Diastasis Recti Abdominis (DRA)
DRA is a separation or spreading of the fascial midline connection of the right and left rectus abdominus muscle bellies at the linea alba. It is not a tear but a stretching of the fascia. This stretching or separation can occur during pregnancy and is usually first seen in the 2nd trimester and peaks in the 3rd trimester. It is most commonly found at the belly button or just above.
Most times women do not report pain with this type of abdominal muscle separation. Women do, however, report discomfort participating in daily activities due to the profound weakness in their core. It is also common for women to report dissatisfaction with the appearance of their abdomen, specifically “flabbiness.” Other symptoms of DRA may include poor posture, pain, weakness, urinary incontinence, and reduced quality of life. Women with DRA tend to have a higher degree of pelvic, abdominal, and/or lower back pain. (1)
DRA most commonly occurs in pregnant women due to the pressure on the stomach muscles as the mother’s belly grows. After giving birth, DRA may close by itself, but other times it may not. When DRA does not resolve itself, it may cause continued weakness, poor posture, and pain (low back, pelvis, hip). Women also report difficulty regaining muscle tone in their abdomen and having an abdomen that looks different and softer than before pregnancy.
Q: Is diastases recti abdominis (DRA) common?
A: Yes. Statistics vary but one study identifies 30-70% of women report having DRA after the conclusion of their pregnancy. (2)
Q: Does DRA get better over time?
A: Sometimes. However, women who have symptoms associated with their DRA report a decreased quality of life due to having low back pain and urinary incontinence as well. (3) In the majority of women, DRA does get better over time, however studies show that there are still women in later stages of postpartum still report having persistent DRA. (4)
Q: Will crunches or planks improve my DRA?
A: No. DRA may be worsened by participating in exercises or activities which place too much pressure on your weakened and separated abdominal muscles. You must be intentional and knowledgeable about which exercises are safe and how to move your body in order to improve your DRA, not worsen it. A pelvic floor physical therapist will explain how to safely participate in daily activities such as lifting your baby or other objects, getting up from the floor, exercising, working, and more.
Q: Would I benefit from pelvic floor physical therapy (PFPT)?
A: If you are a postpartum mother and experiencing any of the symptoms described here or have noticed that your muscles are separated though you have no pain, you may benefit from PFPT. This specialized therapy is useful in identifying the extent of your abdominal muscle separation and how to treat it. One study shows that women who participate in core stability exercises experience a significant improvement in their DRA as well as improved quality of life. (5)
Treating and Managing Your Diastases Recti Abdominis
Our approach to healing your DRA will depend on the extent of your abdominal muscle separation and the type of symptoms you are having. Generally, we will provide education about how to move safely and protectively to prevent worsening your DRA, instruct you on improved postural training in which you learn to functionally use movement of your body and breathing to activate your deep core muscles, and provide you with exercises to improve your muscle weakness and separation.
At N-Balance Physical Therapy, we offer a comprehensive treatment plan that includes a thorough evaluation to identify the cause of the problems you are experiencing and implement an individualized treatment plan to improve your symptoms and resolve your DRA.
- Parker M et al. J Women’s Health Phys Ther, 2008; 32(1): 15 -22
- Kimmich, N., Haslinger, C., Kreft, M., & Zimmermann, R. (2015). Rektusdiastase und Schwangerschaft [Diastasis Recti Abdominis and Pregnancy]. Praxis, 104(15), 803–806. https://doi.org/10.1024/1661-8157/a002075
- Gitta, S., Magyar, Z., Tardi, P., Füge, I., Járomi, M., Ács, P., Garai, J., Bódis, J., & Hock, M. (2017). A rectus diastasis prevalenciája, lehetséges rizikófaktorai és szövődményei [Prevalence, potential risk factors and sequelae of diastasis recti abdominis]. Orvosi hetilap, 158(12), 454–460.
- Boissonnault, J. S., & Blaschak, M. J. (1988). Incidence of diastasis recti abdominis during the childbearing year. Physical therapy, 68(7), 1082–1086. https://doi.org/10.1093/ptj/68.7.1082
- Thabet, A. A., & Alshehri, M. A. (2019). Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial. Journal of musculoskeletal & neuronal interactions, 19(1), 62–68.