Diastasis Rectus Abdominis: Fix Your Belly Pooch

diastasis rectus abdominis
Thanks to babycenter for the use of their image.

Diastasis Rectus Abdominis (DRA) is very common among both men and women, although it is best known as a side effect of pregnancy. Basically, pressure increases in your abdominal cavity so that your rectus abdominis stretches and the connective tissue that holds your right rectus to your left starts to thin.

The area that thins is called the linea alba, and it runs right down the middle of your six-pack. (Yes, you have six-pack abs. They just might be hiding under some fat.) And, if you’ve got DRA, your six-pack might veer toward your side body instead of being front and center.

It’s important to know about the location and function of the rectus abdominis so you can choose the best, most appropriate exercises for self-rehabilitation. For a refresher about your abdominals, read this article.

Diastasis Rectus Abdominis

Causes

Pregnancy is a leading cause of diastasis rectus abdominis. According to WebMD, about two-thirds of pregnant women have a diastasis. However, the incidence of DRA increases the more children you have. Likewise, if you give birth to multiples, you are also more likely to have DRA.

Another cause of diastasis rectus abdominis is rapid weight gain or loss, which normally comes with yo-yo dieting. Maybe you go on a crazy diet, and you lose a lot of weight. Whenever you resume your regular eating habits, the weight will come back. This causes stress to your body so significant that it can impact your muscles.

Incorrectly lifting or exercising can also cause DRA. Using incorrect form for lifting things will train your muscles to work incorrectly. For example, sometimes when people do sit-ups or crunches their abdominals will incorrectly dome outward.

This is the exact opposite of what your body should be doing. Instead of pushing outward, your abdominals should be pulling inward toward your spine. When the abdominals draw toward the spine, they work in a supportive way that protects your back and strengthens your core. By letting your abs push outward, you cause abdominal weakness and possibly a back injury.

Effects

Because of the thinned linea alba, there is reduced abdominal strength. This is possibly for two reasons. First, as the connective tissue thins, the rectus abdominis slides to the side. When the muscle is in a different position, it will be confused about how to work correctly. Second, a thinned muscle will have less strength than the same muscle with standard density.

DRA has also been linked to low back pain and urinary incontinence. A recent study with 200 women with and without DRA concluded that there was “a significant difference in quality of life, in presence of low back pain and urinary incontinence” between the two groups of women.

In some cases, the linea alba thins so much that an umbilical hernia may develop. You may be able to tell if you have an umbilical hernia when you do your self check for DRA. Instead of finding a gap between the muscles around your belly button, you may find a hole. Unfortunately, if you have developed an umbilical hernia, exercises will not help you repair the hole. Only surgery can repair a hernia.

If you think you have an umbilical hernia, you may want to read my article about my hernia repair surgery.

Self Assessment

To check if you have DRA, lie on your back with your knees bent, feet flat on the floor. Place your fingertips down the center line of your abdominals just above your belly button. Slightly lift your head and neck off the floor. If you feel a gap in your abdominal muscles with your fingertips, that’s DRA.

You should also check right at the belly button and just below it. If you don’t feel any gaps at any of the spots, you don’t have DRA.

For some people, it’s not even necessary to lift your head and neck from the floor. If your DRA is significant, you may be able to feel it without exerting effort.

If you think that you have DRA, try to use your fingertips to determine where your separation begins and ends. The top and bottom points of the DRA will be focal points for you self-rehabilitation.

Measuring Your DRA

You will also want to try to measure the width of the gap with your fingertips. For example, let’s say you have a gap at one spot and your fingertip very easily fits in the gap. Very gently, check to see how many fingertips fit there.

Then, check the gap width at the top and bottom of your DRA. Since surgery is rarely performed to correct DRA, these measurements are more for your records than anyone else’s. This gives you a good idea of where you’re starting so that you can measure your progress in the future.

I have read that some people advocate for trying to measure the depth of your gap. In my opinion, this is bad advice since you can disrupt your body’s natural healing process by poking and prodding a wound. By sticking your fingertip deeply in the gap, you could potentially rip some new fibers that were trying to bridge the gap.

That being said, don’t assess yourself more than once a month because you can damage some of your new connective tissue growth.

Fix Your Abdominal Gap

Congratulations! You’ve done the hard part. Figuring out that you have DRA can be tricky. Personally, I lived with the pain from abdominal instability (with a DRA/umbilical hernia combo) for longer than I should have.

If you have both DRA and an umbilical hernia, get your umbilical hernia fixed. Your body can only make so much progress until it gets to the hole in your body (your hernia). With your hernia repaired, there should be nothing in your way as you work on healing.

Also, if you are pregnant, I would not begin trying to fix your DRA now. Wait until after you’ve had your baby (or babies).

Before Exercising

Each time before you exercise, I want you to think about what you’re doing. What are you doing? If you’re working to repair your DRA, that’s your answer. Repeatedly tell yourself, I’m working to repair my DRA.

I know that sounds silly, but after you do the 10th rep of an exercise that your brain believes is beneath you, you’ll be glad for the reminder. You see, your brain has this memory of how things used to be, and it so badly wants your body to get with the program and return to normal.

However, the only way you can return to normal is by doing really basic movements to strengthen your rectus abdominis. Use your hands to feel how your muscles are moving and working. If, at any point in time, you feel tired or your muscles quit working exactly the way they are supposed to, stop.

Just stop. That was great effort for today. Move on to another exercise or be done. These exercises are light enough that you can do them everyday, so if your body isn’t working correctly one day, just try again tomorrow.

Exercises

I selected these exercises because I have used them to help clients (and myself) repair DRA.

  1. Supine breathing. Come on to your back with your knees bent, heels in line with your SITs bones. Place your hands so that your fingertips are on the outside edge of your diastasis. We’re going to do some Pilates breathing. Inhale through your nose and feel your ribs spread to the side. As you exhale through pursed lips, try to draw your abdominals and fingertips toward each other. At the end of your exhale, use your hands to finish sliding your abdominals so that they meet. Take 5-10 breaths.
  2. Leg slides/Leg lifts. We’re going to use the form from Supine breathing and add some leg movement. Inhale and slide one leg away from you. On the exhale, bring it back up. For Leg lifts, lift one leg up to table top as you inhale. Bring it back to starting position as you exhale. The very most important part of these exercises is that you exhale to your fullest and then use your fingertips to finish sliding your abs back together. Do 5-10 of each on each side.
  3. Modified obliques. I picked this exercise because it gives us the opportunity to work with some light, supported flexion and we get to work the muscles directly beneath the rectus, the obliques. This exercise is a little involved, so you should read my step-by-step directions in my previous article on Obliques. Click this link and remember, we’re doing the Modification for Obliques.
  4. Sunbird/Swimming prep. Depending on if you do yoga or Pilates, you may know this exercise by different names. Again, this exercise is very specific, so I’ll refer you to the step-by-step instructions from a previous article. Make sure that when you begin, you only lift one leg or only lift one arm. It’s very challenging to the core to stabilize with one limb lifted, and it’s intensified by lifting an arm and a leg. Intense is not a word that should be associated with your workout right now.

For a video on how to do these exercises, check back on Saturday! This Saturday’s Weekend Workout! is Fix Your Diastasis Rectus Abdominis.

What else do you do to help heal your DRA? Let us know in the comments.

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Sarah Stockett is STOTT certified in Matwork, Reformer, Cadillac, Chair, & Barrels, Injuries & Special Populations, and CORE; a Yoga Alliance RYT-200; and has studied Active Isolated Stretching. When she is not trying to discover the best exercises to get rid of pain, she likes watching movies and travelling with her family.

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