Can physiotherapy help Rectus Abdominis Diastasis following pregnancy?
During pregnancy women undergo a lot of changes! As the baby grow this puts mechanical pressure on the rectus abdominis muscles and many will experience an increase in the inter recti abdominal muscle distance due to thinning of the linea alba. This effect is often caused by the hormonal changes which increase elasticity of the connective tissue. It often occurs in the 2nd-3rd trimesters and unfortunately can continue to increase until pregnancy.
Around 53% of women will experience diastasis of the rectus abdominus (DRAM) muscle directly after pregnancy. Although many women are concerned about how it looks the muscles abdominal wall is important for trunk stability, pelvic stability and posture.
Regular exercise prior to pregnancy appears to reduce your risk and also the size of a DRAM however this is anecdotal evidence and to the best of my knowledge has not be trialed thoroughly yet.
8 studies were included in this review with the participants aged between 18-40 years. There was a total of 366 participants of which 170 were exposed to interventions to reduce the risk of DRAM. All intervention included a form of exercise.
Core strengthening and targeted abdominal wall strengthening were mainly targeted.
Exercises were carried out in isolation s only intervention
Exercises carried out with corset/tubi grip application and/or education
Exercises carried out at different activity levels i.e. delivery/frequency/duration
Effects of exercise of DRAM
This particular review found (after pooling results). For every three pregnant women treated with antenatal exercise one woman would be prevented from developing DRAM
In 2 studies (Hsia and Jones, 2000 and Chiarello et al, 2005) the width decreases during antenatal and post natal periods.
Those who followed a 6 week course of antenatal abdominal exercises had smaller DRAM widths that the non exercising control group. They also saw reduced DRAM widths 48 hours after delivery compared to those in the control group who hadn’t exercised (Charello et al, 2005).
Unfortunately when using the gold standard of a systematic review there was not enough high quality evidence to be able to recommend any firm guidelines
Although studies suggested that exercise was protective and may reduce the risk of developing DRAM further widerning, more robust studies need to be done.
A possible explanation for why exercise may help could be that as the hormones relax the connective tissue the muscle strengthen helps to reduce mechanical load on the line alba and therefore the more conditioned these muscle are prior to delivery, the better. It is important that exercises focus on the deep abdominal muscle and do not slate the rectus abdominis ( such as sit ups). This is likely to make the problem worse due the way the muscle contracts. (Benjamin et al, 2014)
How can physio help?
While we await larger, robust studies to guide us we continue to treat muscle dysfunctions that we find to help minimise the impact of DRAM.
Proving antenatal guidance ( even within the first trimester to allow the muscles time to strengthen before the mechanical and hormonal pressures are at their greatest.
Anecdotally, we have found providing education on avoiding the activities which put unnecessary strain on the rectus abdomens ( such as sit ups) is important to avoid DRAM.
Exercises that focus on the the transverses abdominis ( with care not to over activate the rectis abdominis).
Education on caring for other children and ways to dress and care for them through techniques that minimise the risk of DRAM.
If you go to see a physio they will usually look at the width of the divarification ( the distance between the two borders of the rectus abdomens muscles) You may be asked to lift your shirt up of take it off if they want to a assess whether you have developed an postural compensation which may be contributing to it.
Hope thats been helpful!
Benjamin, A., Van de Water b, A.T.M., Peiris C.L.(2014) Systematic review Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review (2014)(2014) Physiotherapy 100 1–8.
Candido G, Lo T, Janssen P. Risk factors for diastasis of the recti abdominis. J Assoc Chart Physiother Womens Health 2005;97: 49–54.
] Hsia M, Jones S. Natural resolution of rectus abdominis diastasis. Two single case studies. Aust J Physiother 2000;46:301–7.
Chiarello CM, Falzone LA, McCaslin KE, Patel MN, Ulery KR. The effects of an exercise program on diastasis recti abdominis in pregnant women. J Womens Health Phys Ther 2005;29: 11–6 [corrected, published erratum appears in J Womens Health Phys Ther 2005;29:76].