Pregnancy can put a great deal of stress on the mother’s body, and sometimes there is long-term damage after the baby is born. One of the more frustrating and challenging after-effects of childbirth is diastasis rectus abdominis (DRA), the separation of the left and right halves of the long rectus abdominis (RA) muscle that forms the six-pack.
While separation of the RA during pregnancy is normal and indeed necessary to accommodate the growing fetus, in some cases the two halves do not come back together after childbirth. This happens when the linea alba, the strip of fascial tissue that dissects the right and left RA, is overstretched and thinned. In some cases, the linea alba actually splits.
The prevailing consensus among the medical community is that if DRA has not been resolved within a year after childbirth, surgery is the only option. Yet the female body is highly adaptive, and the same principles that apply to gaining muscle and improving bone density also apply to increasing the density of connective tissue. When subjected to the right sort of overload (the challenge posed by exercise), and using proper mechanics in exercise execution and breathing, the density of the linea alba can be increased and the gap narrowed in most women.
The vast volume of information about DRA zeros in on the distance between the halves of the RA, however, the problem is often more complex than just closing the gap. Many other factors may play a role in DRA, and understanding the complexities of the lumbro-pelvic area is key to resolving DRA.
Some factors involved with DRA include:
- Breathing mechanics and the actions of the diaphragm
- Bladder continence
- Uterine prolapse
- Alignment of the spine and pelvis
- Core stability
- Movement control
- Overall fitness
Low fitness, deficient movement and breathing mechanics and postural issues can actually place additional stress on the linea alba, preventing it from becoming denser and healing. In order to resolve DRA, the entire lumbro-pelvic region must be addressed, to realign the spine and pelvis, and strengthen the structures that stabilize and reduce pressure in the pelvic area.
While not all cases of DRA can be resolved with conservative treatment, many can, even years after childbirth. The determining factors are largely dependent on the individual patient.
- Genetics and hormones affect the quality of fascial tissue, and its elasticity. While the fascial tissue of some women may not respond to conservative treatment, fascia that has retained its elasticity and responds to directed overload stands a good chance of regenerating to resolve DRA.
- Consistently applying the principles of good mechanics in movement and breathing, correct abdominal recruitment patterns, and good postural alignment during the execution of daily tasks is key to repairing DRA. In other words, the patient must be compliant, and willing to take responsibility for resolving her DRA on a daily basis.
- Patient education is key to resolving DRA. As the saying goes, if you don’t believe you can do a thing, you are right. Education, along with support and encouragement, can help the patient to buy into her own treatment and persevere with the treatment protocol.
Many new mothers want a quick fix to resolve their DRA, and lack the patience and dedication needed for successful conservative treatment. For some, surgery may seem like the most practical solution to what they see as a cosmetic issue. However, while surgery may close the gap, it will not resolve the underlying postural and mechanical issues that contribute to DRA.
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