Diastasis rectus abdominis (DRA) is a condition wherein there is stretching and thinning of the rectus abdominis muscle at the linea alba, a line extending vertically down the center of the abdomen. The traditional determinant for a DRA is a 2 finger width separation recorded above, at, and below the umbilicus.
It occurs in more than 50% of pregnancies due to the expanding size of the uterus and hormonal changes. A DRA does not resolve spontaneously postpartum.
A study by Chiarello et al found that 90% of non-exercising pregnant women exhibited DRA, whilst only 12.5% of exercising pregnant women had a DRA.
A study by Bursch found that all women have DRA postpartum and 85% presented with at least 2 finger width separation.
DRA will result in impaired abdominal muscle and pelvic muscle strength and stability. The abdominal muscles play a big role in functional activities and trunk control and function. Thus, a DRA may affect posture, trunk stability and motion, respiration, urination, and vaginal delivery.
Strengthening of the transversus abdominis muscle in isolation and with functional activities is key to resolving a DRA and improving core stabilization.
The pelvic muscles and the abdominal muscles work together to maintain abdomino-pelvic control in functional tasks. Thus, it is imperative to screen for a DRA in pregnant and post-partum women and treat it with a therapeutic exercise program. Exercise improves the tone and strength of abdominal and pelvic muscles, and thus strengthening these muscles during and after pregnancy will decrease the incidence and/or size of the DRA.
Manual therapy techniques used to treat patients with DRA include myofascial release, trigger point release, muscle energy techniques, and visceral manipulation. Other manual therapy techniques used include manual facilitation for abdominal contraction, soft tissue mobilization, connective tissue manipulation, and joint mobilization at the sacrum, innominate, lumbar spine, coccyx, and pubic symphysis.