positions and functional movements.

 How can we treat DRA?

Firstly, we have to LOAD our tissues in order to see change and build tension. According to Davis’ Law, soft tissue (including our fascia, tendon, ligaments) adapts to the stress put onto these tissues. This means that soft tissue must be gradually stressed in order to build strength. 

Additionally, strengthening soft tissue in different planes of movement is imperative. If we only stick to exercises in only one plane, (i.e. sit-ups, crunches, planks), our tissues has a harder time to adapt to tasks that require twisting/rotational movements. 

That being said, we have to do more than just lie on our backs and engage our deep core system. Connecting to our deep core system is very important. Once that connection is made, we must load our tissues in different movements and activities. All while managing our pressure and creating good tension through the linea alba!

Things to remember:

1. Allow your tissues TIME to heal.
2. We must LOAD our tissues to see change.
3. There is no cookie cutter program that works for everyone. You should be individually assessed to see what YOU specifically need in order to build GOOD TENSION through your tissues.
4. MULTIPLE factors affect DRA – how we move, pressure system, breathing mechanics, alignment, diet, core control, etc. Performing specific exercises is only part of the rehab process.

If you have any questions or concerns around your postpartum recovery, including DRA, us pelvic health physiotherapists at Bloom can help! Feel free to book a free 15 minute consultation where we can discuss your concerns, or book an appointment at www.bloomintegrativehealth.ca or at (613)725-9496.