In this article we provide an overview of Diastasis Rectus Abdominis (DRA), a condition affecting many women, particularly during pregnancy. We will cover the underlying causes, common occurrences, and guidance on prevention and management. Our aim is to offer clear and concise information for those affected by DRA.
Understanding Diastasis Rectus Abdominis During Pregnancy
DRA is defined as the separation of the Rectus Abdominis muscles secondary to the thinning and partitioning of the linea alba. DRA can be caused by multiple factors; however, it’s most commonly seen during pregnancy from approximately the 14 week mark. During pregnancy, as the uterus grows larger the abdominal muscles are stretched, resulting in the linea alba thinning and pulling apart. DRA is an extremely common condition that affects over two thirds of women during their third trimester and approximately 50% of women post-partum.
Common causes of DRA other than pregnancy include major weight loss, hormonal changes that occur with menopause or hormone replacement therapy (HRT), regular heavy weightlifting and surgery involving the midline abdomen. For pregnant individuals, factors such as multiple pregnancy, quick successions of pregnancies, childcare, larger babies, a smaller torso and pelvis, obesity, overuse of the abdominal muscles and sedentary behaviour may increase the incidence and likelihood of DRA occurring.
Preventing and Rehabilitating DRA: Pregnancy Pilates and Physiotherapy
To avoid exacerbating DRA during pregnancy, after the first trimester, individuals should avoid exercises that place increased tension or strain through the abdomen. Pregnant women are encouraged to continue exercising throughout their pregnancy, and activities like pregnancy Pilates may be an ideal option. However, they should be guided by the appropriate health professional to ensure suitable exercises are being performed.
With a focus on holistic care during pregnancy, Pregnancy Physiotherapy plays a vital role not only in managing and preventing DRA but also in promoting overall well-being. It can bridge the gap between guided exercise routines like pilates and post-partum recovery, creating a seamless continuum of care. By tailoring exercises to individual needs, Pregnancy Physiotherapy ensures that women receive the support and guidance they require throughout their pregnancy journey.
It is important to note that there is some natural recovery of DRA within the first eight weeks post-partum, even with no physiotherapy intervention, however at the one year mark no further closure will occur.
To get the best outcomes for DRA rehabilitation, physiotherapy intervention is essential. An individualised exercise program will be designed based on the physiotherapist’s assessment which is suitable for the individual’s presentation and level of function. Exercises for DRA rehabilitation aim to improve strength in the deeper and more specifical core muscles with the goal of creating closure of the DRA. Pelvic floor muscle retraining is also essential in this time.
Rehabilitating DRA correctly is not only important for day to day tasks and functionality, but even more important for mothers who would like to return to heavier impact-type exercise, for example running. The guidelines outlined for women planning to return to running explains that before running is resumed, functional control of the abdominal wall must be regained. Whilst a woman may still run with a DRA if it’s functional, running with a non-functional/non rehabilitated DRA may result in overload and compensation of other structures in the surrounding area, namely the pelvic floor. This then creates further issues for the individual.
If you would like further information about DRA or feel like you need one of our physiotherapists who specialises in this area to assess you, please don’t hesitate to contact us.