What is a DRA?
A Diastasis Rectus Abdominis, or DRA, is a widening of the space between the two sides of your abdominal muscles. The connective tissue that holds the two sides together is called the linea alba, which thins and stretches to allow room for a growing baby during pregnancy.
Do you have a DRA?
If you’ve just had a baby, the answer is technically yes; 100% of women have a DRA at the end stage of pregnancy. This is not a problem, it is a normal and natural thinning and stretching that allows a tiny human to grow. There is usually a major improvement in the first 8 weeks (down to 50% incidence) and 6 months (down to 40% incidence) with no intervention at all.
There is no agreed upon measurement to officially diagnose a DRA, but if you feel a space or see a bulge along the midline of your stomach when you do a curl up, you may have a DRA. If you feel like you can’t strengthen your core no matter how hard you try, you may have a DRA. However, the presence of a DRA is not necessarily a problem.
Is it a problem?
This is the million dollar question.
Some women function very well with a DRA while others do not. If you have post-partum low back or pelvic pain, working on your DRA may reduce your pain and improve your function. Maintaining tension across your abdominal wall is an important aspect of core strength, and a DRA can interfere with all aspects of your core (your abdominals, pelvic floor, diaphragm, and back muscles). Having a DRA can make it very difficult to strengthen your core and return to pre-pregnancy activities, especially high intensity exercise in which form is important.
How can Physiotherapy help?
If you are concerned about your DRA, the width of the gap isn’t as important as your ability to maintain tension across it. Even if the linea alba remains thinned and lengthened, it’s possible to use other muscles to take up the slack. A qualified Physiotherapist can help to identify a DRA, teach you strategies to move with more confidence and stability, and help you return to activity and exercise.
The other part of the puzzle is the issue of fascial density, which is the thickness of the linea alba and its ability to resist stretch. Specific exercises have been shown to improve the density of connective tissue in other parts of the body, and may be able to improve symptoms associated with a DRA.
It’s not a matter of “healing” the diastasis, your body will have taken care of that in the first 6 to 8 weeks post-partum. It’s about learning to use what you’ve got more effectively and doing what you can to make the fascia of your linea alba thicker and stronger. There is no one-size-fits-all solution or magical exercise that is guaranteed to help, but we can help you figure out what works for you.
How Can Real-Time Ultrasound help?
We use Real-Time Ultrasound (RTUS) to measure the distance between the two sides of the rectus abdominis muscle. More importantly, we can see exactly what the fascia of the linea alba looks like and how it responds to load. Is it thick or thin? Does it bulge, crimp, or remain taut while you move?
We can also see how the individual muscles of your abdominal wall are working. If you’ve been frustrated by trying to “find” your transversus abdominus, we can use RTUS to see exactly which muscles you are activating. We can also see whether muscle contraction actually builds tension through the linea alba the way it is supposed to.
Perhaps most importantly, RTUS can provide biofeedback and allow you to clearly see what is happening, which can make the rehabilitation process much less difficult and frustrating. It can also help us to determine when to refer you on to another medical professional to discuss the need for surgical intervention.
There is a huge gap in research in this emerging field, but there are some amazing Physiotherapists leading the way. Julie Wiebe (www.juliewiebept.com), Antony Lo (www.physiodetective.com) and Diane Lee (www.dianelee.ca) are all amazing sources of further information. Please check out their online resources or call Lindsay or Tara at The Joint for more information: 250.331.1200.
Lindsay Baker is a Registered Physiotherapist who has had specialized training in the use of Real-Time Ultrasound to assess and treat DRA, as well as in Pelvic Floor Physiotherapy.
Tara Gornall is a Registered Physiotherapist who has had advanced training in the assessment and treatment of DRA.