Diastasis recti is a condition affecting the most superficial muscular layer of the abdominal wall (rectus abdominis aka the 6 pack muscle) causing separation along the midline of the muscle. I will usually encounter this when treating women during pregnancy or in their postpartum recovery. I definitely enjoy working with women in the earlier stages of their pregnancy because we get to work together to help protect the abdominal wall and prevent or minimize any abdominal separation. In this population, DRA is usually occurring due to increased tension across the abdomen to accommodate their growing belly and if left untreated, can lead to core weakness, back pain as well as pelvic floor issues including urinary incontinence, constipation and painful sex.
Patients will usually tell me that their core feels weak even many months after giving birth. They may also talk about mild to moderate pain near their abdominal midline. Some may even start to notice “coning” which can appear like a bulge near the abdominal midline during activities that increase inner-abdominal pressure such as exercise or daily tasks like getting in and out of bed or having a bowel movement. These are usually symptoms that suggest the core system is no longer managing inner-abdominal pressure successfully. In pelvic rehab, we will work on strengthening the abdominal wall specifically and the core system more broadly – including the glute and spinal muscles, respiratory diaphragm, and pelvic floor musculature, in order to address the mismanagement of inner-abdominal pressure and prevent any aches and pains down the line.
A major contributor to this condition is poor utilization of the deepest core muscle, your transverse abdominis (TA) and overutilization of the more superficial layers including the obliques and rectus abdominis. The TA wraps horizontally around your torso blending into the tissues of your lower back and acts as a corset and a major stabilizer for the spine. If the TA isn’t helping provide stabilization at your spine, more often than not I am also treating low back pain in addition to the abdominal separation. When a patient is able to correctly activate their TA then it's time to work on coordination of their breathing and pelvic floor. In addition to strengthening, I am also focusing my attention on body mechanics and posture to mitigate any further stress on the abdominal wall. Therapeutic exercise starting in the prenatal stage is shown to reduce your risk for developing DRA in the future. If you're concerned about abdominal separation, have observed signs of coning, or simply feel like you have been unable to get your strength back after pregnancy you should reach out to a Pelvic Expert Physical Therapy for assessment.
Author: Allison Feldt
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