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Diastasis Recti

Post Natal Considerations: What is Diastasis Recti?

What is Diastasis Recti Abdominus? 

1. Pathology & Mechanism 

– Increased intraabdominal pressure results in 

separation of Rectus Abdominus musculature at the linea alba. —

-Linea Alba = Connective tissue that runs superior to inferior from 

xiphoid process to pubic symphysis. Laterally approximates the rectus abdominus and 

abdominal musculature.

Abdominal Anatomy & Physiology 

What is the DRA (Diastasis Recti Abdominus) Anatomy? 

  • Separation of Rectus Abdominus due to linea alba stretching. 

  • Effects the functionality of core. —

  • Lack of deep abdominal stability —

  • Lack of muscular coordination of core muscles due to structural changes (Diaphragm, pelvic floor, TA, lumbar multifidi) 

“The Core” = Hydraulic Amplifier 

— Our functional core is compromised of: 

  1. — Diaphragm —

  2. Transverse Abdominus —

  3. Lumbar Multifidi —

  4. Pelvic Floor 

— ***These four muscle groups must work in synchrony to maintain 

proper IAP (intraabdominal pressure). ***

—

Function of “Core” is to maintain IAP, stabilize spine, and 

internal organs. 

— When IAP is not balanced, dysfunction can occur:

  • — Urinary Incontinence —

  • Back Pain 

Common Populations That Experience Diastasis Recti Abdominus (DRA) 

1. Post-natal women 

2. Athletes (weight lifters, military service 

members) 

3. Individuals whom BMI is in the category of Obese 

Symptoms of Diastasis Recti 

1. Bloated, “Pregnant” Belly appearance 

2. Back Pain 

3. Urinary Incontinence 

4. Feeling “unsupported” or “unstable” in 

abdomen. 

Incidence of Diastasis Recti 

1. ***More common in multiparous women (2 or 

more pregnancies). 

2. Age >33 y.o. 

3. Large Baby 

4. Greater Weight Gain 

5. C-section birth 

6. *Women who completed heavy lifting > 20x week 

→ 2x increased risk of DRA 

Prevalence of DRA 

— 21 weeks= 33.1% 

— 6 weeks post partum= 60% 

— 6 months postpartum= 45.4% 

— 12 months postpartum= 32.6% 

Diagnosis of Diastasis Recti —

Diagnosis is made by finger width distance between the 2 rectus abdominus muscle bellies at approximatley 4.5 cm above the umbilicus and below. 

— Special Tests: 

1. Head Lift Test

2. Active SLR 

— Some research says that > or = 2 fingers width separation indicates a clinical Diastasis Recti 

— However, my training is that > or = 1 finger width separation is clinically significant and can cause functional limitations. 

Treatment of Diastasis Recti 

— Physical Therapy Treatment: 

— Manual Therapy (Hands-On Treatment): 

  • — Myofascial release to structures creating pull on rectus abdominus and may be keeping separation. 

  • Thoracolumbar fascia —

  • Hamstrings —

  • C- secttion scar mobilization —

  • Visceral= mesentery, jejeunoilium, uterus, ovaries —

  • KT tape to approxiimate the DRA —

    Neuromuscular Re-Education 

  • — Diaphragmatic breathing full circumference→ focus on posterior rib cage breathing—

  • Pelvic Tilts, Pelvic Clocks —

  • Pelvic Floor strength in all positions anti gravity and against gravity. —

  • Bracing 

— *Abdominal brace use as recommended by Physician. 

Movement Contraindications 

— **With guided “core” strengthening and PT treatment as indicated, individuals with DRA should be able to return to all premorbid exercises. 

— However, there are movement contradications until the abdominal wall integrity is restored. 

1. Crunches 

2. Exercises while laying on back with both legs in the air. 

3. Heavy Lifting 

4. Planksintiially 

Focus of DRA Exercise Programs 

1. Promoting Approximation of Rectus Abdominus by avoiding overuse of Rectus Abdominus 

2. Strengthen Transverse Abdominus ot facility approximation of Rectus Abdominus 

3. Ensure “Core” is functioning in synchrony (Diaphragm, TA, Pelvic Floor, Lumbar Multifidi) 

4. Address other postural, musculoskeletal impairments (hamstring Tightness, thoracolumbar fascia tightness, forward head posturing) 

Pilates Rehabilitation Protocol- Diastasis Recti 

1. Diaphragmatic Breathing → focus on posterior rib cage 

2. Pelvic Tilts 

3. Bent Knee Opening 

4. Pelvic Clocks 

5. Supine Arm arcs with Theraband 

6. Footwork on Reformer with Franklin Balls at midline 

7. Bridging with Franklin Balls at midline 

8. Quadruped on Reformer 

— 8. Sidelying Footwork on Reformer 

— 9. Sidelying in Spine Corrector on Reformer- Feet 

in straps 

— 10. Sidelying Thoracic Rotation on Reformer 

— 11. Seated Rowing for posture 

— 12. Seated Footwork on Reformer 

— 13. Standing Hip Stretch on Reformer 

Other Non-Pilates Exercises & Info 

1. General lower extremity stretching 

2. Neutral Spine Exercises 

3. Safe Thoracic Spine Rotation 

4. Upper Trap & Levator Scapulae Stretch 

Cues: 

— Focus on pelvic floor engagement and relaxation paired with deep transverse abdominus engagement in all positions. (First anti-gravity → against gravity) 

Any Questions? Thank you! 

melanie@inspiraphysicaltherapy.com 

929-295-6566 

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