A highly feared and misunderstood development during pregnancy and in the post-natal period is what is often known as “the gap” or abdominal separation, more formally known as rectus abdominis diastasis (RAD), rectus diastasis, diastasis recti abdominis (DRA), diastasis of the rectus abdominis muscle (DRAM), abdominis rectus diastasis (ARD), divarication of the rectus abdominis, diastasis recti or simply, diastasis.
These are all different names for the same thing!
A rectus abdominis diastasis is a stretching and weakening of the connective tissue in the middle of the superficial abdominal muscles (the “six pack” muscles), creating more space between the left and right muscle bellies. This occurs during pregnancy and can continue afterwards as the tissues have difficulty returning to a normal tension state at rest and the abdominal muscles remain weaker than they were.
Despite the term “separation” being commonly used, it is more of a stretch than a tear or gap.
So have no fear! Fascia still covers this area and keeps the abdominal contents safe and protected. It’s just a little less tough than it was before.
How common is it?
Rectus abdominis diastasis is extremely common in pregnant women. The abdominal muscles and fascia need to stretch in order to make way for a growing baby!
Within a few months following pregnancy, women regain strength in their abdominal wall but with varying degrees of strength and effect. Around 40% of women struggle with their abdominal wall strength and “the gap” in the postnatal period and will need a bit of assistance to generate good strength across their abdominal wall again.
How is it treated, and how can physiotherapy help?
The way to approach RAD is to understand what is happening in the gap, rather than focus on “closing” the gap.
A physiotherapist will usually assess the width of the gap and if it can be modified with certain movements. They will then determine which muscles should be released or strengthened and develop activities and exercises to get tension generating across this area again. They will discuss your concerns particularly around managing aggravating activities and appropriate exercises. An exercise program tailored to you and your needs will be the most effective way to achieve healthy results.
Physiotherapy is the ideal way to manage RAD. Supportive options such as pregnancy shorts, binders, and compressive underwear can be used for comfort but are not shown to be a good substitute for exercise or therapy. The best way to address this issue is addressing muscle activation patterns, postures and looking at each person individually.
What can I do to help?
Generally, avoid activities that cause the diastasis to be symptomatic – e.g. any bulging out, caving in, pain, discomfort. These tend to be activities like:
- Heavy lifting, especially in a bent position
- Holding your baby on one hip
- Loading twisting e.g. picking your baby up by reaching to the side
- Sitting up in bed and getting up with a twist – instead you can try a log roll or braced get ups for getting in and out of bed
To see a physiotherapist for assessment and management of RAD or other pregnancy or post-natal issues, book an appointment to see Heidi, our physiotherapist with a special interest in women’s health, or contact Hoys Allied Health + Wellness.