There are too many changes to count that occur to a woman’s body during pregnancy. An all too common one that happens while the baby is getting big is a splitting of the linea alba, also known as a diastasis recti abdominis (DRA). It has been shown to effect 66-100% of pregnant women. It isn’t just women that are affected, men who have gained weight can also get a splitting of the rectus abdominis muscle. The space created from this stretching of the tissue does not fully go back after delivering the baby and has significant impact on the integrity of the abdominal muscles and core strength. Women can complain of low back pain, weakness, incontinence and can get an umbilical hernia as a complication of the DRA. Surgery is only performed on severe cases and most patients are sent to physical therapy to help decrease the space.
Older schools of thought use lots of bracing and pulling the stomach muscles together while performing progressive abdominal exercises. The thought is to increase the tone and strength of the muscles again while ensuring there is no separation of the muscle to increase the diastasis. This can only get the patient so far and they are often plagued with low back pain.
New research and case studies out there are showing the importance of not only preventative care but also the impact visceral mobilization and stretching to the fibers has on the successful treatment of DRA. We encourage patients when they are considering getting pregnant or are in the beginning of their 2nd trimester to come in for overall preventative care of the possible ailments associated with pregnancy. One of the areas treated are the soft tissue adhesions of the rectus abdominis muscle. There has been great success with clearing the lateral borders of the muscle to prevent outward spreading as the baby grows. To help with creating adequate room for the baby to grow and move, mobilization of the intestines is helpful to ensure efficient expansion of the peritoneal cavity.
Not everyone makes it into a manual physical therapist before the diastasis occurs and so there are effective treatments used to correct the separation of the linea alba. We treat the same areas as in the preventative care with major focus on the mesenteric root, which suspends the small intestines within the peritoneal cavity. A recent case series presented by Brandi Kirk and Teri Elliot-Burke shows promising results with the mobilization of the mesenteric root. Their research shows restrictions of the root can cause outward (lateral) tension on the front abdominal muscles. Once efficient mobility is restored, the separation of the rectus abdominis can decrease by over 60%.
Once the tissues are more mobile, it is critical to strengthen them appropriately. We strive to limit bracing and cognitive thought when working your core muscles because when your child runs to jump into your arms most people won’t be thinking bracing. We want your core to fire automatically and we achieve this through proprioceptive neuromuscular facilitation (PNF) principles of manual contact. Research has also shown a slight stretching of the linea alba actually increases the contraction and brings the tissues together. You will be going home with a home exercise program that will encourage this automatic core activation that will leave more lasting results for overall low back health and core strength.
Too many factors are out of the hands of pregnant women but a DRA does not need to be a given with the use of manual therapy. If you’re thinking about getting pregnant or are in your second trimester, strongly think about seeing a manual therapist for preventative care. If you’re post-partum and struggling with a DRA, know there is hope for an effective treatment and speedy recovery.