Split down the Middle? I recently had the opportunity to attend a lecture put on by the renowned Diane Lee on a relatively common yet often undiagnosed problem called Diastasis Rectus Abdominus (DRA). Diane has vast knowledge and experience in dealing with pelvic girdle or sacroiliac pain and dysfunction and is an excellent speaker, so it was a pleasure to hear her talk on this subject.
DRA is a condition that involves a separation of the two long abdominal muscles that run vertically down the middle of our abdomen, the rectus abdominus (otherwise known as the “six-pack” muscles, if any of us can ever recall ever having those!).
Normally these muscles are held together by a thick connective tissue called the linea alba. A defect in this tissue is what causes the separation, resulting in either a bulging or caving in of the midline with a load applied (for example, lifting oneself up off the bed). DRA occurs primarily in pregnant women (66% in their third trimester) due to the extra weight of the baby on the abdominal muscles. However, and I have seen this clinically, it can also occur in the male population (especially in the over 40-50 age group). So far the reason as to why DRA happens to some people and not others is unknown. However, 52% of women with a pelvic floor dysfunction also have DRA. So it seems fair to say that pelvic girdle muscle dysfunction, whether that is due to poor muscle recruitment (neuromuscular control) or weakness may be a factor in DRA. Age and subsequent pregnancies may also play a role.
In most cases DRA remains to be a problem (meaning the abdominal wall separation has not changed) if left untreated. 53% of pregnant women with DRA still have DRA postpartum. 36% will continue to have an abnormally widened abdomen 1 year after having their baby. Sometimes DRA can be painless and more of a cosmetic concern. However, in many patients there are issues coinciding with DRA that are the most problematic. These can include low back pain, sacroiliac pain, hip pain, lumbo-pelvic and/or thoraco-lumbar instability and functional weakness (all of which greatly impact the ability to do things like look after your new baby or keep up with the other children you may already have!!).
So how do you know if you have DRA and what can you do about it? Have your physiotherapist assess you to determine IF you have DRA and what are the circumstances surrounding it. The physio will check to see if the problem is trainable with specific exercises (the goal of treatment being to restore form and function of the abdominal wall and regain trunk control), or if the problem is structural and may require more intervention. In a small number of cases, women postpartum may have a permanent structural impairment that may require cosmetic surgery, but this is relatively rare.