A Physical Therapy Guide to Diastasis Rectus Abdominis
It would be redundant to say that the body undergoes some major changes during pregnancy—beyond the heart remodeling, the ribs splaying, and hormones changing, an ever-expanding abdomen can be hard to miss.
While the body makes space for a growing uterus, the stretch across the abdominal wall can create an abdominal separation, also known as a diastasis recti abdominis (DRA).
Although this can sound scary, it’s a very normal part of pregnancy, and getting diagnosed with a DRA doesn’t have to be a prescription for lifelong inactivity. Here’s everything you need to know about pregnancy-related DRA, how to treat it, and how working with a specialized physical therapist can help.
What is a Diastasis Recti Abdominis (DRA)?
A DRA is a temporary problem of coordination, exercise intensity, and pressure management in the abdomen. Simply put, a DRA is a big stretch across the linea alba, the tendon that vertically connects all the abdominal muscles (including the rectus abdominis, the six-pack muscle).
The linea alba runs from the bottom of your sternum bone to the pubic symphysis at the top of the pelvis. During a rapid and sizable expansion of the abdomen, like in pregnancy, the muscle bellies of the six-pack muscle can be pulled farther from each other, creating a ‘gap’.
This ‘gap’ can occur at the belly button, above the belly button, or least commonly, below the belly button. This ‘gap’ can make it more difficult to generate muscular force during exercise or functional activities, like lifting.
What is Considered Normal?
Studies have shown that up to 100% of women may experience a DRA in the third trimester of pregnancy. Whether it resolves postpartum depends on several factors, such as maternal age, tissue health, or pregnancy with multiples (twins or triplets).1
There isn’t a clear consensus on how to measure a DRA, because it can vary by where the measurement is taken in the linea alba. The most generally agreed upon measurement is <3 cm as measured by ultrasound, or about two finger widths.
A physical therapist who specializes in women’s health will also measure the depth of the ‘gap’, measuring tension and efficiency of loading across the fascia. Again, however, there aren’t clear normative values shown in scientific research.