Hello 😊
Welcome back to my blog 😊 Hopefully you’ve made a cup of tea and you’re ready to delve into my favourite subject, I wanted to talk to you about this because, it’s been in the media lately and I wanted to reassure women there is always help out there, we just need to know where to go.
What is my favourite subject?
A Diastasis Rectus Abdominis (DRA) Also Known as a tummy gap.
Now, having written this post several times over the past week or so, I have established I literally can talk about it all day! In fact: I may have to do a follow up! OR if you find this useful you can join our facebook group here and ask any questions you need 😊
HOWEVER, I want to keep it relevant to my audience of mums. So, for the purpose of this blog only: The DRA is present due to pregnancy.
When a woman is pregnant the body adapts in many ways, one of them is that the linea alba separates. (a tendinous fibrous sheath that runs down the centre line of the body from the breastbone to the pubic bone) An increase in laxity in the connective tissue and the baby increasing in size means something needs to expand. All women get it to some degree, some quite early on in pregnancy and some towards the end, its completely normal. Another miracle of your body 😊
Some closure of the diastsis recti (DRA) takes place as part of the recovery post-partum, your midwife can assess this post birth- generally as with everything it takes a little time to heal so don’t worry if it is there a few weeks later. While there may be a residual gap anything under 2cms (roughly 2 fingers) is considered unproblematic. Obviously if it is there a long time (I have known women 5+ years post birth) it can also be problematic.
Sadly, we just don’t know why some women recover quickly after and others do not.
It used to be thought that ONLY surgery is there to correct it and that women could not do things like heavy lifting with one present! Now, depending on which school of thought you’re in, its shown that physio intervention (or corrective exercise programming) is successful.. Previously, studies have shown an increased risk of low back pain, pelvic floor dysfunction, urinary incontinence, constipation, bloating, issues with sex, and SI joint pain. HOWEVER, While the subject is still relatively new in research, there is new evidence suggesting little to no correlation to the above and a DRA.
From my point of view: As a PT who specialises in Diastasis Recti- 100% I am on the side of intervention helping! Once you have been cleared from physio (or in many cases we work together for your needs) what am I looking at?
The number one thing mums come to us concerned about is the way their tummy looks AND research now shows evidence that DRA is problematic for many women, causing distress from a negative body image, abdominal pain, decreased quality of life and a reduction in physical function.
I am not a fan of ‘TONE THAT MUM TUM’ PHRASE! But I acknowledge that’s what mums focus on.
When I hear a reference to a DRA as ‘dysfunctional’ my skin crawl…We may need to look at how to help you move differently, but your body is doing all it can to keep you moving! You’re certainly not ‘dysfunctional’
We know that the DRA can affect the whole body- NOT just the abdominals. You’re a unit! If something isn’t as strong as it was, there is a compensation somewhere! The DRA will affect the whole of the abdominal position. The abdominal wall muscles work synergistically to support each other with load support, orifice support, breathing, elimination and movement, control and mobility. The Core system isn’t just about your abs! Your body has spent 9 months redistributing its strength so that you can remain standing while you’re growing your human(s) so it is much more than lying on the floor crunching up and down.
It starts with your posture, your body alignment, your breathing, your ability to create and hold tension both with and without load. Then, its about the daily movements that you do as a mother 😉 and there is the key! Show me a mum that doesn’t lift heavy everyday, (kids/prams), crunch down (washing in the machine) and twist around daily. We know that these movements *may* exacerbate a DRA and cause it to widen, or at least not close, we also know that mums have to do them… So, lets help her and make her stronger. A comprehensive program will address the movements with the need to create and hold tension to support your body while making it stronger than ever.
Does this mean you can never plank, crunch or lift heavy again? NO! I mean, personally I don’t have crunches in my antenatal or postnatal program because I believe there are better, more effective movement patterns to make you stronger….but if you PT with me and your goal is to crunch, I’m there to facilitate that in a safe way for your body!.......I want to see you safely create and hold the tension rather than forcing it down into the pelvic floor or causing ‘doming’ I want to get you to your goals safely 😊
Most instructors do and there are some great programs out there. PT lead and Physio led (most of us PT’s follow the amazing physios around to learn from 😉
A very passionate physio (and mum of 4) Grainne Donnelly (absolute.phyio on Instagram) has recently done a study with fit2B and is due to publish soon, and they found that over 60% of women who accessed intervention found it successful.
Sadly, studies are out there to show (elwin et al 2017, gluppe et al 2018 and Jessen et al 2019) that say the evidence does not support the successful treatment with a DRA with physio therapy or exercise program.
The reason this is sad is because if the people at the forefront are unable to support what is happening on the ground…..well that’s a huge barrier. If a multi disciplinary team are not understanding the benefit, how do we get the knowledge out there?
We empower our mums to keep asking for help, we share where we get great care from and we put ourselves in the right hands. We follow the latest research, and we share as much as we can 😊
I know a safe effective program works, I do it daily! I’m very lucky and feel very privileged that the local midwives, physios and GP’s support us.
If it is something you are worried about you can speak to your doctor and ask for a referral to a women’s health physio. A women’s health physio is especially trained to understand a woman’s body, the effects of birth and labour and most importantly, how to rehabilitate it.
It may be that further down the line you are referred to a specialist exercise instructor like myself to help further your rehabilitation to decrease any risk of injury. Our team will help you get your goals safely 😊
I hope you enjoyed your read and found some useful information here. If so please be sure to drop us a like on Instagram and facebook
I will see you next time…. For part two 😉