What is a Diastasis Recti?
DRA stands for Diastasis rectus abdominis. It describes the separation (diastasis) of the two rectus abdominis (the 6-pack) muscles. The midline structure at ‘fault’ here is the Linear Alba, the fascial band down your midline.
How does a diastasis happen?
Diastasis recti is a normal adaptation to pregnancy
The hormone-driven changes in collagen elasticity result in the linear alba becoming more elastic, allowing it to widen and lengthen.
Research shows that ALL women will have an increased distance between their rectus abdominis muscles by 35 weeks of their pregnancy.
So it is, in fact, perfectly normal to have a gap and to see midline doming towards the end of the pregnancy, and in the first few weeks after the delivery.
Normally, by 6-8 weeks the linear alba will have restored enough to close, or mostly close, the gap.
When this closure does not happen spontaneously, its called a Diastasis.
When the distorted collagen of the linear alba can’t spontaneously restore, leaving the gap between the recti, it’s called a diastasis.
How do I know if I have a diastasis (DRA)?
This is a simple test to check how your gap is closing and regaining tension.
How to monitor your own diastasis healing from 4-8 weeks post partum
Lie down flat on the floor.
Breathe in. Hold your breath and lift your head to look at your toes.
Watch the shape of your midline (linea alba). Does it dome or ‘tent’?
Relax your head down again.
To test the width of the diatasis place 2 fingers in your linea alba, at the level of 4 fingers above your belly button. Lift your head again, holding your breath. Now wiggle your fingers across, left to right, to feel the boundaries of the gap. Add fingers to fill the gap between the 2 taut rectus abdominis muscles. Count how many fingers it takes to fill the gap.
Rest your neck down again and breathe.
Finally, check the tension of the linea alba.
Lift your head again and press straight down on the linea alba. Does it feel soft and ‘squishy’, a little firm (some tension), moderately firm or taut under your fingertips? This gives you an idea of the integrity of the linear alba.
Repeat the 2 steps above at the level of your belly button and again 2-4 fingers below your belly button.
3 characteristics of the linea alba are checked when assessing a DRA:
- the width of the gap
- the tension in the linear alba
- the ability to control doming with the correct core muscle activation strategy
These 3 factors improve spontaneously during your recovery. If there’s a failure of automatic complete healing by 8 weeks, the doming persists, and we then call it a diastasis recti.
Facilitate the healing of your diastasis
Protect
Protect the healing linea alba by avoiding movements which cause doming when moving between lying down and sitting up, typically sit-up like movements. Rather roll onto your sides and use your arms to push yourself up.
Avoid breath-holding, which causes doming, when straining.
Tension optimally
Learn how to activate your abdominal correctly as soon as possible.
It is ideal to learn this before or early in the pregnancy.
Nourish
Hydrate well, as this helps collagen healing
Eat nutritious food that is rich in high-quality protein and vitamin C. Protein gives your body the building blocks for cellular repair, and vitamin C facilitates collagen healing.
What if my diastasis is not closed by 8 weeks?
Other factors may cause you to feel weak, appear not to have gained muscle tone, and make you question whether you have a diastasis. Spasm in the abdominal muscles, poorly coordinated muscle work, spine and pelvic posture problems, and incorrect breathing technique are a few of the movement dysfunctions that can trip up the abdominal muscles.
For reasons unknown, the diastasis will sometimes not spontaneously draw closed with the same pre-pregnancy tension.
If, by your assessment, you are not steadily improving by 8 weeks, consider excluding contributing factors so you can gain your best recovery.
We know that to have a normal functioning abdominal wall, you do not need to have a 2cm gap or smaller.
What is necessary is that you have
- the coordination of the core muscles to give you stability and control pressure in your abdomen
- the ability to transfer force across the midline, which requires tensioning of the linea alba
What about a tummy tuck?
The linea alba can be distorted to the point where no tension can be generated in it, preventing coordinated muscle action. If this happens, abdominal muscle strength and appearance of the tummy will unlikely improve, and surgery may be indicated.
Differentiating a hernia from diastasis
If you are experiencing pain, a popping sensation, or see or feel a bulge in your abdominal wall, it is important to differentiate this from a diastasis. An assessment by a doctor and investigations, such as an ultrasound, will check for conditions such as a hernia.
Dispelling diastasis myths
“its my fault” – we know that having a DRA that doesn’t spontaneously heal has nothing to do with pre-pregnancy weight, pregnancy weight gain, the size of your baby, or any physical activity you did or didn’t do while pregnant or after.
“do this exercise to heal your DRA” – there is no single silver bullet exercise that will fix everything.
“never ever do a sit up again” – there is no such thing as a bad exercise – its how you do it. You now have to move in a coordinated way with control of your doming.
Being able to do a sit-up is a basic movement – one that we all need to be able to do again.
“I’m damaged forever” – you can achieve a functional abdominal wall without having your pre-baby belly appearance back. It may never look the same again, but just as your life will never be the same again after kids, your body is unlikely to escape all change either.
“My ’baby-related’ back pain is caused by my DRA” – In research, the two have not been linked. In practice, cases where a woman has a DRA and has not regained a functional abdominal wall, her back pain persists. When she achieves a functional wall, the back pain often disappears, regardless of the size of the gap.
The solution for your diastasis
Having your body assessed by a physiotherapist specialising in postnatal recovery will give you all the direction you need to correct or manage your diastasis.
No body, pregnancy or diastsis is the same, and therefore neither is the solution standard.
You will receive treatment to facilitate the normal activation of your core muscles, for example with myofascial release and treatment of the spine. You’ll be taught the correct movement patterns, with the right exercises at the appropriate time.
