Diastasis Rectus- Navigating the Ins & Outs: Part 1

What is Diastasis Rectus Abdominis?

Diastasis Rectus Abdominis (DRA) is caused when the rectus abdominis muscles (two large, superficial, parallel bands of muscles commonly referred to as the 6-pack) become separated by a larger distance than normal. Diastasis recti occurs when the linea alba, a collagen structure of connective tissue, is no longer able to provide stability and appropriate tension.

In the pregnant or postpartum mom, DRA is commonly noticed when the abdominal muscles are firing in a non-optimal pattern. This is seen as “tenting” or “coning” of the abdomen that is often seen when women are going from lying down to sitting up or when exercising. Even at rest, DRA may be noticeable as it is commonly nicknamed “mummy tummy” or “mommy pooch” as even after a mom has lost the baby weight her stomach may not appear skinny due to a DRA.

How common is DRA?

According to a study, the prevalence of DRA decreased from 100% at 35 weeks gestation to 39% at 6 months postpartum.¹That means that 100% of women have some level of DRA in their third trimester. One study showed the prevalence of DRA above the umbilicus was 68% and 32% below the umbilicus. While there was no difference the DRA above the umbilicus, the DRA below the umbilicus was greater in women who had given birth more than once.⁶

It’s important to note that at 6 weeks postpartum 60% of mothers had a DRA, 45.5% at 5 months postpartum and 32.5% at 12 months postpartum.⁷ A different study showed that 36% of postpartum mom’s rectus abdominis remained abnormally wide at 5–7 weeks postpartum.¹¹

Furthermore, diastasis recti and pelvic floor problems tense to go hand-in-hand and 66% of women with a diastasis recti have some level of pelvic floor dysfunction whether it be inconinence or pelvic pain.^5,7

When can I check for a Diastasis Rectus?

Since almost all moms have some degree of abdominal separation, it is important to act as if you have a separation until at least 6 weeks postpartum. Remember, 60% of mothers have a DRA at 6 weeks postpartum and 32.5% continue to have a DRA after one year. It is safe to assume (and act/exercise as though) you have an abdominal separation until 6 months postpartum.

How do I measure for a DRA and what is normal?

Mota found that “palpation has sufficient reliability to be used in clinical practice.”² The following is how to palpate for a DRA and what is considered “normal” for a diastasis rectus abdominis.

First, lay on your back with your knees bent to a 45 degree angle with your feet resting gently on the ground. Next, make sure you are in a neutral position so your low back has a gentle curve and your butt is untucked.  Then as you exhale, gently lift your head and shoulders off the floor, tucking your chin and use your index finger and middle finger to measure based on the following palpation:

1. Location and width - there are three locations to palpate for a DRA and width is measured from side-to-side in fingertip width:¹⁰
   1. Just above the umbilicus: 2.7cm is normal (at most 2 fingertip widths)
   2. Midway between the pubic symphysis and the umbilicus: .9cm is normal
   3. Midway between the umbilicus and xyphoid process: 1.0cm
2. Depth or tension of the linea alba
   1. The linea alba is connective tissue and should be both strong and taut. There should be some natural flexibility but the tissue should resist the pressure of your fingers.
   2. If the linea alba is not able to optimally contract, you will feel as if your fingers are sinking in deeper when light fingertip pressure is applied.
   3. Depth can be measured as fingertip, knuckle or even finger depth or more specifically:
      1. Shallow: 0-3cm
      2. Medium: 3-6cm
      3. Deep: 6-7cm

*One other thing to look for as you lift your head is tenting or coning of the abdominal musculature. Although this is not specific to a diastasis rectus abdominis, it is commonly a sign that you are recruiting the wrong abdominal musculature and indicates instability that may need to be addressed.

How frequently can I check my DRA?

Not too often!  Checking too frequently can actually damage the tissue and weaken the muscles which makes the gap worse! If you “have to know” the most frequently you should check for a DRA is 4-6 weeks....give yourself time to heal from the inside out!

Keep an eye out for Diastasis Rectus- Navigating the Ins & Outs: Part 2 - The Causes of DRA

References:

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.
2. Reliability of the inter-rectus distance measured by palpation. Comparison of palpation and ultrasound measurements. Mota, Patrícia et al. Manual Therapy , Volume 18 , Issue 4 , 294 - 298
3. Corrêa MC, Corrêa MD. Puerpério. In: Corrêa MD, editor. Noções práticas de obstetrícia. 12ª ed. Rio de Janeiro: Medisi; 1999. p. 95-104.
4. Gilleard WL, Brown JM. Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period. Phys Ther. 1996;76(7):750-62.
5. Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(3):321-8.
6. Rett, MT, Braga, MD, Bernardes, NO, & Andrade, SC. (2009). Prevalence of diastasis of the rectus abdominis muscles immediately postpartum: comparison between primiparae and multiparae. Brazilian Journal of Physical Therapy, 13(4), 275-280. Epub August 21, 2009.https://dx.doi.org/10.1590/S1413-35552009005000037
7. Sperstad JB, et al. Br J Sports Med 2016;0:1–6. doi:10.1136/bjsports-2016-096065
8. Boissonnault JS, Kotarinos KR. Diastasis recti I. In: Wilder E. ed. Obstetric andgynecologic physical therapy. New York: Churchill Livingstone, 1988:63–81.
9. Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther 1988;68:1082–6.
10. Rath, A.M., Attali, P., Dumas, J.L., et al., 1996. The abdominal linea alba: an anatomo-radiologic and biomechanical study. Surgical Radiologic Anatomy 18, 281–288.
11. Coldron, Y., Stokes, M.J., Newham, D.J., Cook, K., 2007. Postpartum characteristics of rectus abdominis on ultrasound imaging. Manual Therapy. Epub.

*Disclaimer:

The information by Dr. Lauren Keller of Elemental Chiropractic, Inc. is provided for general information only and should in no way be considered as a substitute for medical advice or information about any particular condition. While every effort has been made to ensure that the information is accurate, Dr. Lauren Keller nor Elemental Chiropractic, Inc. make no warranties or representations as to its accuracy and accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. If you have any specific questions about any medical matter or think you may be suffering from any medical conditions, you should consult your doctor or other professional healthcare provider. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.