What is Diastasis Recti Abdominus (DRA)?
Diastasis Recti Abdominus (DRA) is ultimately, the separation of the rectus abdominus muscles, or the "6-pack muscles".
Between the two sides of the rectus abdominus muscles lies some connective tissue, called the linea alba. This connective tissue, which runs from the xiphoid process (the base of the sternum) down to the pubic symphysis becomes more lax and stretches during pregnancy to make room for the growing baby.
The stretching and thinning of the linea alba can impair the ability of the core muscles to function at their best.
A study from 2014, found that 100% of women in their 35th week of pregnancy had DRA. The prevalence of DRA decreased to 35-39% at 6 months postnatal.
Coldron et al (2008) measured the inter-recti distance in postnatal women from Day 1 through the first year and found the distance decreased markedly by 8 weeks postpartum. With no intervention, such as exercise training or physiotherapy, there was no further reduction in the gap by one year.
A DRA might worsen postnatally if exercise is occurring at loads that the body cannot manage, which is why it is important to take care to heal it well.
Again, DRA is a very common occurrence in pregnant and postnatal bodies, but you do not need to worry if you do have it.
A "closed gap" is not the definition of a healed DRA!
The most important thing you need to know is this.....
In a DRA, the linea albal loses the ability to generate 'tension' as well as it once did, and is not as 'dense' in quality as it once was.
You may thing you look bloated all the time, or that you still look 5 months pregnant. Or, that your lower back and pelvis don't seem as stable and secure anymore. Perhaps, you feel like you cannot generate as much power and strength from your core.
You can think of the loss of density as the linea alba being thinned out and not as thick as it once was.
The gap down the middle of the abdominals is of varying degrees in each body. The gap can be present all the way down from under your sternum to the pubic bone, or only certain places along that line - most typically, the largest gap will be around the umbilicus.
What we are more concerned about is the ability of your core to generate tension in the linea alba rather than how large the 'gap' is.
How do you know if you have a DRA?
If you've ever given birth, then ideally you should be assessed for DRA before commencing any exercise. In an ideal world, this would happen at your GP postnatal check (but it very rarely does!).
If you would like to assess yourself, then I recommend you wait until 10 days to two weeks postnatal to do the first assessment. Please note, all Mums booking classes or Core Restore with Mummy Movers receive a free DRA check.
Lie on your back with your knees bent and feet flat on the floor.
Walk your hand down along the midline of your tummy to get a sense of the tension in the linea alba. You can start from just under your sternum and work your way down towards your pubic bone, straight down this line.
Feel if there are areas that are squishier than others. Can you press your fingers way down into your tummy? Does the tissue feel supportive when you press into it?
Using the middle two fingers of one hand, press straight down into the belly just above the tummy button. Tuck your chin towards your chest and lift your head (this isn't a crunch, just a head lift!). Keep the shoulders down.
Repeat a couple of times if needed, adding or taking away fingers to get an accurate measurement with the same, very small head lift.
Repeat step 3 above above the belly button.
Re-test below the belly button.
Re-test all three measurement sites, but now exhale, perform a kegal (pelvic floor contraction), and then re-do the head lift test.
How often should you assess?
I recommend re-assessing every 2-3 weeks. This will typically give you good feedback as to whether your exercise is effective.
How do you know if your DRA has healed?
As I mentioned earlier, the quality of the linea alba is what's important in assessing the healing process. You can still have a gap with a 'healed diastasis'. That's why it's important to assess and feel the progress.
You'll know when you have solid tension and density along your linea alba. This means you'll feel the strong tissue under your fingers when you press into your tummy, when assessing with the exhale and pelvic floor lift.
You're aiming for a harder, more supportive linea alba.