Diastasis Rectus Abdominis (DRA) (aka Diastasis Recti)
What is Diastasis Recti?
The linea alba (intricate connective tissue) that runs between the rectus abdominis muscles (“6 pack abs”) and the transversus abdominis is designed to thin out during pregnancy to accommodate baby. It is also meant to thicken up again after baby is born.
Diastasis rectus abdominis (sometimes called diastasis recti) has been undergoing some new research and in the process, the definition of it has changed (officially in 2017 with 22 pelvic health experts from Canada led by Dr. Sinead Dufour). The confusion around this is likely because literally, diastasis translates to separation.
Artwork by Lindsay Hobbs
Who is Susceptible to DRA?
DRA is common in pregnancy (66% of pregnant women in 3rd trimester) and newborns. For newborns, the rectus abdominis may not be sealed at the midline. For pregnant or postpartum women the separation is caused by the pressure of the growing uterus in conjunction with pregnancy hormones that soften the connective tissue of the linea alba.
Diastasis recti can occur anytime in the last half of pregnancy but is most commonly seen after pregnancy when the abdominal wall is lax and the thinner midline tissue no longer provides adequate support for the torso and internal organs.
DRA often lessens in the months after childbirth. However, some degree of damage / strain might remain up to a year after childbirth and beyond.
- 35+ in age
- Multiple pregnancy (twins, triplets, etc.)
- High birth weight baby
- Repeated pregnancies
Prenatal – how can we prevent Diastasis?
- Avoid exercises that concentrically engage the superficial abdominal muscles such as crunches and sit-ups
- Emphasis on facilitating optimal co-activation of the deep inner unit in a synergistic manner (pelvic floor, diaphragm, transversus abdominis and multifidus)
- Promoting effective, tension free diaphragmatic breathing – more rib cage breath, less abdominal breathing that will be extending the abdomen more
- Modify postures that are creating excessive intra-abdominal pressure (example: plank pose)
- Watch for breath holding
- Watch for invagination or doming at the linea alba
Intrapartum (during childbirth) considerations
- Continuous breath – no Valsalva breath (ensure glottis is open)
- Avoiding a back lying position when possible
Prenatal yoga teachers are the ones who can advocate, inform and empower those who are susceptible to diastasis or other pelvic health issues.
Postpartum (4th trimester) – “critical healing period”
- Promote exercises that engage abdominal muscles without concentrically engagement (crunch, flexion) – example of zipper hoodie in a crunch – imagine a small split in the zipper first
- Everybody is unique and so each person needs something different – some might be able to get back to certain poses in weeks postpartum, while others may need to find other options
- Watch for doming or invagination at linea alba during movement / yoga poses
- Aim for optimal load transfer at linea alba
When can we do front-loaded poses (bird dog, plank)?
Wait until the linea alba can maintain tension, the breath is tension-free and continuous and there isn’t any doming or invagination at the linea alba.
Autonomic nervous system tension affects the tissues of the body. Yin, restorative or gentle yoga to help our connective tissue, so it is a great addition for those with DRA.
“We cannot train tight tissue.” ~ Dr. Sinead Dufour
Do I Have Diastasis?
According to a 2017 Delphi study, Diastasis has nothing to do with the inter-recti distance (the width between the rectus abdominis muscles).
It is more about:
- The behaviour and the ability of the linea alba tissue to generate tension
- The intra-abdominal pressure or manometric pressure system (pressure system modulated by the core four)
- The quality of the linea alba tissue (palpate and see if it changes in texture – The linea alba runs from the xiphoid process (base of sternum) to the symphysis pubis (center of pelvic bone))
Now that the Delphi study was done, 22 experts have asked that we now let go of the inter-recti distance that used to be the test for DRA.
Self-Assessment for Diastasis Recti (DRA)
It is best to see a pelvic floor physiotherapist (physical therapist in the US) if you think you may have DRA. Here is a quick at-home test, but you really need an expert to diagnose you and to give you tools to help if you do have DRA.
- Lie on your back, with your feet on the floor bend your knees.
- With a relaxed abdomen place fingers up near the xiphoid process (where the ribs meet)
- Push down gently and see what the linea alba tissue feels like.
- Continue down towards the pubic bone and notice what the difference in the tissue is.
- Roll your upper body off the floor into a very slight “crunch,” and see how that changes the tissue along the linea alba line. Watch for the doming or invagination at the linea alba. If this is happening, leave out the tiny crunch.
- Now, what is it like if you engage pf and/or TvA?
If at any time you see a round, hard, or painful bulge protruding from your belly button area, or along your mid line, consult with your healthcare provider.