• Renee Cinco, PT

Diastasis Rectus Abdominis and your health, Post Partum



Diastasis Rectus Abdominis (DRA) is a current hot topic in perinatal health and wellness, with lots of research and fitness formats being developed to “help it heal”. It is a thinning and separation of the central insertion site of all the abdominals, the “linea alba”. It occurs most often in pregnancy in the later months, and can persist indefinitely into the post partum time. It can be a small separation that heals naturally on its own, or it can be a cosmetic as well as fitness problem with persistence post partum. Very rarely does it require surgery! Likely it is a natural thinning of the fascia (connective tissue) to allow for growth of the baby. Men and non pregnant women can also exhibit this, and in contrast to a hernia, the internal structures are not bulging out.


Do you have it? If so , how wide, and what region? We have a few methods to assess, with surface belly real time ultrasound being the easiest and most accurate. Is there an associated pain problem in the back, pelvic or hip area? How do you do in attempts at every day living, and your “core”, with rolling over, getting out of bed, lifting, pushing and pulling, and twisting motions? These are motions that can be screened and keyed into exercise prescriptions as needed, in a scaffolding format. In other words, no double leg lifts or planks if you have pain symptoms or doming and bulging of the belly, in my expert opinion. Why not exert to the max even if it hurts or bulges? Because the abdominal wall works with your spine and pelvic muscles for integrity of load transfer, with abdominals optimally providing support like a brace or corset. Overexertion may put pressure into the pelvic area contributing to pelvic floor dysfunction, such as bladder leakage, bowel leaks, pelvic organ prolapse, and /or compensatory clenching of the pelvic and spine associated with pain and loss of mobility and comfort.


The deepest layer of the abdominal wall, the transverse abdominus (TRA) is one of the key factors to address in DRA rehab. TRA functions for support throughout the trunk and its fascia blends all the way into the back, the latissimus dorsi and several other muscles. Sometimes just the upper, or lower sections are working and the rib cage is locked up (stiff).There are easy ways to get TRA to wake up and get back to work again for performance from getting out of bed (a double leg lift, perhaps?) to lifting a baby and carseat, to getting back to Pilates, Yoga, Running or CrossFit, whatever your goals. TRA works intimately with the pelvic floor muscles (kegels) as well, in timing and stamina for each task. There is such a need for this type of progressive fitness programming that we are developing a post partum fitness class this summer, stay tuned, and remember to breathe and relax as well, the diaphragm needs its full excursion for vitality!


Chiarello C, Falzone L, McCaslin K, Patel M, Ulery K, The effects of Exercise on Diastasis Rectus Abdominus in Pregnant Women, Journal of Women’s health physical therapy 2005: (29):1 pgs 11-16


Dufour S, Bernard S, Murray-Davis B, Graham N, Establishing expert based recommendations for the conservative management of pregnancy-related diastasis rectus abdominis;a delphi concensus study, JWHPT 2019, 43;2


Lee D, Hodges PW, Behavior of the linea alba during a curl up task in diastasis rectus abdominus: An observational study, JOSPT


Lee, D, 2017 Diastasis Rectus Abdominus e book,https://www.blurb.com/b/7904675-diastasis-rectus-abdominis


Litos, K, Progressive therapeutic exercise program for successful treatment of a postpartum woman with a severe diastasis rectus abdominus, J Womens Health Phys Ther 2014 38(2) 58-73


Mota P, Pascoal A, Carita A, Bo K, Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship to lumbo pelvic pain Manual therapy 2015: 20:1 pgs 200-205


Tuttle LJ, Fasching J, Keller A, Milan P, Saville C, et al, Noninvasive treatment of post- partum diastasis recti abdominus, A Pilot Study, JWHPT 2018, 42(2)

 

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