What is Diastasis Recti Abdominis and how do we fix it?
The number one question I receive after telling people what my profession is as a pelvic physical therapist, is usually, “Do you fix a stomach separation? I hate my mommy tummy”. My answer is usually that I would love to waive my magic wand and make all my patients abdominal muscles go back to pre- birth status, however, this is an area of treatment that is very complex. The diastasis recti is much more then an abdominal separation.
Diastais recti abominis (DRA) is the excessive separation between the two sides of the rectus abdominis (the six pack muscle), which creates a pooching of the belly, particularly when someone is performing difficult tasks, such as heavy lifting or exercise.
During the third trimester 100% of women have a DRA, defined as a separation greater than 2 cm at, above or below the umbilicus (belly button). DRA has been assumed to predispose a long term sequelae of breakdown in the body. The cosmetic appearance associated with DRA improves as the width between the bellies of the rectus abdominis decreases. The original literature has stated that with a DRA, one would eventually have low back pain and urinary incontinence, as the abdominal support is no longer there to provide stability. This may be the case, however we also see that our bodies are extremely resilient and constantly adapting to our environment.
Patients often want a “brace or abdominal support” to help bring the 2 sides of the muscle back together. What we have learned over time is that support can be good, however, too much support allows for the muscles to stop working, we limit the bodies ability to adapt and heal. As therapists treating damaged muscles we have to find a way to challenge the muscle group, while at the same time giving it time to heal. We need just enough movement and challenge without too much strain.
As assumptions about DRA and its relationship to long term dysfunction start to shift, the question is how do we treat and heal a DRA to prevent the other symptoms of low back pain and pelvic muscle weakness?
Here are some tips to dealing with a diastasis recti:
1. Patience. 100% of women have a diastasis recti (DRA) at the end of the third trimester. Postpartum, 52-60% of women have a diastasis at 6 weeks, 39-45% at 6 months with effects on abdominal strength and endurance and 33% at 12 months. Most improvement happens before 6-12 months, but can continue to 24 months without specific intervention.
2. Nutrition. This is out of my league, but understandably important, particularly early post-postpartum. Consult your favorite nutritionist. But for starters, vitamin C is widely touted to help collagen production. Also, make sure to stay hydrated. Don’t waste your time on the creams. The body needs internal signaling and cellular level building blocks to increase collagen production.
3. Move your body. Regular and progressive 3D movement that requires the abdominal system to stabilize, to lengthen, to contract, to work is an easy way to load the system. This translates into activities like laughing really hard, reaching up for things on the top shelf, lifting a child, twisting to grab a cookie, or walking really fast with arms swinging. With some exceptions for pain and loss of the ability to do everyday tasks, limit abdominal bracing techniques such as belly binding, and second skin Spanx. These push pressure elsewhere in the system and decrease the signal for the body to rebuild. We want as much motion that the body can handle without losing its stability.
4. Managing abdominal pressure. The abdominal canister—the multifidus muscles of the back, the respiratory diaphragm at the top, the pelvic floor on the bottom, and abdominals in the front—contain most of the body’s organs and manages fluctuating intra-abdominal pressures. Adopting better posture and movement patterns help manage intra-abdominal pressures taking off excess strain and help resolve DRA.
5. Breath and wiggle the ribs. Sigh and drop those ribs. A rib flare adds a strain on the linea alba. An easy way to safely challenge the system may be as simple as raising your arms over your head while keeping your ribs down. Or spend some time doing diaphragmatic breathing adding gentle twisting on the exhale.
6. Battle of the ab exercises: Transverse abdominis vs. Rectus abdominis (RA). Women who do specific transverse abdominis exercises are less likely to have a DRA during pregnancy and postpartum as compared to women who have a general exercise program . These exercises are focused on the small, deep lower abdominal muscles. A prenatal abdominal exercise program will prevent 1 in 3 women from developing DRA. Almost 90% of physical therapists use transverse abdominis and pelvic floor training with their patients, and up to 63% of physical therapists use the Noble method which combines the physical approximation of the muscle bellies while doing an abdominal crunch.
7. See a specialized physical therapist. Postpartum pelvic floor therapy is the norm wellness program for most of Western Europe. A specialized physical therapist will assess how you uniquely go through everyday life and can suggest ways to improve the efficiency of your abdominal pressure system, to give more input in places that are sleepy, and to quiet the overloaded parts. We teach, monitor and appropriately progress your exercise program and functional integration to appropriately challenge without overloading deficient muscles. On a blog, it’s easy to talk about the transverse abdominis, but actually recruiting and integrating this muscle without overloading others, often requires extensive cues, sometimes manual techniques, and adjustments at other parts of the body. 59% of physical therapist use some type of manual technique to treat DRA as well as postural education, exercise progression, and abdominal pressure management, are part of our regular program for diastasis recti at Able Pelvic Physical Therapy.
Thank you so much for reading our blog, if you think physical therapy can help you. Please give us a call at 770-709-5519.