Diastasis Recti Abdominis (DRA) is defined as a separation of the connective tissue in between your abdominal muscles and can develop during pregnancy and progress into postpartum periods. Many women develop this condition but aren’t sure what to do about it. Some believe it’s just a part of childbearing and one that will remain forever, others do their best to reduce it with exercise however find it extremely difficult to overcome. 

DRA can be limiting to many while others recover from it relatively quickly. The important takeaway is that ALL women can recover from DRA, you just need the proper guidance and knowledge. So let’s give you that knowledge via the ABCs of DRA.   

APPEARANCE

DRA presentation can vary woman to woman. In some it can be a visible outward doming or coning in the center of your abdomen when standing, lifting, carrying, or trying to do a sit up. It can also look like you’re still pregnant after 6+months postpartum, and for others your posture just continues to feel like it did in pregnancy with an arched back and anteriorly rotated hips. 

With any of these, there’s this feeling of disconnect with your abdomen. You may feel you have no control over it, it’s extremely weak, and doesn’t support you when you lift and carry heavier things. This results in back pain or pressure in your abdomen or sometimes even your vulva. 

BREATHING

Those with DRA tend to also have a limited breathing pattern that can either worsen the DRA or prevent it from improving. Usually there is more chest breathing instead of diaphragmatic breathing in women with DRA. More so, you may even hold your breath with exertion which is a big problem! Doing both of these techniques when breathing (chest breathing and holding your breath with exertion) ends up causing excessive intra-abdominal pressure in your abdomen which then puts more tension on the DRA. Since the abdominal muscles don’t have the strength to support against this pressure, you get decreased stability for your spine, pelvis, and ultimately your entire body. This then opens up the possibility for many other physiological problems.  

CONTROL

Most people are not in tune with what proper core activation is. Most of us are conditioned to believe doing crunches and sit ups is how you get strong abs. We also think of simply sucking in our gut when we’re told to “activate our core”. A big gap between recovering from DRA and women who try to exercise without proper guidance is found within this concept. 

There are two main core stabilizing muscles in our abdomen - transversus abdominis (TrA) and internal obliques (IO). Guess what - neither one is the muscle that creates the six pack physique yet that’s the one we think we must strengthen to recover from DRA and get a strong core! Proper core activation is a subtle movement one that you should be able to breath through and incorporate into day to day life. It’s what helps close the DRA separation and regain stability in your trunk and core! Learning how to activate the TrA and IO requires guidance and observation. We need to be able to feel and see what your abdominal muscles are doing in order to determine how well you activate and what you need to progress. 

So now you know the ABCs of DRA. The next question is, how do you implement the proper techniques to recover? This is where I highly recommend working with a pelvic floor physical therapist to guide you through this process, but in the meantime here are some tips: 

1. Observe and assess your abdomen. What does it do when you stand? What about when you try to do a crunch? If there’s a separation, bulging, coning of any sort, it's more likely that you have DRA. Now you can be mindful of the movements and stresses you put on your body, understand why some create pains and other unwanted symptoms, and avoid doing them for the time being. 

2. Avoid doing global core exercises to try and reduce the separation. Instead, focus on diaphragmatic breathing and having that become a fluid motion. Then incorporate it into your day to day life until it becomes a habit and you find yourself always breathing in this manner. It doesn’t have to be a deep breath every time, but simply breathing through your belly versus your chest will start to wake up your abdominal muscles in the desired manner. 

3. Stop holding your breath. If you ever need to exert any force to lift, carrying, pull/push anything at all do the following. Inhale to prepare, then exhale through your mouth as you do the exertion. When working against resistance whether it be lifting grocery bags, pushing a chair, or carrying a baby, the difficult part should always be done with an exhale! This will balance out the intra-abdominal pressure in your abdomen and prevent any excessive tension on it.  

Pregnancy and postpartum recovery isn’t linear and usually requires some guidance and input from those who understand the changes in our bodies as we transition through these stages. If you find yourself having DRA and wanting to address it properly, reach out to learn how we can make that happen together. 

Want To Learn More?

Dr. Jenny is hosting a Postpartum Core Recovery Workshop on Tuesday January 17th from 6pm-8pm and Saturday January 21st from 9am-11am. If you are in the Murrieta, San Diego, Temecula or Orange County area you can register for this in-person workshop online through femme-strong.com.

About Dr. Jennifer Santamaria PT, DPT

Dr. Jennifer Santamaria is a SoCal resident who specializes in pelvic floor and orthopedic conditions. She received her Doctorate of Physical Therapy from the University of St Augustine for Health Sciences in San Marcos, Ca. Throughout her career, Jennifer has gained experience working with orthopedic, neurological, pelvic floor/women's health, and pediatric patients. She developed further neurological therapy skills while completing a two-month internship in Italy and has completed various manual therapy courses. As her career progressed, she developed a passion for pelvic health rehabilitation and completed advanced coursework to address women's health and pelvic dysfunction. Since then, her passion towards helping women address their concerns flourished into creating Femme Strong Physical Therapy.