By Motion Physical Therapist: Dr. Alyssa George, PT, DPT, OCS
Diastasis Rectus Abdominis (DRA) has been getting a lot of press lately. The topic even made it to the headlines of NPR last month.(1) DRA is the separation of the right and left abdominal muscles at the midline of the abdomen, the linea alba that is common among women during pregnancy. In fact, a study found that up to 66% of pregnant women will experience DRA by their third trimester.(2)
The growing fetus stretches and expands the abdominal muscles during pregnancy which can lead to the muscle bellies separating. If this separation becomes greater than 2 cm, then you have DRA. It can occur at, above, or below the belly button, creating an unwanted bulge, pooch, or separation in the abdomen. Women with DRA also report feelings of “flabbiness” in their abdominal muscles. It may also contribute to low back pain, urinary or bowel problems, poor posture and difficulty performing load transfer tasks necessary for bending, reaching, lifting, carrying, squatting, walking, and stair climbing–all the activities that new moms quickly become experts in.
When most postpartum women notice this bulge, they likely think that they need to do more crunches and abdominal exercises in attempt to reduce the bulge. Unfortunately, these types of exercises may not be effective at reducing DRA and often may actually make the separation worse.
Our trunk or “core” is actually made up of several different muscles all pulling from different directions and it includes our respiratory diaphragm “above” and our pelvic floor muscles “below.” It is important to incorporate all of these muscle groups, especially breathing, into exercises to reduce a DRA.
One Common Cue
I tell patients to imagine you are fogging a mirror while lightly drawing your belly button into your spine. Hold this contraction while you continue to breathe for 10 seconds. This can be done sitting or lying down. Additionally, it is important to perform pelvic floor muscle contractions or “kegels” as these muscles are part of our trunk or “core” system. In addition to specific exercises aimed at reducing the DRA, manual therapy can be another useful tool. Significant body changes occur during pregnancy that have an effect on posture, strength, and flexibility. It is important to target these impairments that may include: tightness in the thoracic and lumbar spine, weakness or tightness in the hips, and poor postural awareness. I have had numerous postpartum patients (both post-vaginal delivery and c-section) tell me they just don’t feel like themselves because of all the muscle changes that occurred in their abdominal and pelvic region. A skilled PT can help identify which areas need the most attention in order to maximize your outcomes and return you to your optimal level of function.
Of course, there is always the question of “how can I prevent the development of DRA?” Unfortunately, there is not a lot we can do to prevent DRA because it is a natural consequence of pregnancy. What we do know is that some women are more prone to development of DRA if they are older age, have had multiple pregnancies, have large babies, or are pregnant with multiple children. Studies have shown that starting a specific core and pelvic floor strengthening program with a trained physical therapist is effective in reducing DRA and restoring function both during and after pregnancy.(3)
Dr. Alyssa George, PT, DPT, OCS
Alyssa wants to get you back to doing what you love, whether that be sports/recreational activities, your career, or caring for your family. Specializing in treating pelvic and orthopedic conditions, Alyssa develops individualized treatment plans because she understands that no two bodies are alike. She has been involved in research projects to help advance the field of physical therapy. Most recently she has written a case series detailing the benefits of dry needling for chronic pelvic pain and presented on the function of breathing muscles in pelvic pain at the American Physical Therapy Association’s Combined Sections Meeting. She has over nine years of experience as a physical therapist and has started and led pelvic health programs at clinics in Texas, Ohio, and now Minnesota, her home state.
Alyssa earned a Bachelor of Arts degree in biology from Gustavus Adolphus College, a Master of Physical Therapy degree from the University of Wisconsin-Madison, and continued her education at the University of Montana, earning her Doctorate in Physical Therapy. She is a board-certified clinical specialist in orthopedics and earned her certification in pelvic physical therapy from the American Physical Therapy Association Section on Women’s Health. She has been a lecturer and faculty mentor of both orthopedic residency and manual therapy fellowship programs at The Ohio State University and is a credentialed clinical instructor for physical therapy students. Alyssa has been certified in dry needling and utilizes other various manual therapy techniques in her management of abdominopelvic disorders (including incontinence, constipation, lumbopelvic pain, and pregnancy-related musculoskeletal disorders) and orthopedic conditions of the neck, back, shoulder, hip, knee, and foot/ankle.
2. Boissonnault J, Blaschak M. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther. 1988;68:1082-1086.
3. Mommers, E.H.H., Ponten, J.E.H., Al Omar, A.K. et al. Surg Endosc (2017). https://doi.org/10.1007/s00464-017-5607-9