Diastasis Rectus Abdominus aka ‘Mummy Tummy’
If you are a mom or mom-to-be and are part of a moms group in your community, you may be familiar with diastasis rectus abdominus (DRA). If not, no worries, I am going to give you the inside story on this common condition.
Diastasis rectus abdominus literally translates to the separation of the rectus abdominus muscles. This muscle group is also known as your ‘six-pack’ muscles and is the most superficial muscle group of the abdominal region. As your baby grows during pregnancy, these muscles begin to stretch. They do so via the connective tissue that joins the left and right recti muscles through the midline of the body.
This connective tissue is known as the linea alba and runs up and down from the bottom of your breastbone to the pubic bone. The muscles themselves don’t split open (thank god!) but rather the linea alba between the muscles stretch thus creating a pseudo-gap or separation.
So is it normal for this tissue to stretch during pregnancy? Of course it is! For some women the linea alba will stretch and several weeks after giving birth, the tissue returns back to its pre-separation state. For some moms, a DRA persists and can compromise functional core strength and contribute to low back pain. How so?
Imagine your abdominal region as a canister. The top of the canister is your diaphragm, the bottom of your canister is your pelvic floor and the body of the canister is formed by your abdominal muscles. If the canister is open through the front (i.e. DRA) then it will not be able to optimally transmit forces through the canister. The lack of co-ordination between the three parts of the canister can lead to problems such as diminished abdominal strength, back pain, pelvic girdle pain and poor posture.
This is one of the reasons why doing abdominal crunches after having a baby may not be the best choice of exercise to flatten your tummy. If there is a DRA present, crunches can create increased intra-abdominal pressure that may cause more doming or pouching of the abdomen through the linea alba separation. Thus a cycle begins as moms feel their tummies are not getting flatter, so they do more crunches; which then potentially makes the pouching worse.
Oh boy, so how do we resolve this? If you suspect that you may have a separation, get assessed by a pelvic floor physiotherapist or a pre/post-natal fitness trainer who has been trained to assess for DRA. They will be able to guide you on the progression of the DRA and give you the appropriate exercises to help improve the separation. A pelvic floor physiotherapist will be able to help you balance the very intricate relationship that the diaphragm, pelvic floor and abdominal region have with one another.
So if you think you have a DRA don’t fret. There are ways to help improve your canister with exercise, improved body mechanics and the use of abdominal supports. In the end, if properly managed, you can get some ‘closure’ to this issue.
Angelique Montano-Bresolin is a graduate of the University of Toronto Physical Therapy program and has been practicing as a Registered Physiotherapist for over 20 years with a specialty practice in pelvic health. Her extensive post-graduate training has included courses to assess and treat all genders and ages with concerns such as: incontinence, abdomino-pelvic pain and sexual pain in many populations including: pre and postnatal, post-surgical, post-menopausal and post-cancer. In 2012, she founded Proactive Pelvic Health Centre in Toronto, Ontario.