Diastasis Rectus Abdominis – Are you Split On What To Do About It?

Often times new practice/family members come into The Health Loft with Diastasis Rectus Abdominis (DRA) and will not even mention that they have it. Sometimes this is because they don’t realize they have it, but many times they feel that it’s ‘normal’ after childbirth and they just need to deal with it.

Wrong!

Not only is it important to focus on healing this area of the body for functional purposes but also by not acknowledging it, it can perpetuate an unconstructive body image, which can be harmful for our mental health.

Let’s define DRA first:

DRA can occur in men as well as women, it’s simply the stretching of the connective tissue between the rectus abdominus muscles causing the muscle bellies of your ‘six-pack’ to separate (along the linea alba). This is due to an increase in tension at this tendon and poor management of the intra-abdominal system, which can occur from repetitive improper loading of the abdomen – not stabilizing the abdomen when lifting for example, as well as from rapid expansion of these tissues, which occurs in pregnancy. This is why DRA is a topic of conversation in the perinatal world as the hormone Relaxin is still coursing through the body further facilitating the possible over-stretching (1, 2).

 

DRA definitions and measurements fluctuate in the literature but a separation of more than 2.7cm is significant. (3) In absence of a specific measurement, we can also use fingerbreadths to determine the state of the tendon sheath and monitor progress and change. It’s much easier and more reliable to have a health professional check for DRA but a quick screen would be to lay on your back and come into an abdominal crunch just to when your shoulder blades come off of the floor, using a flat hand, fingers pointing down, check for a protrusion/separation. Two fingers? Three fingers? More? This can be confused with a type of hernia so it is still important to have a health professional check as well.

So why does DRA affect you but your best friend Julie just gave birth and doesn’t have any of this?

First of all, let’s not compare our unique and badass selves to anyone else. Capiche?  You are a glorious piece of art.

Secondly, the research is still out on true risk factors and predisposition to DRA but a few things have been semi-established: Multi-parous women (having had more than one child) have a heightened risk due to the repeated stretch of the abdominal wall (2). Additionally, caesarian section and older age have also been found to increase the risk of DRA (1). Studies show that the incidence of DRA during pregnancy increases as the pregnancy evolves, first showing in the second trimester and peaking in the third with continuation postpartum (2, 3 ). DRA is common within pregnancy but not normal, and continuing past 8 weeks postpartum is also not normal but can occur in as high as 60% of cases 4(Kimmich).

 

So what now? Well, right now you may feel a little less stable. This makes sense because part of the core has lost some of its integrity. It’s important to remember however, that our core is not just our ‘six-pack.’ Our core consists of our abdominal wall, as well as our back, our pelvic floor and our diaphragm. These structures must work together equally in order for us to maintain ideal stability, posture and strength. As these components work as a unit, it follows that strengthening or focusing on only one of those components won’t fix the problem. There seem to be many thoughts around how to correct and heal DRA but not a whole lot of consistency or focus on all aspects of the core. For example, the transverse abdominus (TrA) gets a lot of attention these days because of studies that showed that people with low back pain had TrA’s that were slow to fire compared to those without low back pain and so weren’t as helpful in supporting the core with stability 5(4). But further studies have shown that there are multiple muscles that do not fire properly in those with low back pain 6(5) because again, our core works as a unit! Along with these inconsistencies, there is varied research regarding the effects of exercise on DRA. Some studies indicate that there is a correlation between strength of the abdominal muscles and incidence of DRA, finding DRA absent in those who took part in physical activity well before pregnancy as well as those who were vigorously active just prior to pregnancy (2,7,8), whereas other studies show no relation between regular exercise and DRA (9, 10). So where do we go from here? We go to where there is stronger research in stability and rewind to when we were toddlers.

 

When we are born, we don’t have core stability. In fact, we are actually born with DRA. How do we heal? We heal by practicing breathing and with movement as we develop. Developmental Kinesiology is the basis for exercises directed at helping to heal DRA. It takes us back to when we were about 7 months old, stabilizing on our sides and getting ready to turn (11). We’ve also discovered that the diaphragm doesn’t only function in breathing but also plays a huge role in core stabilization (12). With a combination of breathing exercises and developmentally basic movement patterns we are seeing changes in those aberrant firing patterns within the core unit, and ultimately an improvement in DRA appearance.

 

It may seem obvious but one of the most powerful things we can do is make sure that those nerves that innervate the muscles of the abdominal wall are firing at full capacity. If our spines are out of alignment, there is an added stress to the nervous system because the spine surrounds our spinal cord. When there is added stress it means that those nerves don’t get to provide the tissues with their full potential. We need this potential to heal tissues but also to relay that information to the brain so that all of our muscles can work together to fire as the unit its meant to. That’s where chiropractic steps in to support you in your journey of healing. With proper alignment comes proper communication, flow and healing.

