Diastasis recti abdominis (DRA) is seen in many women during and post pregnancy. It is a midline separation of the rectus abdominis at the linea alba. It can present at the site of the belly button and/or above or below. It is clinically significant if the separation is more than 2.5cm or if there is abdominal doming on exertion. DRA usually occurs due to an increase in maternal hormones and stretching of the rectus abdominis (RA) due to the uterus expanding. DRA can lead to low back pain, pelvic floor dysfunction, umbilical hernias, poor posture and reduction in quality of life. Although some may need surgery to repair the abdominal wall, there has been a lot of research that shows exercise can help to reduce the level of separation. The below article looks at the effect of corrective rectus abdominis exercises to reduce DRA in both vaginal and cesarean delivery in women who have had a single pregnancy. Similar results have been also been seen in women who have had multiple births. The aim of the exercises is to increase the strength of transverse abdominis (TA) which is a deep core stabiliser and pelvic floor strength. Activating TA helps to shorten RA and brings together the gap in the linea alba. This article also highlights the importance of education and beginning training relatively early after child birth, depending on the type of delivery, instead of waiting for DRA consequences to appear.
If the 4 pillars of you core (TA, pelvic floor, multifidus and diaphragm) are strong and engage well, it reduces the pressure on RA and allows for ‘healing’ of DRA. Standard TA exercises should always be encouraged first to help regulate intra-abdominal pressure. Once you believe your strength and control has improved you can progress to other abdominal exercises but as a rule of thumb, if you have any abdominal doming or bulging during the exercise (especially in curl up exercises), stop. The bulging means that you still aren’t engaging TA effectively and increasing strain on RA. This may differ depending on the severity of the DRA , but if in doubt, contact a physiotherapist to do an assessment or see an exercise physiologist for appropriate programming.
It is important to remember that a DRA isn’t a tear of the RA, rather a separation
