Diástasis Recto Abdominal (DRA)

66% de las mujeres presenta diástasis en el 3* trimestre de embarazo y el 53% persiste en el post parto inmediato.
36% vuelve a la normalidad luego de 7 semanas post parto
 
Definition
Separated abdominals are referred to as diastasis recti. The National Institutes of Health’s MedlinePlus service defines diastasis recti as the separation of the right and left sides of the rectus abdominus muscle in the abdomen. It most typically occurs after 20 weeks of pregnancy, especially in woman who carry multiple children, have repeated multiple births or have a larger than average baby. Most women will experience a small degree of diastasis recti during pregnancy, but often the condition will remain small and fix itself. Cases of abdominal separation larger than two finger lengths can be a problem and may require special exercises or even surgery to correct.
 
Assessment
To determine if your abdominals have separated, lie flat on your back. Contract your abdominal muscles and place your index finger just below your belly button. 

Pregnancy

 info . net recommends that if you are unable to contract your muscles, try lifting your head and shoulders a few inches off the ground to assist with contraction. Press your fingers into your belly and feel for two distinct muscles to either side of your belly button. If there is a gap between the muscles more than two finger widths, then you may have diastasis recti.

Muscles
A common misconception after pregnancy is that doing sit-ups and crunches will help to re-strengthen the abdominals and achieve flat abs again. Crunches and sit-ups exercise the rectus abdominus muscle and cause it to bulge; however, they will not help the two halves fuse back together and can in fact further separate them. Focus on exercises that target deeper abdominal muscles such as the transverse abdominus and internal obliques, which are responsible for holding the rectus abdominus together.
 
DIAGNOSIS & PRECAUTIONS
You should wait three days after your labor to perform the check for diastasis recti. If you had a C-section, you should wait six weeks, or until your incision has healed. To check for the condition, lie on your back with your knees bent. Slowly lift your head and shoulders off the ground while you reach your fingertips to your knees. Maintain this position as you place one hand along the center of your rectus abdominis. You should feel a soft area between your abdominal muscles. Measure how many finger-widths can fit between your muscles. One finger-width is normal, but two or more confirms that you have diastasis recti. If you are unsure that you have diastasis recti, a doctor can perform a physical exam to confirm the condition. Do not begin any abdominal work if you have this condition. Exercises like situps, for example, can worsen and aggravate the separation, according to Airedale General Hospital’s Women’s Health Physiotherapy Team. Instead, you should begin to strengthen your transverse abdominis, the deepest layer of your abdominal muscles.
 

 
CORRECTIVE EXERCISE
 
To correct diastasis recti, begin by lying on your back with your knees bent. Cross your hands at your waist, or use a towel to wrap around your midsection, and begin to guide your stomach muscles together. Take a deep breath in, and as you exhale, contract your pelvic floor while you raise only your head off of the ground. While you lift, continue to pull your muscles together to start lessening the gap. Perform 10 repetitions three times per day.
 
NEXT STEPS
Once you have stabilized your midsection and closed the gap, it should then be safe to try post-natal exercise classes, such as a post-natal Pilates class to further strengthen your abdominal muscles. On your own, you should begin to strengthen your transverse abdominis, or TVA, and pelvic floor. An example exercise that can help strengthen both is called a heel slide with belly scoop. Begin by lying on your back with your knees bent. Squeeze your belly toward your spine to activate your TVA. Tilt your pelvis up away from the floor as you slide the heel of one foot forward until your leg is almost straight. Slide the heel back in and repeat on the other side. Continue drawing your belly in and tilting your pelvis up as you perform 10 repetitions on each side. Only once your TVA and pelvic floor have strengthened should you begin to strengthen your outer abdominal wall, including the obliques and rectus abdominis.
 
WARNINGS
Exercising too aggressively while having diastasis recti can worsen the issue. If after four weeks the condition still persists, the function of your abdominal musculature can be altered. Take extra care as your abdominal muscles are returning to normal. Avoid twisting, lifting heavy items, doing heavy housework, and carrying things on one side. Speak to your doctor or physical therapist to determine next steps if the problem still persists as well as to determine when exercising will be appropriate.
 
Exercises
Pilates Pro states that movements that involve subtle contractions of the inner abdominals are best for increasing strength. Do exercises where you are on both hands and knees in a quadruped position. Arch your back and allow your belly to drop toward the floor, then contract it and pull your belly up toward your spine. Pelvic tilts will help engage the lower abs and transverse abdominus. Lie with your back on the floor and knees bent. Tilt your pelvis up while pushing your belly button toward your spine and hold it. Do exercises that focus on drawing the ribs in and up.
 
PULL-INS
This exercise mainly targets your transverse abdominis muscles which act as a girdle for your entire midsection. Strengthening these muscles will help close the gap in your abdomen. Lie face up on the floor with your head resting on a pillow and your knees bent with feet flat on the floor. Place your hands on your stomach on either side of your naval to support your abdomen. Take a deep breath in and, as you exhale, gently pull your belly button toward your spine to encourage the gap to close. Hold this position for 10 seconds then slowly relax. Repeat the exercise 10 to 20 times.
 
