Diastasis Rectus Abdominis (DRA)

 
 Visual demonstration of a patient with DRA, left, versus a patient without, right.

Visual demonstration of a patient with DRA, left, versus a patient without, right.

 

Both men and women can have DRA, or separation of the abdomen.

Did you know that a 10-15% contraction of the PFM (pelvic floor muscles) should result in activation of the TA (transverse abdominis), independent of the other abdominal muscles in a healthy person? (Diane lee, 2017).

Or, if you are a woman, did you know that when you are or were 35 weeks pregnant, there is a 100% chance of having DRA? (Kamel & Yousif,  2017).

 

What exactly is DRA?

Diastasis Rectus Abdominis, also known as DRA, is the separation of the two rectus abdominis muscles along the linea alba due to hormonal changes and a growing uterus. Males can be susceptible to this as if they are obese.

If you have a DRA, you could see doming present between what is commonly known as the “six pack muscle.”

The abdominal wall is made to transfer force, adapt to changes, be mobile, and stabilize the trunk while supporting limb movement. If DRA is present it could lead to abdominal pain, low back pain, prolapses, difficulty with functional task, and instability throughout the pelvis and spine.

 

What the research shows:

 Transverse Abdominis:  Increases intra-abdominal pressure, stabilize lumbopelvic region, increases fascial tension in the abodminals.  

Transverse Abdominis:  Increases intra-abdominal pressure, stabilize lumbopelvic region, increases fascial tension in the abodminals.  

A Study by D. Kamel and A. Yousif 2017 revealed a direct relationship between the intensity of muscle overload and strength gains. In essence, the greater the intensity of muscle overload, the greater the increase in strength gains. This is why using a combination of neuromuscular re-education alongside abdominal exercises reduced DRA, compared to just performing abdominal exercises.

A study by Diane Lee and Paul Hodges 2016 suggested that when you perform a crunch, the “six pack muscle” comes closer together with the linea alba on slack. However, when you perform a transverse abdominal contraction (“Pull belly into spine”), the “six pack muscle” widens and the linea alba is taught. If you combined a “pulling belly in” while performing a mini crunch, the linea alba is at the most optimal position and the abdominals can function the most efficiently. This suggests when performing abdominal exercises, try to recruit the TA (transverse abdominis) in combination with all other abdominal muscles so that no pressure is lost through the abdominals. Otherwise, this loss in pressure can create an increase in IRD (inter-recti distance), which “widens the gap” or causes an abdominal hernia.

Do we have to close “the gap”?

As per research stated above, it is not necessary to close the gap if the person is able to demonstrate how to contract the abdominals correctly without over-activating or under-activating the muscles and without bulging or doming happing.  

The misconception is that the linea alba has to be less than 2 finger widths apart be able to have functional abdominals, which is not true.

You can have a gap of 3 fingers widths apart and if you can activate the Transverse abdominis correctly, then you are less susceptible for a prolapse, hernias, and low back pain.



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Do I need surgery?

Before deciding whether or not to get surgery, be sure to get evaluated by a pelvic floor physical therapist. An experienced pelvic floor PT will be able to determine if you fail the load transfer test, if the lumbar or thoracic spine has instability, and if the abdominal “gap”can create tension. 

Wait at least 4 months after stopping breastfeeding to see tissue changes occur due to hormonal changes. Typical rehabilitation time is between 6 weeks (if it’s a motor control issue) to 1 ½years (if it’s a connective tissue issue).  

 

The Good News

 
 
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How does Pelvic Floor Physical Therapy Help?

Get checked by a pelvic floor physical therapist to assess the abdominal wall, diaphragm, and muscular skeletal system.

A physical therapist can help you understand which abdominal muscles are turning on, and which ones are not functioning properly. Based off of the PT assessment, the PT should be able to give you a guide of appropriate exercises customized for your individual needs and lifestyle.

Sarton Physical Therapy is home to the best pelvic health physical therapists in Orange County. The women at Sarton PT have an eclectic perspective in treating Endometriosis with their successful interventions. Let our advance board certified physical therapists help, please contact us with any questions or requests for additional information. 

 

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