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Diastasis Recti Abdominis (“Mummy Tummy”)

What is Diastasis Recti Abdominis (DRA) and what causes it?

DRA is a separation of the rectus abdominus (RA) muscles (or “abs”) due to a stretching of the connective tissue (the “linea alba”) that joins them together. These muscles run vertically from your rib cage to your pelvis, and of course you have one set on each side of your midline. The contents of your abdomen are enclosed by these – and other – muscles at the front, and by your spine and back muscles behind. This contains everything neatly, but these muscles also provide support for your back in stabilising your upper body and keeping you upright!

DRA can occur in women and men if the abdomen becomes distended due to obesity, or weakens due to chronic straining, or many years of abdominal loading / lifting with a poor technique. However, one of the most common causes of DRA is pregnancy, or pregnancies, resulting from a stretching of the abdomen in the 3rd trimester, and the associated changes in hormones, which makes connective tissue and ligaments more stretchy – which, of course, is all a necessary process! Not all women will have a lasting DRA, and indeed in many cases it will resolve. Unfortunately, the risk factors for a DRA beyond 8 weeks postpartum are unclear and recent research (Mota et al, 2014), found factors such as pre-pregnancy BMI, weight gain during pregnancy, baby’s weight, or hypermobility, to be of little value in terms of predicting the condition. That said, DRA is common and the above study found that around 40% of women had a DRA at 6 months postpartum.

Does DRA matter?

Despite the high incidence of DRA, the answer is yes – DRA does matter! And for different reasons. For a lot of women, their initial concerns may be cosmetic. Their abdomen may look and feel quite different to how it used to and for some this is enough to seek advice. However, even if this is not of concern to you, it does not mean it isn’t important to get help from your physiotherapist. As alluded to above, DRA weakens the overall important role of the abdomen – particularly when it comes to support for your upper body. The los of tension across the abdomen reduces the ability of this large muscle group to support your posture, resulting in an increased reliance on the muscles in your back, and often, back pain. Couple this loss of support with a change in regular movements and activities (such as increased the lifting and bending over that comes with early motherhood), and you have a number of risk factors for chronic low back pain.

Although most commonly we think of our ‘six-pack’ muscles (RA) as our abs, our abdominals are actually formed by 3 layers of muscles and also closely related to our all-important pelvic floor muscles. So, not only do our back muscles have an increased demand, but also all of these muscle groups. Without the support of the RA, these muscles struggle to do their own tasks and we can experience associated difficulties such as a loss of pelvic stability, and reduced pelvic floor control. Of course, this can manifest in myriad ways, such as pelvic or hip pain, and a loss of bladder and bowel control, or painful sex. These are topics in themselves and I will save that for another day, but hopefully you can now see the importance of doing what you can to address a DRA and loss of abdominal support.

How can I tell if I have DRA?

It is always best to ask your physiotherapist to check your abdominals for you and gain a professional opinion, but there is a small test you can do at home yourself. Lie on your back with knees bent and feet flat on the floor. Have your top rolled up so that you can see your tummy. Gently tuck in your chin and lift your head and shoulders up off the floor. Your tummy should remain flat. If you see a bulging section down the mid section of your abdomen then you may have a degree of DRA. In addition, when lying or standing, this midsection will feel squidgy and baggy, and you may have an area that is visibly wrinkled or bulging. However, if in doubt, it is always best to ask a physiotherapist to assess it for you in clinic. This will be a non-invasive procedure and is very straightforward. At Physiolistic, we are lucky enough to have a diagnostic ultrasound in clinic so we can make a very accurate diagnosis and take you through the rehab process whilst monitoring your progress.


What can I do about it?

Treatment will depend on the extent of your DRA, but will consist of a mix of advice for everyday activity, adjusting awkward or poor lifting techniques, and of course an individualised exercise programme to get those muscles strengthened again and doing their job! It is important to note that the degree of separation of the 2 muscle groups may not always reduce. The aim of the rehab is to improve the overall tension of the abdominal structures (muscles and connective tissue) to improve both the look and function of the core, as described above. We achieve this by firstly strengthening the deeper core muscles (which we can also assess and monitor using the diagnostic ultrasound) and pelvic floor. We will then move onto strengthening the RA themselves with simple exercises that you can do at home and fit in and around your other daily activities.

At Physiolistic, we are very fortunate in being able to provide you with access to Compex, a top of the range neuromuscular stimulation tool. This will boost your rehab and get you stronger quicker. We use these during sessions and also have them available to take home with you between sessions to maximise your exercise gains. Below, I have included a couple of basic exercises to get you started, but if you think you might be at risk of DRA, or have concerns, do not hesitate to give us a call to get yourself booked in for a full assessment and begin your treatment.

This article provides some further reading on DRA:

http://dianelee.ca/article-diastasis-rectus-abdominis.php

EXERCISES

1) Deep tummy muscles

· Lie on your back or your side with knees bent and feet flat. Maintain a normal curve through your lower back throughout the exercise.

· Place your fingers just inside your pelvic bone, as pictured.

· Now imagine that you are wearing a low-slung belt around your hips and you are trying to tighten it another hole or two – you should feel your muscles tighten and flatten under your fingers.

· Hold this contraction for as long as you can (eg 10 seconds or so). Relax and repeat, trying to hold for longer next time.

· Try this exercise whilst standing or sitting as you become stronger.

2) Bent knee fall-outs

· Lie on your back with your knees bent

· Tighten your abdominal muscles as described above

· Carefully lower your right knee down to the floor, keeping it bent

· Try to control through the pelvis and avoid tilting or rotating it by using your tummy muscles

· Bring your knee back to the starting position as soon as you start to lose the pelvic control

· Repeat around 5 times each side to begin with, relaxing your tummy muscles between each repetition

· You can start to increase the number of repetitions as it becomes easier

3) Heel slides

· Lie on your back with your knees bent

· Tighten your abdominal muscles as described above

· Gently slide one heel away from you, keeping the weight of the heel into the floor (without pushing down)

· Make sure you do not lose the contraction of your tummy muscles, or allow your back to arch as you slide your heel out and back again – if you do sense this happening, slide the heel back towards your bottom

· Repeat on the other leg and do around 5 repetitions on each side to start with, relaxing momentarily in between. Increase reps as you progress and are able to contract the muscles more easily

Sophie Davies

Senior Physiotherapist

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Weekdays 8am - 8pm, Saturdays 8am - 4.30pm and Sundays 9am- 1pm  |  (01491) 598 043  |  info@physiolistic.co.uk

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