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Diastasis recti (DRA) is a separation of muscle and fascia at the midline connection of the abdominal wall. A linea alba separation of 2 cm or more is considered abnormal. A DRA is very common in pregnancy and postpartum as stretching occurs to make room for the baby. A DRA can also be present in kids and men with reduced core strength who have a reduced ability to manage pressure in the abdominal canister. It is never too late to rehab a DRA.
Separation can occur anywhere along the linea alba, and the separation can occur in multiple locations. Where the separation occurs can help guide a treatment program to promote healing.
Pelvic floor therapists assess the width of the gap and the depth of the gap. The depth of the gap is more important than the width as it has more influence on the ability to transfer force across the pelvis during loading tasks like walking or single-leg exercise. The width, however, can cause more distress for some due to its impact on the abdominal wall’s cosmetic appearance. Both width and depth can be addressed with skilled physical therapy.
An individualized approach and a full body assessment are helpful for optimal DRA healing. Hands-on techniques to help promote length in tight structures can be equally important as a properly prescribed exercise program.
Learning proper breathing can have a huge impact on a DRA as the average person takes around 20,000 breaths a day. Belly breathing could continue to add over-lengthening to structures and prevent the side abs from helping with closure.
A pelvic floor PT should ensure that pelvic floor length and strength are optimal to counter downward pressure produced by certain abdominal exercises as an aggressive abdominal program too soon could increase the risk of pelvic organ prolapse. Learning to identify excessive downward pressure on the pelvic floor can help to identify activities that are overloading the system and should be modified.
Other goals of treatment:
-Evaluating and treating mid-back and upper extremity influences
-Addressing rib flare which can prevent closure
-Addressing tight back musculature and fascia which can prevent closure
-Addressing postural influences
-Evaluating functional movement patterns
-Recommending temporary certain support aids like bottom-up compressive underwear if applicable
-Optimizing load transfer through the abdominal wall
Some cases of DRA could require a surgical intervention. Dianne Lee is a physical therapist who has devoted much of her career to the treatment and research of diastasis recti. The following are her criteria for a referral to a surgeon:
The woman should be at least 1 year postpartum and has failed appropriate therapeutic approaches to restore function and resolve lumbopelvic pain and/or urinary incontinence.
The inter-recti distance is greater than the mean values, and the abdominal contents are easily palpated through the midline fascia.
Multiple vertical loading tasks reveal failed load transfer through the lumbopelvis.
The active straight leg raise test is positive, and the effort to lift the leg improves with both approximation of the pelvis anteriorly, as well as approximation of the lateral fascial edges of the rectus abdominis.
The articular system tests for passive integrity of the joints of the low back and/or pelvis for mobility and stability are normal.
Any questions? Brentwood Pelvic Health would love to hear from you.
*Blog content is for informational purposes only and is not considered medical advice.
