Diastasis Rectus Abdominis (DRA): Is it normal?

Only 5 years ago we were still telling women that doing crunches would widen their diastasis and be harmful. We’ve learned a lot in those five years and now have a better idea of what is helpful for healing diastasis and how common it is during pregnancy. 

What is Diastasis (DRA)? 

Diastasis is the widening or stretching of the linea alba, a connective tissue (similar to a ligament) that connects the left and right sides of the abdominal muscles. The linea alba runs vertically from the pubic bone, up through the belly button and all the way to the sternum. During pregnancy diastasis is normal and beneficial to allow for baby to grow without damage to the muscles. Like ligaments and tendons, the linea alba can stretch allowing the abdominal muscles to be farther apart from each other which is why it’s commonly called ab separation. This can be confusing though because nothing is torn or permanently damaged with diastasis recti abdominis. The tissue is simply stretched and longer than it was previously but can still be as effective as pre-pregnancy. 

Are crunches safe? 

Yes and No. Crunches and sit ups have actually been proven to narrow the distance between the two sides of the abs and shrink the diastasis! We should be doing them more and encouraging our postpartum moms that these exercises should not be avoided. But you’ll often see that crunches and sit ups aren’t safe and should be avoided and this comes from poor core muscle coordination and pressure management. 

If you do these exercises and notice a bulge in the midline of the abdomen that may look like a dome or tent then we want to take a closer look to figure out if these exercises can be improved to be more beneficial for you. That doming/coning could mean that you aren’t managing intra-abdominal pressure well and the abs aren’t able to manage the workload. Intra-abdominal pressure is the pressure in the abdomen (that’s always there) and it changes with different activities. High pressures require more abdominal and pelvic floor strength or better movement strategies to decrease the pressure. 

So rather than avoid all abdominal exercises, we want to make sure that you are managing pressure well and coordinating a good core mm activation to ensure effective strengthening of the abdominal muscles. Do the core exercises correctly helps to close the diastasis and improve the function of the abdominals for better pelvic and back support and flatter appearance of the tummy. 

Checking your diastasis

You can check your own diastasis, though I think it’s difficult, by laying flat on your back and lifting up your head. If you see any doming or bulges pushes up in the abdomen or if you feel pressure down on your pelvic floor then seeing a pelvic health PT would be beneficial to review your technique.

Another part of the diastasis assessment is the width of the diastasis. This is often women’s primary concern because once again it has been prioritized by healthcare providers previously but we’ve learned more and now know that the width of the diastasis is less important than the depth of the diastasis.  The width is just a measurement of the linea alba and distance between the two rectus abdominis muscles (the 6 pack muscles) but does not measure the strength of the linea alba. The strength of the linea alba is observed and felt with doming/coning/tenting and with pressure into the linea alba while your head is lifted. While pressing down we are able to feel the amount of tension created and more tension is better so we don’t want to be able to push down very far or at all.  This is a better indicator of how well your ab muscles are activating and pulling the linea alba tight and how strong that fiber is when challenged with work. 

There is no wrong exercise!

I had a patient who consistently worked out prior to and during her pregnancies. She maintained good abdominal strength and while postpartum she wanted to make sure the diastasis healed and she kept her strength. We started off with more basic core exercises like deadbugs and birddog but were able to progress her to double leg lowering and toes to bars easily because she had the right foundation with good coordination of the abdominal muscles! She wasn’t afraid to challenge herself and we monitored her pressure and doming throughout the exercises which allowed her to gain strength in the first 4 months postpartum. 

Try it out at home

1. So go lay on the floor and lift your head up. 

2. Look for any bulging up in your abdomen over the linea alba (in the middle from ribs to pubic bone). 

3. Press down into the linea alba and see how far down you can push gently before meeting resistance. 

4. Try out a crunch, sit up, plank or other exercise and check for doming, downward pressure on the pelvic floor or pain. 

If everything looks good, you’re okay to continue on with any core exercises you want! 

If you notice bulging or no resistance on #3 then reach out to a pelvic PT and get your diastasis checked so that you can continue with your exercises safely and get the most out of them! 

You can reach us by call or text at 214-600-8168 to schedule and evaluation of your diastasis!