Moving Beyond the ABCs of DRA
By Sinéad Dufour, PT, PhD
Diastasis Rectus Abdominis (DRA) is a prevalent issue women face and one of the most common reasons why women seek my care. Women want to know if they have it, what exercises they can do to fix it, and how to avoid it. Attempts to consult google and social media often leads to a path of oversimplified principles or information that is flat out incorrect.
Let’s start with explaining what DRA is and what it is not.
- It is NOT an actual “separation of abs”: Tissue separation of the abdominal wall denotes a hernia. Thus, the term separation really should never be used when discussing this issue as it is confusing and frankly, unhelpful
- It IS a condition of an overstretched linea alba: The linea alba is a vertical line of connective tissue that connects the right and left sides of your rectus abdominis muscle. Think of it as your “6-pack muscle tendon”. The result of an overstretched “6-pack muscles tendon” means your abdominal and associated core muscles don’t work as well and thus can’t control intra-abdominal pressure (IAP) well. It also means the tummy often has a “pendular” or “pootched” appearance. What it comes down to is women not feeling good in their bodies.
Good News! There are things that can be done on both the prevention and correction side of things. Your best bet is to get guidance from one of the pelvic PTs listed here. Having a sense of some key principles can help, but are only a start.
The ABCs of DRA
A = Alignment
B = Breathing
C = Core Connection
If your posture generally tends to land in a swayed back, tucked bum, popped ribs and tight hip flexors, then it is important to learn not to always be in this position, particularly when you are exercising and tiring to engage your core. A natural spine alignment can assist both how your diaphragm muscle and pelvic floor muscles contract and relax as well as synergize together. Therein lies the crux of the relevance of the first ABCs.
Here’s a fantastic video by highly esteemed physiotherapist colleague Julie Wiebe explaining how alignment impacts your diaphragm and pelvic floor function.
Alignment → Breath → Core Connection
Once we get an understanding of this foundation and we’re able to move into different postures and align well to optimize our connecting during exercises (usually this means slowing down, moving with intention and really listening to our body so we don’t push too hard), we need to make sure we are considering other relevant principles for optimal abdominal wall function – the ones that are rarely discussed and often missed.
We now come to the ABC and D of DRA.
A = Adipokines
B = Body Mass Index
C = Cortisol
D = Diabetes (including Gestational Diabetes)
What do all these aspects of physiology have to do with a structural abdominal wall issue?
Well, like all things in the human body we can use the leaf and the plant analogy to understand the important relevance. The leaf (in this case abdominal wall tissue) can have local factors impacting it, but surely is going to be impacted the most by its root systems and ultimately what is happening in the soil that is feeding the root systems (think immune system, endocrine system, nervous system).
This is why we need to understand key aspects of dysregulated physiology that data shows clearly impact the state and structure of abdominal wall tissue and specifically correlate with DRA.
Adipose tissue functions as an endocrine organ by releasing multiple bioactive substances, known as adipokines, that have pro-inflammatory or anti-inflammatory activities. Dysregulated production or secretion of these adipokines can contribute to the pathogenesis of obesity-linked complications that includes blood sugar dysregulation, insulin resistance and associated musculoskeletal impairment.
Once again, like our ABC, we see how the ABCD factors of DRA are related. That is, diabetes is a metabolic disorder and thus an increased amount of adipokines and body mass index are almost always a feature of the presentation. When too much cortisol is secreted (our survival and stress hormone), this can contribute to low grade inflammation in the gut and associated disruption in the immune and metabolic pathways.
Although appearing to be highly complex, these physiologic systems are ultimately modulated through lifestyle – so again, there is LOTS that can be done.
If you are a mama who needs guidance, seek out the care of one of the pelvic physiotherapists found here. I direct the pelvic health & fitness teams at the WOMB (Milton, Burlington, Vaughan and Woodstock) and Compass Rose Wellness in London, Ontario.
If you are a healthcare provider or fitness provider and you want to learn more about DRA, then come learn with me through my self-paced online level 1 and 2 DRA course. Myself and co-instructor Dr. Stéphanie Bernard cover EVERYTHING related to DRA, perinatal care and more in this two-part course jam packed with videos of assessment techniques, exercises, manual therapy techniques, and interviews with top experts!
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Follow me on IG as my platform is dedicated to knowledge translation on the topics of women’s health, pelvic health, lifestyle medicine and more: @dr.sinead