Two Bears Physiotherapy & Health Services

Two Bears Physiotherapy & Health Services

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Diastisis Rectus Abdominis

Posted on 4 August, 2016 at 23:35

What is it?

Diastisis Recti Abdominis (DRA) is the widening of the connective tissue (linea alba) between the Left and Right muscle bellies of the “6-pack muscles” (rectus abdominis). This widening is commonly worst around the navel area but can occur further up towards the ribs or down towards the pelvis.


While a large number of pregnant woman encounter this issue, it is not specifically caused by pregnancy. Rather it is related to intra-abdominal pressure, and commonly affects men and children as well. In fact most newborns (especially premmie babies) have DRA.

Aside from aesthetic concerns, the widened central tissue no longer provides adequate tension and stability which affects the whole body functionally as well.


 

Important things to remember:

• It is estimated that nearly 100% of pregnant women have some level of DRA by the third trimester. For many women the gap remains widened at 8 weeks, and left untreated this gap will often continue unchanged.

• 66% of women with DRA also suffer from pelvic floor dysfunction. These problems often go hand in hand, and although a weak pelvic floor may not affect you as much aesthetically it can lead or incontinence or prolapse.

• You may see a “pooch” or “mummy tummy” with DRA but your tummy may also be flat unless you contract your abdominals (then you will see some coning). Significant abdominal wall protrusions may also occur without DRA and some women experience “mummy tummy” without a widened linea alba.

• It is never too late! Research has shown that DRA can be improved even many years post-partum.

• While doing specific exercises is fantastic, what you do for the other 23.5 hours a day is also very important and will often determine your long-term outcomes. Posture and movement habits significantly affect our intra-abdominal pressure which is why we believe in a full-body and lifestyle approach.

• Nourish your body (with good food and a good attitude) so it can heal. We all compare ourselves to others, but be kind to yourself and give yourself some breathing room. Try not to continually re-assess your DRA or obsess over fitting into pre-pregnancy clothes. This is your journey and you will recover at your own pace.


 

What to avoid?

• Crunches and sit-ups (ie. exercises that isolate the abdominal muscles). These are generally not recommended for early post-partum women anyway as they forcefully push the internal organs down towards your pelvic floor.

• Front planks or abdominal exercises in 4-point kneeling etc. In the early days of recovery at least, this is not recommended as the abdominal contents are pushing against the weakened linea alba in this position.

• Lifting heavy items or anything that causes you to feel strain through your tummy.

• Thrusting your ribs forward or up, or poking your hip out on one side to carry your baby.

• Sitting straight up to get in/out of bed. It is better to roll onto one side and lower legs at the same time as using your arms to push into sitting up from this position.


 

Why is a whole body approach important?

There are a large number of factors that contribute to the development DRA, some which can be helped and some which are entirely out of your control.

A problematic diastasis rectus is a result of excessive intra-abdominal pressure. This means that the pressure inside your abdominal cavity can’t be contained by the body’s musculoskeletal system and starts pushing outwards (affecting your core), downwards (into your pelvic floor) or upwards (affecting your ribs and breathing). This is the same pressure that can lead to a prolapse or a hernia.

So, in this sense DRA is a symptom of your whole body not functioning optimally to contain a natural pressure. Of the factors that you can control, it is usually a combination of a weak core and poor body alignment (particularly ribs and pelvis) that are to blame. Once these are fixed, the body can start to heal itself and the gap will diminish. There is no point focusing on just one muscle (or obsessing over the gap) as the issue, every person needs to be addressed as a WHOLE.


 

 

Should I use a splint or binder?

Compression is often helpful in the third trimester or early days post-partum for increasing awareness and general support. It is important to remember however that pulling the sides together won’t make them stay there when the support is not on, so any use must be in conjunction with core activation and movement changes.

Furthermore, any compression on the abdominal area can increase pressure on the pelvic floor. Imagine a tube of toothpaste: pressure in one area displaces the contents upwards and downwards. For this reason, compression wear in the form of full pants (such as recovery shorts) is often preferable over a straight waist binder style; but none should really be used long-term.


 

Exercises

1. Finding Transversus and activating the core correctly

Lie on your back with your knees bent and your feet flat on the floor. Place your index and middle fingers just above the top of your iliac crests, and then bring them in approximately an inch towards your navel. Slowly take a deep breath in, and then as you breathe out you are going to gently activate your core. You should feel tension under your fingers (like tightening the sheets) but your fingers should not be pushed upwards, as this means you are using the more superficial muscles (rectus abdominis and the obliques).


Some good cues for proper core activation are:

• Imagine you are wearing a tight pair of jeans that are on around your hips. As you breathe out imagine the zip slowly doing up.

• Float your navel gently to your spine

• Engage your pelvic floor and gently narrow your waist

 

 

2. Activating the Core with a bent knee fallout

Starting in the same position as before. Inhale to prepare, exhale and gently activate your core. Breathe in, and on the next breath out slowly lower one knee down towards the floor keeping the heel/outer foot on the floor. Only the hip/knee should move, try and keep your low back and pelvis still. As your breathe in, gently bring the knee back to the centre.


 

3. Side lying plank

Your elbow should be under your shoulders, and shoulders and hips should be stacked.

 

 

4. Glute Bridges

Lying on your back with knees bent and feet flat on the floor. As you exhale, roll the tailbone away from the floor, squeeze the glutes and lift your bottom. Inhale, and slowly lower.



5. Single leg deadlifts

Try to pivot at the hips rather than bending your back, and aim to keep your hips level. You should feel a stretch in your hamstrings.


 

6. Wall pushup

Place hands shoulder-width apart on the wall infront of you, feet slightly apart with heels slightly lifted and core gently activated. Inhale and lean in towards the wall, gently squeezing between your shoulder blades. Then exhale and push back to the starting position. Take care to keep your back and legs straight.


 

7. Hanging

Start slowly and gently keeping your feet on the ground and varying hand position. Concentrate on maintaining shoulder and pelvic stability.


 

8. Legs up the wall

Make sure your pelvis is untucked and your back is in neutral. You may need to start this pose using a bolster to help with alignment.


 

9. Childs Pose


 

10. Psoas stretch

Make sure to tuck your bottom under before you lean forward.



11. Squat

Inhale to prepare, exhale and engage your pelvic floor. Inhale again, this time as you exhale lower yourself into a squat (as if sitting into a chair).


 

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