Throughout pregnancy, the female body encounters a number of changes to allow room for the baby to grow. Some changes we may notice are that our hips start to tilt forward a little bit more, we have a little more extension in our lumbar spine, the rib cage widens to allow room for organs to move up, and, with that, the abdominal wall stretches too.
With the widening of the abdominal wall, we will also see the connective tissue, the linea alba, in the center of the abdominal muscles widen as well, which is termed diastasis recti abdominis.
One fun fact about these changes is that all women during pregnancy have a diastasis recti abdominis, as it allows for adaptations and fetal growth with pregnancy (Gingerich & Prevett, 2023).
With this particular change, you will hear a lot of talk and concern about pelvic floor weakness, abdominal weakness, and worsening of that widening with abdominal exercises that causes coning or doming of that tissue. However, all of these concerns are not necessarily true. During this blog, we are going to focus on how to return to exercise while addressing your diastasis rectus abdominus or DRA.
Before we address some of the concerns with DRA, I think it’s important to recognize who this might occur in and factors contributing to it. While the pregnancy and postpartum population is the most common to experience this, it can also be seen in the very lean and muscular athletes, babies, and individuals with increased abdominal circumference (Gingerich & Prevett, 2023).
There are many factors that can impact the extent of DRA, including genetics, type of delivery, time between and number of pregnancies prior and current activity level, as well as rehabilitation and strength return between pregnancies or before first pregnancy.
Outside of pregnancy and postpartum and genetics, ability to manage intra-abdominal pressure and willingness to focus on form and quality of movement will also have an impact on an individual's DRA.
So how does this impact our ability to exercising or return to our daily activities? With DRA, many people are aware that coning in the center of the abdomen can cause weakness of the abdominals muscles, particularly rectus abdominis, and pelvic floor weakness as well.
This is thought to be because coning can worsen our DRA, result in poor management or activation of the core, and difficulty managing intra-abdominal pressure. These theories have led a lot of individuals astray from accessory core work that results in abdominal crunching or rotation of the abdomen to prevent weakness or abdominal/pelvic floor dysfunction.
However, in a recent study by Gluppe et al., it has been found that there was no increase in prevalence of pelvic floor dysfunction or low back pain among postpartum individuals with DRA compared to those without (2021). It was noted, however, that abdominal weakness and pain were associated with diastasis recti abdominis (DRA) (Gluppe, et al. 2021).
Along with this, Hills et al., found that individuals who worked on improving abdominal strength with sit-ups and abdominal rotation consistently demonstrated improved strength through abdominal musculature and reduced pain (2018).
While the inter-rectal abdominal distance may not have improved, working on rotation torque and lower sit-ups actually was beneficial with improving the strength of our abdominal muscles regardless of coning (Hills et al., 2018).
So, collectively the answer to the question above is with progressive loading and creating tension across the abdomen!
Lastly, how do we go about this? If you are returning to exercise and are experiencing DRA, we need to focus on managing our intra-abdominal pressure by creating tension across the linea alba…this means we need to load it with exercise and really focus on muscle activation (Gingerich & Prevett, 2023).
Ultimately, this means being intentional about our core activation whether we are squatting, picking up our baby, or lifting in the gym.
And, before you go directly back to kipping and increasing your intensity, take the time to really work on the quality of form and consistency of practice so we can improve our efficiency with movements and reduce risk of injury.
Below are a few exercises that you can incorporate to start practicing:
● Pallof Press
● Strict Pull-Up
● Toes-To-Bar Progression
● Dead Bug Progression
Still unsure of where to start? Contact us for an assessment to help you learn customized modifications and keep you training. We use a 3 step process to help athletes feel and move better, including:
1. Fixing your pain.
2. Figuring out the root cause.
3. Providing you the necessary tools to get back to being active and not dealing with this
again.
References:
Gingerich, J. & Prevett, C. (2023, April). CMFA: Pregnancy & postpartum [Powerpoint slide].
Institute of Clinical Excellence.
Gluppe, S., Ellström Engh, M., & Kari, B. (2021). Women with diastasis recti abdominis might have
weaker abdominal muscles and more abdominal pain, but no higher prevalence of pelvic
floor disorders, low back and pelvic girdle pain than women without diastasis recti
abdominis. Physiotherapy, 111, 57–65. https://doi.org/10.1016/j.physio.2021.01.008
Hills, N. F., Graham, R. B., & McLean, L. (2018). Comparison of trunk muscle function between
women with and without diastasis recti abdominis at 1 year postpartum. Physical therapy
and Rehabilitation Journal, 98(10), 891–901. https://doi.org/10.1093/ptj/pzy083