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Diastasis Rectus Abdominis AKA DRA



We've all heard the term, but do we actually know what it is, how common it is and how it can impact your postpartum recovery? Let's learn!


During Pregnancy


100% of pregnant women will have a diastasis rectus abdominis (DRA) at 35 weeks gestation. This is a normal variant and a natural way for our bodies to adapt during pregnancy. As your baby continues to grow, your abdomen must respond and does so by slowly separating the two bellies of your rectus abdominis muscle as your anterior abdominal musculature continues to lengthen. This separation can make it more difficult for women to properly stabilize through their midline. If women are not able to manage their intra-abdominal pressure (IAP) appropriately they may experience what is referred to as coning and/or doming.


As a clinician, I believe that we should coach our patients to avoid coning and/or doming, as it creates unnecessary stress on the abdomen. Coning and/or doming are commonly seen when performing any type of flexion movement - for example: doing a sit up. It can also be visualized while rowing, doing kipping pull ups, dead bugs and a variety of other core exercises if not modified and/or cued correctly. Many of these movements can be safe during pregnancy, but it is important to understand how to manage your IAP appropriately while doing them.


Postpartum


Diastasis Rectus Abdominis (DRA) is also quite common postpartum. Approximately 90% of moms who present with low back pain, pelvic pain or pain after/during exercise while postpartum have an abdominal separation. Assessing for this separation is a STANDARD part of a postpartum appointment at Pinnacle Hill Chiropractic, as many other healthcare providers unfortunately do not assess for this.


There are many different degrees of DRA - from 1 finger width to 5 finger widths. A separation less than 2 finger widths or 2 cm is considered within normal limits. Width tends to be a concern for most women, however depth and tissue tensegrity are also important to postpartum providers. For many women, a DRA will resolve with time. The literature has shown that at 6 weeks postpartum 60% of women will still have a prevalent separation. At 6 months postpartum the prevalence drops to 45% and at 12 months postpartum it drops even lower to 32%. DRA and pelvic floor dysfunction also go hand-in-hand, as 66% of women with DRA also have some level of pelvic floor dysfunction, whether it be incontinence or pelvic pain.


Treatment, Recovery & Rehabilitation


It is important to understand that one size does NOT fit all. Every woman is different, just like every birth is different. It is important for women and providers to understand that a cookie cutter approach to recovery is inappropriate in most instances. An individualized treatment plan that involves assessment, education, manual therapy and exercise is essential to promote intentional recovery. Moms, please do not Google how to recover postpartum and please do not rely on generalized programs that are not tailored to you, your needs and your experience.


We are excited to now be offering one on one 90-minute Postpartum Recovery Sessions on Saturday morning. You can learn more about this new service by clicking HERE. To schedule your session, please CLICK HERE and scroll to the bottom of the page! If you have any questions about how our postpartum experts can help you, please email Dr. Sarah at dr.sarah@pinnaclehillchiropractic.com.


Don't ever forget that your 6 week postpartum appointment should be the BARE MINIMUM.


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