Dr. Ariel Sernek, PT, DPT
DRA stands for Diastasis Rectus Abdominis. It can be tricky to pronounce but you can just call it DRA, and we’ll know what you’re talking about. First, it helps to understand a bit of the underlying anatomy and terminology. Your “six-pack” muscle is called the Rectus Abdominis and diastasis means “the separation of normally joined parts” (Dictonary.com). So a DRA is a separation of your six pack abdominal muscles. Now, your muscles are not actually splitting apart, there is a ligament between your right and left sides of your rectus abdominus called the Linea Alba. The linea alba is meant to be flexible and this structure is what stretches and recoils back to its original size. Pretty Cool, right?
How common is this?
DRA is most commonly seen around pregnancy and post-partum, in fact 100% of pregnant women will have a DRA to accommodate for the growing baby after 35 weeks gestation. Fun fact: men can also have this too; think “beer belly.”
“Do I need surgery?” This is something I hear all the time. Surgery can fix this, but primarily if there is an abdominal hernia. This is when part of your intestines protrudes through a hole in the linea alba. This can cause abdominal pain and dysfunction with bowel movements because there is now a kink in your bowels limiting stool from moving as it should. Surgery is not the only fix, physical therapy can also help!
How does physical therapy help?
First, we need to get a global assessment of your rib angle, your thoracic spine mobility (your mid back), posture, abdominal strength, and MOST importantly- how you manage pressure through breath work and correct timing of your core. Your core is not just your abdominals, but your diaphragm, your pelvic floor and your lower back muscles. These muscles have to work together in order for pressure to be managed and your body to work properly. Imagine the last time you coughed or sneezed, you probably felt your belly pooch out and maybe down. That’s the internal pressure we have to manage that can pull apart your rectus abdominis muscle.
Picture a can of pop, it’s pressurized until you open the tab and then the pressure can escape. Now, imagine the middle of your abdominal wall being the open part of the can. Pressure is going to travel wherever there is weakness or an opening. This is why surgery does not always fix the issue. Sure they can stitch the rectus abdominis muscle together, but if you cannot manage abdominal pressures, the surgery can fail and you can separate again. This is not a good situation.
People don’t like to hear this, but the distance of the muscles is not my main concern. The strength and tension created by your linea alba ligament and how you manage abdominal pressure with your daily activities is my main concern. Some people have separation, just as some people have stretch marks or looser skin. These are normal changes with pregnancy and post-partum and are okay to have. Genetics, diet, water intake, previous history of exercise and training regimen, and current exercise can all influence the cosmetic look of your abdominal wall.
In addition to pressure management and addressing core dysfunction, we also address urogenital symptoms of urine leakage, urgency, pelvic organ prolapse, constipation, musculoskeletal pains, and anything else that can influence your core.
We are then able to load and progress your abdominal muscles based on where you are at with your activation and control. If the activity is something that causes you to have coning, we back off. That just means your body isn’t ready for that exercise yet. We would also need to address gluteal strength, posture management, strengthening your deep core and pelvic floor, how you move in/out of positions, and teach proper bracing to address… you guessed it, PRESSURE!
Hopefully this article has answered some of your questions surrounding DRA and how you can address your symptoms without the need for surgery.
Please reach out to us if you need help with this condition. We offer 1-on-1 sessions to look at your specific situation and invest in helping you live a healthy, happy life where you are confident to care for yourself and your family. If you know of others who could benefit from this information, please share this article with them.
You can also reach out to me directly at email@example.com or check out our Pelvic Health page https://www.recoverrxpt.com/pelvichealth
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