You’ve Got DRA…We’ve Got Solutions
A very common issue for postpartum women is noticing that their abdominal muscles don’t quite seem the same. During pregnancy, as the belly is slowly expanding to provide space for the growing baby, the rectus abdominis muscles (muscles that start at the bottom the rib cage and move vertically toward the pubic bone - the “six pack muscles”) slowly begin to widen. In the middle of the rectus abdominis is a line of fascia (thick white tissue that surrounds our muscles) that runs vertically. This line of fascia is called the linea alba. It is completely normal for the linea alba to be stretched a bit to accommodate the beautiful growth of the baby during pregnancy.
Immediately postpartum, the uterus begins to shrink back into it’s normal position and size. The abdominal muscles are also beginning to move back to their usual position. Commonly, the linea alba is wider than prior to pregnancy. It may appear sunken in or may “dome out” during movements. If you notice this, you too may have a diastasis recti abdominis (DRA). Don’t fret! There is actually very little evidence that the presence of a DRA will automatically cause problems for the new momma. Also, pelvic floor physical therapists are well-trained in helping you overcome any symptoms that you might experience if they do occur.
One of the first things to note is that the goal of physical therapy will not necessarily be to “close the gap” at the linea alba, because as I mentioned before, just having some space between the two vertical muscles doesn’t necessarily mean anything. That might just be the new position of your rectus abdominis muscles in your postpartum body. What is important to note is whether that gap is very deep and there is not much tension at the bottom of it, or if it “domes up” during movements. When these things are present, it is much more likely you are or will experience symptoms along with your DRA. For example, you may notice urinary incontinence, hip or low back pain, abdominal weakness, or other symptoms.
If you think that doing 100 sit-ups a day will help you overcome your DRA, you are mistaken. In fact, if your emphasis on solely on strengthening the rectus abdominis muscles, you may end up making things worse. This could be the onset of symptoms that you didn’t previously have, or it could be worsening of the DRA. When you work with a pelvic floor physical therapist, they will help determine the right kind of strengthening exercises for you to start with and progress toward. Sit-ups absolutely might be a part of that rehab process, as it is not a forbidden exercise! It just might not be the right place to get started. It is also important to asses if there are other contributing factors to your DRA, such as tight fascia somewhere else such as in the lower back, or possibly scar tissue from previous surgeries (C-section, appendectomy, gallbladder removal, back surgery) that could be contributing to poor mobility of your abdominal muscles or making it difficult to engage some of your abdominal muscles appropriately.
So, if you are one of the many women who have noticed some changes in their abdominal muscles postpartum, or if you are noticing some symptoms in your postpartum phase of life - reach out to us! Don’t accept the status quo and don’t feel like you are alone in trying to recover from your DRA. We have solutions for you at Shift Physical Therapy!
Written by: Renee Hancock, Pelvic Floor Physical Therapist
