Diastasis, diastasis rectus abdominus (DRA), diastasis rectus abdominus muscle (DRAM), abdominal separation, widening of the inter-rectus distance (IRD) - are all terms to describe the same thing.
Diastasis occurs in pregnancy when the linea alba – the connective tissue in the midline, that joins the rectus abdominus muscles, elongates and widens to accommodate a growing belly. It is thought to occur due to abdominal distension, raised levels of estrogen and changes to collagen types 1 and 3.
Diastasis is normal in the majority of pregnancies and 20-50% of women have persistent separation at 6-month post-partum. It is defined as being greater than 2cm or approximately 2 finger widths.
Diastasis frequently co-exists with other conditions, but it’s important that identification does not imply causation - so what does the research tell us?
Diastasis is not correlated with low back pain or pelvic pain
Diastasis is not correlated with pelvic floor disorders such as weakness, prolapse, and incontinence
Diastasis width is correlated with abdominal weakness
Diastasis is correlated with body image dissatisfaction
Diastasis resulting from pregnancy is a normal condition, not an injury or a hernia, rather a clever adaptation to load that is safe - hence it does not need to ‘heal’, but in many cases it can be rehabilitated.
Diastasis Rehabilitation is tailored to an individual but will involve training the rectus abdominus (RA). You need to shorten RA to help close the gap. In contrast, transversus abdominus (TA) pulls laterally and opens the gap.
Diastasis rehab doesn't necessarily need to avoid doming/coning/bulging of the linea alba - it really depends on the individual and their goals. Doming is certainly not to be feared. Our skin and connective tissues are strong. As a general rule, if exercising generates doming of the linea alba and you can compress it easily, there is little to worry about. Should the doming be very hard to press, that suggests there is too much intro-abdominal pressure - the exercise or position at the time is one that is not appropriate, it is not unsafe, but unlikely to be helpful to rehabilitation.
Diastasis rehab can simply be getting moving generally and a focus on whole body strength, and often recovers post-partum doing nothing specific at all. In some cases however, consideration for other injuries is important e.g., an back injury aggravated by bending forwards/flexion is not going to handle doing crunch like exercises and pilates exercise like hundreds or legs in straps - exercises that another person may manage comfortably.
Should your DRA bother you for any reason, we can assess and assist your specific situation to tailor a solution to your needs. There is never a one fits all approach. Our physiotherapists trained in women's health can help with home/gym based exercise guidance or supervised clinical pilates on site. Clinical pilates requires at least one individual session before attending small group classes. Should there be any pelvic floor concerns this should be assessed also before embarking on or resuming an exercise programme.
At Balance health, Casey Cleeland, Kara Cassells and Kristine Miles are physiotherapists trained in women's health. Kristine Miles is also available for clinical pilates assessments and classes.
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