 

Along with the physical component, we require the nutritional aspect of healing. Your linea alba is made up collagen, just like all of your connective tissue, and it’s never too late to heal. Nutrition that aids in this healing should include lots of water to help maintain the circulatory system, support enzymatic activity and function of cell membranes, carrying nutrients in the body and eliminating waste. Vitamin C is a key player in healthy connective tissue as it helps in the production of collagen, elastin and helps to reduce inflammation. You can find great sources of Vitamin C in kiwi, papaya, strawberries, pineapple, oranges, kale, tomatoes, and broccoli among others. Vitamin E helps as it’s an antioxidant, eliminating free radicals in the body that can damage healthy cells. Vitmain E hangs out in sunflower seeds, almonds, eggs, asparagus, avocados and kale too! Make sure to also have adequate protein, which also helps in healing the connective tissue structure (13). Bone broth is a fantastic way to increase the collagen, glucosamine, and all other elements of healthy connective tissue.

 

There is so much value in bringing function back into our lives. But the obvious physical functioning is only the tip of the iceberg. The real healing comes from within. No matter where you are at in your life, it’s so important to love yourself. For most of us, this isn’t easy. Remind yourself of your strength and the wonder of your own body. If you have DRA from pregnancy, see what that experience brought you. You created life and get to share your strength and wonder with another human being. We can heal from a place of love and patience. Negativity has no value.

 

We are self-healing beings; this power to heal ourselves however, is stifled by negative thoughts, poor food choices/toxins, and stress. Anything that puts stress on our bodies drains our healing capacity. To take stress off of the nervous system, it is important to include chiropractic in our lifestyles to make sure that our bodies can function at their optimal potential and our proper nutrition and activity don’t go to waste on a nervous system that isn’t running at full speed.

 

References:

  1. Volkan T,  Colluoglu C, Turkyilmaz E, Korucuoglu U. Prevalance of Diastasis Recti Abdominis in the Population of Young Multiparous Women in Turkey. Ginekol Pol. 2011, 82, 817-821

 

  1. Boissonnault JS, Blaschak MJ. Incidence of Diastasis Recti Abdominis in the Childbearing Year. Physical Therapy. 1988, 68 (7); 1082-1086

 

  1.  Acharry N, Kutty.RK Abdominal Exercise with Bracing; A Therapeutic Efficacy in Reducing Diastasis Recti Among Postpartal Females.  Int J Physiother Res 2015, Vol 3(2): 999-05

 

  1. Kimmich N, Haslinger C, Kreft M, Zimmerman R. Diastasis Recti Abdominis and Pregnancy. Parxis. 2015, 104(15):803-6

 

  1. Hodges PW, Richardson CA. Altered Trunk Muscle Recruitment in People with Low Back Pain with Upper Limb Movement at Different Speeds. Archives of Physical Medicine and Rehabilitation. 1999, 80

 

  1. McGill S. Laying the Foundation – Why We Need a Different Approach. Ultimate Back Fitness and Performance, ed. Stuart McGill, 9-27. Canada: Wabuno Publishers, Backfitpro Inc,

 

  1. Sperstad JB, Tennfjord MK, Hilde G, et al. Diastasis Recti Abdominis during pregnancy and 12 Months after Childbirth: Prevalence, Risk factors and Report of Lumbopelvic Pain. Br J Sports Med 2016; 50:1092–1096.

 

  1. Mota P, Pascoal AG, Carita AI, et al. Prevalence and Risk Factors of Diastasis Recti Abdominis from Late Pregnancy to 6 months Postpartum, and Relationship with Lumbo-pelvic Pain. Man Ther. 2015; 20:200–5

 

  1. Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014,100(1): 1-8

 

  1. Candido G, Lo T, Janssen PA. Risk Factors for Diastasis of the Recti Abdominis. J Assoc Chart Physiother Womens Health 2005; 97:49–54.

 

  1. Blog – What is Diastasis Rectis Abdominus? Retrieved on May 15, 2017 from: http://www.trianglecrc.com/blog/what-is-diastasis-rectus-abdominis/

 

  1. Kolar P, Sulc J, Kyncl M, Sanda J, Neuwirth J, Bokarius AV, Kriz J, Kobesova A.

Stabilizing Function of the Diaphragm: Dynamic MRI and Synchronized Spirometric Assessment. J Appl Physiol. 2012; 42 (4): 352-62

 

  1. Blog – Tupler Technique: Treatment for Diastasis Recti. Retrieved on May 15, 2017 from: https://www.diastsisrehab.com/diastasis-belly-blog/