Healing DRA: Diastasis rectus abdominis (DRA) is the thinning and stretching of the linea alba, which is the connective tissue between the six-pack abs, or your rectus abdominis muscles. This is a normal adaptation to pregnancy because the tissues need to stretch and expand to accommodate babies’ growth.
Almost everyone who carries their pregnancy to term will have diastasis during pregnancy and need to heal from it in postpartum. For many, diastasis will heal spontaneously within the first six weeks postpartum. But for others, we will need to focus on a more deliberate approach to healing DRA in the postpartum.
How can we approach healing DRA?
First, it’s important to define what healing DRA means. For some, the closure of the gap is the main focus when healing a diastasis. However, a small gap does not always equal better function or healing.
When focusing on healing DRA, we need to not only focus on closing the gap, but also increasing the tension at the gap. So, when we have an increased demand, we need the tissue to get denser in response to increase in pressure and force. This increase in tension, and density, will help the tissues be less easily manipulated or changed by pressure and structurally strong to increase demand.
Okay… so how can we close and increase density?
There are several muscles involved with creating tension across the linea alba: the transverse abdominals, internal obliques, and external obliques. If we focus on strengthening these muscles, we can increase the density of the tissue! If you are not finding progress in your healing, you may not be challenging yourself enough, as opposed to doing too much. Incorporating strength and resistance training during the postpartum period can help enhance healing, as lifting weights can help to increase bone density, muscle mass, and tissue density.
The transverse abdominal (TA) muscles help to influence the side-to-side tension and length of the linea alba. The TA is known as your corset muscles and is a part of your deep core stabilization system.
So, when you breathe, the transverse abdominals expand and stretch during inhalation, and then engage or contract during exhalation.
Cues that could help you turn on your transverse of dominoes muscles, include “bring baby to spine”, or “try to bring your two hip bones together.” Another way to help turn on the TA, is to make a “shush” type noise when you exhale.
The obliques, both internal and external, help with rotational movements and help to decrease the gap and increase the density of the linea alba diagonally. The external oblique helps you rotate away, so the right external oblique helps you rotate towards the left. The internal oblique helps you rotate towards the same sign; so, the left internal oblique helps you rotate towards the left. We can use rotational movements, or anti-rotation movements, to help strengthen the obliques.
Our Approach to DRA Healing
1. Posture: We need to set up to allow the core to optimally function. Our muscles operate best in a midrange position; this means that the muscle is in neutral and can respond to demand in any direction. For our core, the midrange position is a neutral spine position. This is when the shoulder, ribs, pelvis/hips, knee, and ankle are generally aligned; we can also focus on ribs being stacked over the pelvis. We are meant to move, so we do not need to remain in a rigid, neutral spine position, but pay attention to how often you find yourself living in other types of posture. Do you favor a sway-back posture or an arched position?
2. Breathing Pattern: how we breathe influences how we can stabilize and can enhance or inhibit our healing. When we breathe, we want to focus on diaphragmatic breathing, where our inhales are down and out, increasing pressure/tension; and our exhales are up and in OR relaxing, where we may activate/contract in our core.
We also want to focus on coordinating our breath to movement! When we are in the eccentric portion or moving WITH gravity, we want to focus on inhalation. When we are in the concentric or challenging portion or moving AGAINST gravity, we want to focus on the exhalation.
3. Cross Body Exercises: and then finally we incorporate exercises that coordinate breath to movement to help turn on the TA, and involve a cross-body movement to help activate the obliques. Our return to fitness programs emphasizes the myofascial slings so that we can utilize the cross-body movement patterns to enhance connection and healing postpartum. We can incorporate a combination of isometric movements (anti-rotation) and rotational exercises to help support strengthening across the DRA for closure of the gap + increase in density of the tissue.
Our prenatal fitness programs focus on helping you stay strong and comfortable throughout pregnancy. Our postpartum return to fitness programs helps you reconnect and heal postpartum and offer sport-specific paths depending on your fitness goals: general strength & conditioning; Olympic weightlifting; C-section recovery; and running. We incorporate core training throughout our programs that are safe for pregnancy and enhance healing postpartum. Learn more about our programs here!