By: Gema Sanchez, PT (Edited by Bradley Brown)
Diastasis rectus abdominis (DRA) is a structural impairment of the muscular and connective tissue of the abdominal wall which presents as a separation of the abdominal muscles along their midline. It is measured as the distance between the right and left sides of the abdominal muscle grid (the “six-pack”), and is referred to as the inter-recti distance (IRD). Measurement of IRD in the clinic is generally made by hand or with calipers. Criteria for the diagnosis of DRA vary, but IRD is generally considered abnormal if it exceeds 2 fingers width at rest, measured at or just above the navel. DRA has been linked to support-related pelvic floor dysfunction and lumbopelvic pain. One study in 2009 found that 74% of women seeking physical therapy for abdominal or lumbopelvic symptoms exhibited increased IRD and had significantly greater pain than those without DRA.
Risk of pregnancy-related DRA is about 27% during the second trimester and peaks in the third trimester at 66-100% due to the baby’s increase in size. Luckily, there is some research which suggests that exercise during pregnancy may mitigate the occurrence of DRA. In 2005, one such study looked at the effect of abdominal strengthening on the presence and size of DRA in pregnant women. Eight women who participated in a prenatal exercise program of abdominal muscle strengthening, pelvic floor exercises and education were compared to 10 non-exercising women. They found that only 12.5% of the exercising women exhibited a DRA as compared to 90% of the non-exercising women.
Incidence of DRA decreases postpartum but is still present in as many as 39% of women six months postpartum, and some women still have not fully recovered one year postpartum. DRA-related abdominal instability can be especially limiting during this time, as women return to previous normal activity in addition to the load of caring for their child.
Integrity of the anterior abdominal wall is essential to stability, posture, breathing, trunk movement and support of internal organs. Specific abdominal exercises are used to narrow the IRD and help prevent future separation. In two recent studies, ultrasound measurements were used to assess the effect of active abdominal contraction on DRA in post-partum women. Both studies concluded that IRD was reduced with regular, static abdominal contraction. In another study, researchers used ultrasound to measure IRD at rest and during abdominal exercises in 84 women during and after their pregnancy. Their results support the notion that conservative abdominal exercises consistently produced a significant narrowing of the IRD.
It is important that women with DRA receive individual supervision and assessment so that adjustments can be made based on each patient’s reaction to exercise as well as rate of improvement.
New Heights Physical Therapy Plus has physical therapists with the training, skill, and knowledge to assist your clients with DRA during and after their pregnancy.