Diastasis Rectus Abdominis (DRA)
is the separation of abdominal muscles away from midline due to a sustained stretch. This is most commonly seen postpartum but can also occur in women and men of any age.
DRA occurs when the abdominal muscles are stretched apart during pregnancy, cut through for surgeries, or put under inappropriate stress for prolonged periods of time (like with long, steady weight gain around the abdomen).
One study showed 100% of women in their 40th week of pregnancy demonstrated a DRA - 100%! If you’re currently pregnant and afraid of getting a DRA, this should ease your mind. Everyone gets DRA at the end of the pregnancy, for good reason. The skin is stretched to capacity, and our muscles need to move to make room for the baby. However, we do want to be screened for DRA postpartum, as that same study showed almost 40% of women 6 months postpartum still had a diastasis.
There is no connection between mom’s BMI, baby’s birth weight or abdominal circumference to DRA. Research is showing our genetics and connective tissue have a larger role in DRA than our weight.
Symptoms of DRA can include:
A gap or bulge in the abdominal wall that is usually worse when the abs are under strain
Lower back pain or abdominal pain
Feeling like something will “fall out” or protrude from the abdomen
Seeing a physical or occupational therapist should be the first line of treatment for DRA. Many different techniques can be used to correct: exercise, manual therapy, and bowel and bladder management.
Exercise: Old school management of DRA focused on NOT loading the abdominal muscles, i.e. avoiding crunches and sit ups. Things have changed since the early days of DRA research, and we now know that putting tension on the abdomen is the best way for it to heal! DRA rehab is not a “one size fits all” process. You need a professional who is trained in monitoring your DRA during exercise, to ensure you’re loading the tissue correctly, in a safe but helpful way. It can be really confusing trying to find exercise programs online, mostly because there is no room for nuance there. Seeing a rehab professional is the best way to get your exercise program tailor made to you and your needs.
Manual Therapy: DRA management is not all about strength training. We have to understand that our abdominal muscles do not function in isolation but work as a unit, in coordination with the muscles in our low back. If our abdominal muscles are not “coming together” in the front, it could be due to muscle tension in the back which is resolved with manual therapy. There are also techniques your therapist can use to the abdominal tissue around the belly button to promote closure of the stomach muscles.
Bowel Management: Most wouldn’t think to ask about constipation or GI upset when dealing with DRA, but it can add to the patient’s report of bloating, “mommy tummy,” and an overall dislike of the way her abdomen looks. We want to make sure you are having regular, complete bowel movements without straining or pain. We also want to screen for any GI upset or a lot of gas after meals, as this can keep your abdomen distended with poorer response to PT.
Diastasis is something that is very manageable with the right therapist. Regardless of how severe, physical therapy is the best first line treatment for exercise prescription and DRA management.