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Diastasis Rectus Abdominis: More than “Closing The Gap”

carlsbad physicaltherapy womenshealth Oct 14, 2020

Hey there, mothers. Are you eager to return to “all the things” postpartum?  During your pregnancy or after the baby's arrival did you have a fear of your “abs separating”?  Many women we work with at Inside Out Strength and Performance come to us with questions and concerns about diastasis recti abdominis (DRA).  So, we wanted to take the time to talk to you more about what it is, common signs, how it happens and learn what you can do about it. 

What it is?

Diastasis Recti: is the separation or thinning of the connective tissue in the middle of the rectus abdominis (6 pack abs). The rectus abdominis runs from the sternum to the pubic bone, and therefore diastasis can occur anywhere along that length of the connective tissue (the linea alba). Oftentimes, the linea alba becomes softened and stretched during pregnancy due to hormonal changes and increased pressure in the abdomen from the developing fetus.

Common Signs associated with DRA: 

  • Feeling of inability to activate your abs or feeling extremely weak (especially when you previously had good core strength and endurance). 

  • Pulling or stretching sensation in the middle of your abdomen with crunches, planks, or other high level core exercises. 

  • Doming or conning with lifting during daily activities or exercise, with core/ab exercises, or with bowel movements. 

How It Happens:

There are many reasons DRA could occur. Interestingly enough, 100% of pregnant women will develop some form of DRA during pregnancy due to the growing fetus.  What’s important to keep in mind is throughout pregnancy and postnatally to be mindful of your movements and lifting to promote safe mechanics. These tissues are softened and stretched, less efficient, and thus more easily injured with various activities. This can be especially true with activities that increase pressure in the abdomen or require forward flexion of our trunk as this is the primary function of the rectus abdominis. This can include certain core exercises during the second and third trimesters of pregnancy or early postpartum, excessive pressure with pushing during delivery, excessive straining due to chronic constipation, sitting up straight from the bed rather than log rolling, dysfunctional pressure management or breath holding with exercise, or poor pressure management with lifting during daily activities.

When someone sees “doming” it’s a visual representation of what is going on as an overload of the linea alba. If we have dysfunctional pressure management within our core the air will want to go to the path of least resistance, which can be along the linea alba for some women.  

What you can do about it:

For those women that do experience some of the common signs or symptoms of DRA we recommend reaching out to a local pelvic health physical therapist for a thorough assessment of your abdominal wall tissue in addition to evaluating your movement patterns, strength, mobility and range of motion to see if there are other things that may be contributing to your symptoms. 

Many people fear crunches, planks and core work if they have DRA, which is to be expected. With appropriate training, guidance and an individualized approach to safely and strategically load the tissues this will allow them to strengthen. It’s like a teeter totter in some ways that if you don’t load the tissues enough no adaptation will occur but we also can’t overload it too much or overload of pressure because we’ll see compromise to the tissue such as coning or limited ability to effectively contract the core musculature.

Below is a DRA self screen video. It’s a place to start to have an awareness of where you’re starting from.  It’s a way to check the width and depth of the tissue on the abdominal wall.

 

Some research states 1- 1½ finger widths of separation is considered “normal”.  A consideration to keep in mind is most women haven’t checked this prior to having a baby, so their starting point may be different based on their movement patterns, habits, workouts.  Its very common to see a reduction of tissue integrity at 2-3cm above the belly button, usually due to that being the farthest point of stretch during pregnancy. 

The main point we want to get across to mothers is the goal is to not “close” the diastasis but rather generate tension through it.  This allows for a functional DRA and an improved strategy to manage pressure and loads throughout the trunk.  As much as society may want you to “close the gap”, I’m here to encourage you to focus on your breathing, body mechanics and building a dynamic core strength system starting from the basics first. 

3 Strategies to Get You Started:

Log Roll Technique

 

Core Connection Breathing 

 

Side Plank with Clams 

**More advanced exercise, be mindful of your breathing throughout and pay attention to any symptoms that may occur. If you notice an increase of symptoms please stop exercising as it is too challenging for you at this time.

Many women in the postpartum time are discouraged and lost in where to start when it comes to returning to exercise which is keeping them from living out their full potential, so we’ve created a way to help you get your 'mom fitness mojo' back. At Inside Out Strength and Performance, we teach you how to return to exercise with confidence and be the strong mom you know you can be.

If you’re concerned about if you have DRA or what to do please reach out to a local pelvic health physical therapist for a thorough assessment of your abdominal wall tissue in addition to evaluating your movement patterns, strength, mobility and range of motion to see if there are other things that may be contributing to your symptoms. 

Are you feeling embarrassed, frustrated or tired of leaking limiting your workouts and active lifestyle as a mother? I put together a free download for mothers like you to help guide your return to exercise and build up your fitness routine and get healthy, strong and confident in your health. Click the link below to learn more about the Leakproof Running Guide For The Postpartum Woman.

https://www.iostrengthperformance.com/leakproof-running-guide 

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