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Split down the middle… How to deal with post-partum Diastasis Rectus

Many women are unaware that pregnancy has left them with a split down the middle of their abdomen called a Diastasis Rectus Abdominus (DRA).   This occurs when the fibrous structure that connects the left and right rectus abdominal muscles called the linea alba, separates due to an inability of the muscle to stretch enough to accommodate a growing belly.  This can cause a multitude of problems such as low back or pelvic pain, incontinence, weak low back muscles, as well as that all too common “mummy tummy”.  If you have to ask, you don’t have it….Many women think they just need to eat better and do countless sit-ups but end up frustrated when there isn’t any change to the appearance of their abdomen.  In fact, doing sit-ups and crunches will likely cause a worsening of this problem and a bigger GAP!

There is huge variability in the potential size of this separation.   It can vary from a few millimetres (to many!) and can affect both the appearance of the abdomen as well as cause pain in the low back or pelvic area.  The majority of women will develop this in their third trimester because the abdomen is unable to stretch further to accommodate the growing baby.  This condition can be exacerbated in overweight individuals with large abdomens or by doing exercises that cause increased intraabdominal pressure such as curl-ups and crunches.

The GAP test

One of the fastest ways to tell if you have had a separation of your linea alba or the tissue that joins the left and right side of your rectus abdominals is by lying on your back and doing a partial sit-up while feeling the middle of your abdomen.  In the early stages post-pregnancy, this can be determined by an increased gap between the abdominals as well as a “peaking” between the abdominals.  Often, it is seen clinically as a range of one finger’s breadth to four finger’s breadth wide.

The good news is that the majority of women will heal from this tear in eight weeks; however, there is a small population of women who continue to suffer from this indefinitely and sometimes require a surgical procedure to correct this potentially debilitating condition.

The research…

There is a large variety in this gap or inter-rectus distance (IRD). A study quoted by Diane Lee from Beer et al 2007 showed the width above the belly button to be 7mm +/- 5 mm, 13mm +/-7.5 at the belly button and 8mm +/- 6.2 below the belly button.  There is some thought that the width of your DRA at 8 weeks post-pregnancy is the same as what it will be at one year post without having any interventions.

Traditionally, it was believed that closing this gap would be the answer to restoring normality and stability to the system.  Extensive research done by physiotherapist Diane Lee, suggests that is not the width of the gap that determines whether or not the individual would benefit from surgery but rather the person’s ability to generate the needed tension to support the lumbar spine and pelvic area through muscular re-training.

The treatment…

Learning the proper way to recruit, strengthen and progress your abdominal and core muscular systems is the solution to fixing this problem.

Recruitment of the transversus abdominus muscle, which is part of the deep core muscles system, causes it to broaden horizontally which generates tension across this area.  Proper recruitment of this muscle can cause improved function and narrowing of the gap.

There are many other ways to move and use the wrong abdominal muscles (i.e. inappropriate core exercises) that can cause the gap to narrow but less tension to be generated.  These compensatory techniques should be assessed and corrected for the best results to heal the separation.

This separation can be continued to be made worse post-pregnancy by doing exercises that cause a dome-like appearance to be seen between the rectus abdominus.  This is the contents of your abdomen bulging out!  It is so important to learn the proper form for core exercises and movements that do not cause this….

Post-pregnancy it is important not to exercise or perform movements that may cause increased abdominal pressure as this can worsen and delay the healing of this tissue.  Even movements such as sitting straight up from lying on your back should be avoided as this can worsen the gap.  For example, even a small curl up can cause bulging of the abdominal contents through the gap and you will be able to feel a doming or peaking between your rectus abdominals.

Who Knew!?

It is important to know that it is not just the post-partum women who experience these symptoms!  It can also occur in anyone who performs high repetitions over time of exercises such as crunches and curl-ups with poor form and contraction of the abdominal muscle.  Overweight individuals with large abdomens also can experience this type of injury.

Awareness of how to manage a diastasis or how to prevent one from occurring is the first step. The rehabilitation of a diastasis is very specific to each individual. However, recovery from this is the key to improving low back and pelvic pain, as well as the esthetic appearance of the abdomen.   Early awareness of having a diastasis, initial protection of the tear by avoidance of certain movements and exercise, and then specific strengthening are important in the rehabilitation of a diastasis.  Consult your physiotherapist if you suspect this is happening to you!

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