Diastasis Rectus Abdominis: People over Protocols
By now many of you reading this have heard the term Diastasis Rectus Abdominis (DRA) and if you don’t know, now you know or will very shortly.
DRA most commonly happens in the 3rd trimester of pregnancy when the tissue that connects the right and left sides of the abdomen (linea alba) has no choice but to widen to make space for the growing baby. It will happen in 100% of pregnancies carried to term and there is no way to prevent it and we wouldn't want to anyway.
Is possible but not common for someone who has never had a pregnancy to have a DRA. Some people with rapid abdominal weight gain may have it and babies are born with quite a wide linea alba though rarely do I see the term DRA assigned to kiddos (thank gawd).
If you have found yourself typing in “how to heal my DRA” into your search bar you have been made keenly aware of all of the top 5 exercises you MUST do to heal it and the top 5 exercises to NEVER ever do again in a million years. Simple enough but then you notice that one program has one of the nevers in their top 5 healing exercises so you dig a little deeper. Always belly breathe, never belly breathe, never plank, planking is the bees knees, engage your pelvic floor, don’t engage your pelvic floor. So what the heck do you do? If you are like many of our clients you may do nothing because at least then you are not making anything worse, right? Or maybe you just say F it and go on doing whatever the heck kind of exercise you feel like doing. Or it is quite possible that you purchase an online program that ends up being boring as hell so you quit (because you are human).
Here are some observations that I have made in my 10+ years helping hundreds of women sort through the BS they have been fed online or by other well meaning health and fitness pros. By the way it is not lost on me that I am gently bashing the influencers while writing online content but hopefully my message is something new and refreshing. You are not broken and you do not need to be fixed. You simply need a guide that will help you find a way to do the kind of exercise you love and feel great doing. It is possible. At New Seasons we throw many of the rules out the window (its okay, they were not helping anyway). Instead we use an anti rigid framework to guide decision making utilizing strength and conditioning principles, we toss in a healthy dose of common sense and a bit of trial and error because if we don't we are probably being way too conservative. And you know what is so fun about this way rather than following a set protocol? It is F-U-N! If you like HIIT- we got you; Yoga - For sure; running- cool but we probably need to throw in some cross training; CrossFit - Hell yeah!
Okay cool, now I have you all riled up, I will ask that you sit back and relax while I share what I know and what I don’t in no particular order.
You can have a weak core postpartum without a DRA.
You can have a strong core postpartum with a DRA.
You can have a weak core postpartum with a DRA.
You can have a mummy tummy (excuse me while I barf in my mouth a little at that term) and not have DRA. Mummy tummy is a commonly used term to refer to some of the roundness and skin changes or stretch marks that many people have after (go figure) growing a human.
5. Not all people with a linea alba that has widened compared to pre-pregnancy will be diagnosed with DRA. There are measurement norms that help establish a diagnosis.
6. In most other parts of the musculoskeletal system we challenge it with load to build strength. We do the same with DRA, finding that right load can be a bit of a goldilocks situation which is where working with a trusted professional can be helpful. Where many programs fail is that they introduce too much load too soon or too little too late.
7. Some online programs are fabulous for the right people.
8. The literature to date has not been able to prove that having DRA puts you at greater risk for things like stress urinary incontinence or prolapse.
9. Scare care sucks. I have seen people out there tell new moms that they shouldn't pick up their toddler or get this, that there is a right way to shower when you have a DRA.
10. You can totally rehab your core and be strong as a mother and your belly may not look like it did pre-pregnancy.
11. Sometimes a surgical correction is required but that is very very rare. And if you do require a surgeon you want to make a smart decision here. We can help you with that.
12. It is biologically implausible that you will make your DRA wider or deeper through most forms of exercise.
13. There is more we (the health and fitness community) don't know about DRA than we do know.
14. We don't know the best exercises because they don't exist. We will work to help you find the best exercises for you taking into account what you like and what is feasible for your lifestyle.
15. We don't actually know that doming is bad or that it is something to be avoided at all costs. What if allowing a little doming helps build tissue strength through loading? Does doming a lot lead to long term problems?
16.Sometimes crunches are helpful.
The health and fitness industry has freaked you out and/or confused the heck out of you when it comes to DRA. If you are finding yourself in a state of overwhelm over the next step to take in your healing journey why don't you join me for a webinar on March 24th, 2021. I will be offering an afternoon and an evening option 12:15-1pm and 8:30-9:15pm and it is all totally
free minus the 45 minute time investment on your part.
To register, email firstname.lastname@example.org. Tell us your name, what time you plan on attending (afternoon or evening) and your top question or concern about DRA. We will send you the zoom link. Registration closes Monday March 22nd at 9am.
We will be taking a deeper dive into the anatomy and physiology of the abdominal wall and what happens in DRA.
We will be busting some myths.
We will be making suggestions for when you are probably just fine to go about your business as usual and when you may benefit from working with a pro.
We will be introducing the principles we use at New Seasons when designing and progressing a rehab program.
We will be providing an exciting opportunity for a personalized assessment.
If you are a physical therapy student with an interest in better serving your future clients please join me virtually at the APTA MI student conclave.
Thanks for reading this “ranty” piece. If you are curious why I revealed so much of what I don't know when I should be trying to convince you that you need my help, I guess it is because it feels like the right thing to do. The “wealth and hellness” industry (a term I heard first from Rachel Ricketts, not sure if it is hers originally) will have you believing that you are broken and that you need to be fixed through a never ending series of complicated protocols. They use complexity to make you think you are less than and that they have all the answers. It is simply not true.
If you do need some help then we at New Seasons are here for you. The help we offer to people concerned with Diastasis Rectus Abdominis ranges from a one visit assessment to rule out a problem to a 6 month comprehensive rehabilitation program and everything in between. Not sure if you need help? Then let's chat. Book that call HERE.
And here are those webinar details again.
March 24th, 2021
12:15-1pm or 8:30-9:15pm
To register, email email@example.com Tell us your name, what time you plan on attending (afternoon or evening) and your top question or concern about DRA. We will send you the zoom link. Registration closes Monday March 22nd at 9am.