The first year of mother-hood is accompanied by vast physical, hormonal and emotional changes. The female body undergoes remarkable transformation during pregnancy, the most obvious change being the growth of the abdomen, stretching to accommodate the growing fetus. In fact, studies show that during the third trimester around 70% of pregnant women develop a condition of over-stretched abdominal muscles (Boissonnault & Blaschak, 1988). This over-stretching is medically referred to as Diastasis-Rectus Abdominus (DRA) and occurs along the linea alba, the tendon that cuts through the middle of your “six-pack muscle.”
DRA is most commonly identified by measuring the space between the two inner edges of your rectus abdominus muscle (six-pack muscle). This is referred to as Inter-Recti Distance (IRD). In a clinical setting, finger widths are often used to measure this space. An IRD of two or more fingers widths is considered to be a DRA (Noble, 1982). However, IRD is not the only measurement to consider when diagnosing DRA. More recent studies have been focusing on the tension that one is able to generate along the abdominal wall and the linea alba. What that means is that the distance between your six-pack muscles is not the be all and end all. The ability of the abdomen to generate force, fully contract and maintain its structural integrity is more relevant than finger widths.
Identifying Diastasis-Rectus Abdominus
Let me be perfectly clear, DRA is a normal change that occurs during pregnancy. Your lower ribs will flare, the pelvis will broaden and your abdominal wall must expand to accommodate the watermelon-sized uterus underneath. It is the persistence of a DRA in the postnatal period which is not ideal. This is because the lack of abdominal tone, endurance or integrity can lead to dysfunctions elsewhere in the body. Many of the symptoms reported by women during their first year of mother hood can be explained by an underlying DRA. Some of these common symptoms include low back pain, pelvic area pain, stress urinary incontinence and urogynecological discomfort. Researchers Parker, Millar and Dugan (2009) found that 74% of women seeking care for low back and pelvic pain had a DRA. Multiple pregnancies very close together, previous abdominal surgeries and a mean maternal age greater than 34 years old have been shown to increase one’s risk of developing a DRA.
Currently, postpartum care consists of a six-week follow-up with a family physician. Granted there are no complications with delivery, surgical incisions or perineal sutures, the majority of women are cleared by their physicians at six weeks to resume all regular activity. Sperstad, Tennfjord, Hilde, Ellstrom-Engh and Bo (2016) observed a DRA present in 60% of the women at six weeks postpartum. Diastasis-Rectus Abdominus is often overlooked by physicians, although the awareness around the condition is growing, it is important for women to advocate for themselves and ensure they are getting the right care.
Steps to Core Restoration:
In the case of repairing Diastasis-Rectus Abdominus it is vital to strengthen the deep core muscles and to establish functional thoracic and pelvic floor mechanics. Diaphragmatic breathing and correct kegel work are important places to start for new moms looking to fix DRA. Following your six-week check up with your physician, I would recommend booking with a Pelvic Floor Physiotherapist. They will help you to restore all the muscles of the pelvis and pelvic floor, which are often significantly impacted by pregnancy and birth. It is well understood that the maximal contraction of the transversus abdominus muscle (your deep corset-like abdominal muscle) relies on the full contraction of the muscles of your pelvic floor. In other words, you can perform plenty of Rocky Balboa-style crunches (strongly NOT recommended) without actually engaging the right muscles because your pelvic floor has not fully recovered. Osteopathic manual therapy can offer additional relief and restoration by increasing the mobility of the thoracic spine, thoracic diaphragm and pelvis.
Florence is due to begin her research on “The effects of global osteopathic treatment on diastasis-rectus abdominus in postnatal women” in the fall. If you are interested in participating in her research or learning more, please contact her via e-mail at: Florence@rpmstudio.ca
Florence was first introduced to alternative therapeutic modalities in her teens, as a dancer and competitive athlete. After high school, Florence furthered her dance training and obtained her Honors Bachelor of Science in Kinesiology from McMaster University. Teaming up with the artistic director of the McMaster University contemporary dance company, she developed introductory dance classes for children and teens across Hamilton. Inspired to further her teaching skill-set, she obtained her yoga teacher certification in Hatha yoga. Florence teaches across the city and combines her knowledge of human kinetics, dance, strength and conditioning, and yoga. Teaching movement to pre and postnatal women, and coaching as a birth doula, she gained a unique perspective into the supportive systems available to new and expecting mothers. Florence has an affinity for the holistic approach to women’s care. She is passionate about the assimilation of progressive knowledge to educate and empower women at any stage of life including: pre-conception, pregnancy and recovery after birth. Most recently, Florence completed her five years of study at the Canadian College of Osteopathy in Toronto. As a manual therapist, she believes in having her patients actively participate in their healing. She currently is working to complete her thesis which will examine how osteopathic treatment effects diastasis-recti abdominus in postnatal women.