LEG SLIDE
The leg slide works the bulk of your abdomen, especially the muscles of your lower abdomen. Lie face up with your head resting on a pillow, knees bent and feet flat on the floor. With your pelvis in a neutral position and your lower back just slightly off the floor, pull your belly button into your spine and slowly slide your right foot out along the floor until your leg is straight. Pull your foot back toward your body and repeat the slide with your left leg. Perform 10 to 20 leg slides.
 
Once you are able to easily do 20 leg slides, perform the exercise by keeping your sliding foot lifted 2 to 3 inches off the floor rather than sliding it along the floor.
 
SINGLE-LEG FLOOR TOUCH
This exercise effectively conditions and strengthens your core muscles and helps you get a sense for maintaining a neutral spine. Lie on your back with your head on a pillow, knees bent and feet flat on the floor. Keeping your right leg bent, lift your right foot off the floor so that your thigh is perpendicular to the floor. Lift your left leg up to meet your right leg. Pull your belly button into your spine and contract your abdominal muscles. Keeping both knees bent and your right leg still, slowly lower your left leg until your foot touches the floor. Lift your leg back to the starting position. Repeat the floor touch with your right foot. Complete 10 to 20 repetitions with each leg.
 
Once you are able to easily do 20 reps, perform the floor touch with both legs at the same time.
 
HEEL SLIDE WITH BELLY SCOOP
This two-part exercise from BeFit-Mom allows you to tone and flatten your abdominal wall, which strengthens the muscular separation from diastasis recti. Begin by lying on your back with your palms facedown on the floor. Bend your legs to place your feet flat on the ground. Scoop the belly to perform a pelvic tilt. The pelvis should curve the body into a “C” shape. Slowly slide the right leg out to straighten it, stopping just before the leg becomes completely straight. Slowly bring the leg back in toward your starting position. Lower the pelvis to your starting position, rest and then repeat for five to eight repetitions moving the right leg. Rest and then switch sides to straighten the left leg instead. Repeat for an additional set.
 
MODIFIED CRUNCH WITH TOWEL
This exercise from Lisa Stone, an American Council on Exercise-certified fitness trainer writing on 

StorkNet.com

, utilizes a towel to encourage the abdominal muscles to tighten back together. Begin by wrapping a bath towel around you, with the ends of the towel held in your hands, hovering just over your belly button. Perform a modified crunch by activating your abdominal muscles to lift your head, neck and upper shoulders off the floor. Keep your head aligned with your body as much as possible—resist the urge to dip your chin toward your chest. Pull the ends of the towel closer to your belly button as you lift up—this helps to move your abdominal muscles back together. Repeat for a total of 10 times and then perform two additional sets.

 
MANUAL RECONDITIONING
Another exercise developed by Stone focuses on using the hands to manipulate the abdominal muscles. To perform, lie on your back with your feet flat on the floor. Put your hands on your stomach, fingers pointing away from your head. Contract the abdominal muscles to perform an abdominal crunch that slightly lifts the shoulders off the ground. As you crunch up, push the abdominal muscles in and down—manipulating them to where you would want them to return. Slowly lower your head to return to your starting position. Repeat eight to 10 times and work your way up to completing three sets.
 
QUADRUPED CONTRACTIONS
Get in a quadruped position on your hands and knees and with your back horizontal to the floor. Relax and let your belly sag toward the floor, then pull your belly button in and tighten all the muscles in the midsection, straightening your back out. Hold for three seconds, relax and repeat. Debbi Goodman, a manual physical therapist, recommends doing 50 to 100 repetitions.
 
PLANK
This is a progression from the quadruped exercise. To do the plank, start lying on your stomach. Place your elbows and forearms on the floor. Lift your body so your weight is distributed between your forearms and toes. Your back should be straight, not sagging toward the floor, and draw your belly button in toward spine. Hold for 30 seconds. Repeat 12 to 15 times. Once 30 seconds is easy, increase the time by 15 seconds. You can also do these on one side of the body by turning sideways. Place your left forearm and left foot on the ground with your right foot on top or it and lift your body so that it is straight.
 
LEG EXTENSIONS
Lie on your back with your knees bent and feet flat on the floor. Extend one leg straight out so it is about 12 inches above the floor. Hold it there for three seconds while drawing in the muscles of your abs tight. Bend the leg back and switch sides. Repeat 12 to 15 times per side. This exercise isolates each side of the obliques and transverse abdominus.
 
 
 
Avoid
Be-Fit Mom advises against doing any exercises that put extra stress on the abs or cause them to stretch. Avoid twisting exercises as they may cause further separation. Do not do hyperextension abdominal stretching such as lying over an exercise ball or arching your back. Do not do traditional crunches as they cause abs to bulge out rather than compressing them inward. Avoid heavy lifting, straining or intense coughing without support that can cause you to press outward with your abs.

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