All About Abdominal Separation (Diastasis Recti)
Diastasis Rectus Abdominus (DRA) is a buzzword during pregnancy and postpartum so let’s break it down! At our pelvic floor physical therapy clinic in Boston’s South End, Foundations Pelvic Health, our pelvic floor PTs see a lot of pregnancy and postpartum patients coming in with this.
Anatomy and Function of the Abdominals/Diastasis Recti:
Diastasis recti (or abdominal separation) is defined as increased distance between the rectus abdominus muscles (“six-pack” muscles) along the linea alba (the connective tissue at the midline of the abdomen). The linea alba itself is extremely strong and does not separate or tear, which can be a common misconception.
Our abdominals are made up of different muscle groups that are surrounded by fascia, which is the “saran wrap” or connective tissue that holds muscles in place.
The rectus abdominis muscles are the “six-pack” muscles, which help us flex forward like a crunch motion. The 2 parallel muscles are connected by a line of fascia called the linea alba.
The transverse abdominis muscle is the one we talk about the most in pelvic floor PT. It acts to provide general support to our trunk with all movement, including supporting the linea alba when activating our abs.
During pregnancy, as the baby is growing, the body must accommodate the larger size of the child. This can cause a stretching of the linea alba. It is very difficult to prevent DRA during pregnancy, with about 67-100% of people exhibiting DRA in the third trimester - it’s very common and normal! However, our pelvic floor PTs can teach you:
How to activate your deeper core muscles
Proper lifting mechanics
Breathing techniques to limit putting additional pressure through the area
Various types of Diastasis Recti
During the postpartum period, we always check for DRA. DRA is not always visible to the naked eye, but some folks may notice “coning” or bulging at their midline with abdominal exercises, coughing, or lifting. Other people may notice a “divet” downward between their “six-pack” muscles during core exercises.
Assessing for Diastasis Recti
Assessment for DRA includes observing how your core is activating and stabilizing throughout a series of movements as well as assessing for width and depth of the DRA. We recommend being checked by your pelvic floor PT for DRA at your appointment, but you can also do a mini self-assessment at home.
Lie on your back with your knees bent and feet flat on the floor.
Place 2-3 fingers at your belly button perpendicular to the floor.
Lift your head off the floor and notice what it feels like under your fingers. If your fingers sink down into the tissue, you may have DRA.
Repeat a few inches below and above your belly button.
If your fingers sink into the tissue, a DRA may be present - a space of 2 finger widths or less is considered “normal”
In terms of exercise, it is beneficial to consult one of our pelvic floor specialists. What may cause coning in one person, may be totally fine for another. Coning occurs on a spectrum, so even if coning is present during an exercise your pelvic floor PT may clear you to continue. Our goal is to keep you moving and strengthening your core throughout the perinatal period. Research shows DRA can improve over time with progressive loading of the muscles i.e. progressing difficulty of core exercises.
Considerations:
The research is changing, so how we treat DRA is also evolving. PTs are currently moving away from the “Dos and Don’ts” or exercises that are “bad” for DRA. We now have higher consideration for the following:
Can you do the exercise without pain? Leaking? Pelvic pressure?
Do you have control over your body and core when doing the exercise?
Do you maintain tension in linea alba throughout the exercise?
Is the exercise done without excessive doming or bulging?
Do you exhibit appropriate core strategy with movement?
Can you maintain proper form and technique for the duration of an exercise?
How can our pelvic health specialists at Foundations Pelvic Health help manage your Diastasis Recti?
During pregnancy and postpartum, if you feel pain or pulling at the midline of your abdomen or if you notice coning/bulging during activity, you may need to modify that particular exercise. Your pelvic floor therapist will provide you with insight as to how to make the exercise easier, modify how you’re breathing, or activate your deep core muscles during the task.
Pelvic floor physical therapy can help you figure out how to connect with your core using your breathing and posture, and can help to incorporate appropriate strengthening into your pregnancy and postpartum workout routine!