DRA Physical Therapy
Have you ever heard that you shouldn’t do sit ups during pregnancy? That this will ruin your abs? This myth refers to the presence of diastasis rectus abdominis (DRA). DRA occurs during pregnancy due to the expansion of the abdomen. By the way, this typically presents in gentlemen with larger midsections as well.
What is DRA?
The linea alba is a thin band of connective tissue that runs down the middle of your stomach, connecting your 6-pack abdominals, also known as the rectus abdominis. During pregnancy (or other abdominal growth), the linea alba adapts to the stretch, and therefore has a change in tissue quality. 33% of women have a wider linea alba during the second trimester, which increases to 100% by the end of the third trimester. That’s right, you can’t prevent DRA, and you shouldn’t want to!
A visual sign of DRA either during or after pregnancy is the presence of coning or doming during an exercise that requires core engagement. When we contract our abdominals, we increase the pressure within our abdomen. If coning or doming is present, it signals that we currently are unable to handle the level of intra-abdominal pressure that a specific movement or exercise requires.
NOW, there is NO evidence that avoiding coning during pregnancy improves the outcome of DRA post-pregnancy. What we DO know is that coning is a sign of relative weakness, and therefore something to coach, modify, and strengthen, just as you would with any other exercise.
For example, if I have someone perform a dumbbell shoulder press that they are not yet able to functionally manage, they may compensate by shifting their torso or changing the path of the dumbbell. While it is not hurting them to do it that way, it’s also not necessarily helping them get stronger.
What’s Next?
So, now that we know what DRA is, how do we know if we have it and what’s the next step? Here at MOTION RX, we are equipped to assess for the presence of DRA. If DRA is present, our first goal is ensure that you are aware of how to co-contract your abdominals. Sometimes, coning is present with an exercise if only the rectus abdominis muscle is working. If cued to include transverse abdominis and oblique contraction, for some, the coning can go away.
Now, if you’ve seen a physical therapist or other healthcare provider, and all they’ve assessed is the presence of DRA while laying on your back, they have done you a disservice. Most of our life, especially in fitness endeavors, is not spent laying on our backs. After checking for DRA while lying down, our next goal would be to watch for movement quality during other tasks (ex. Pull ups, snatches, burpees). From there, we would find modifications that you are currently able to manage.
On top of that, our goal would be to get you as strong as possible so that you can progressively return to all the activities that you love in the most functional way. Again, I want to reiterate that DRA is NOT bad! It’s your body’s way of adapting. For some, DRA will completely resolve and for others it may persist. We can never guarantee that DRA will completely resolve (some of that can depend on genetics and collagen makeup), but we can guarantee that we can make you stronger and more functional.
Dufour S, Bernard S, Murray-Davis B, Graham N. Establishing Expert-Based Recommendations for the Conservative Management of Pregnancy-Related Diastasis REctus Abdominis: A Delphi Consensus Study. J Womens Health Phys Therap. 2019;43(2):72-81.