Diastasis Rectus Abdominis (DRA)… What exactly does it mean and what steps can you take during your pregnancy (and beyond) to help guard against it happening to you? We enlisted Specialist Women’s Health Physiotherapist Clare Pacey of Beyond Health to break it down – and then firm it back up again…
DRA is a thinning of the linea alba that allows a mother’s abdomen to stretch; it is a natural part of the baby making process. In fact, 36% of women remain abnormally wide at 5-7 weeks postpartum.
Conservative diastasis resolution is possible at any time with good education and training. Improvement has to do with the bodies’ capacity for fascia recovery and the willingness to change how you are using your body. I regularly help women who are years beyond their last delivery – here are the top tips I share with my clients.
The number one piece of advice I can offer any woman is to know what good alignment is and to maintain it as best they can throughout pregnancy and beyond. This is a vital part of correcting a diastasis. Many women lean back as their tummy grows during pregnancy and often this continues postpartum, too.
Is your rib cage too far back, are you breathing with your upper chest, is your pelvis tucked under?
If so I want you to untuck your bottom (you need glutes!) – shift the ribcage over the top of the pelvis. This is the optimum position for the pelvic floor and gluteal muscles to activate.
Remember to be conscious of your alignment when exercising too. Exercising in correct alignment will promote a better result from your fitness program.
I encourage my clients to exhale prior to movements, such as lifting their baby. This activates the inner core. Continuing this exhale throughout the exertion will help protect and maintain diastasis closure throughout the activity. It also prevents breath holding which causes increases in abdominal pressure.
Unfortunately, dealing with diastasis recti isn’t simple and straightforward and there is no set protocol for all women. Generally it requires individual assessment of the deep central stability system (diaphragm, transversus abdominis, pelvic floor) that creates tension over the fascia and regulates abdominal pressure and a personalised progressive exercise programme to rebuild the abdominal wall and restore optimal function. In some cases this may include bracing or taping when appropriate, but that’s not in everyone!
No abdominal exercises are forbidden – your ability to perform an activity needs to be assessed. Exercise that makes the abdomen bulge or causes you to fix your abdominals is best avoided.
Exercising the abdominal muscles correctly during pregnancy decreases the presence of diastasis rectus abdominis post natally by 35%.
During pregnancy I would recommend avoiding any activities that cause the abdomen to bulge, to stop sit ups once the uterus comes above the pelvis brim (12-14 weeks), to minimise twisting activities and maintain good alignment.
For some women physiotherapy is not enough and a surgical abdominoplasty is necessary. A woman would be appropriate for this if she has completed her family and is one year postpartum, has trialled and failed a multi tiered rehabilitation pro-gramme and is unable to generate sufficient tension through the abdominal wall for resolution of function. Surgery should always be combined with a rehabilitation programme as an abdominoplasty will restore anatomical structure but not the abdominal muscle function.