This writing is informational in nature and is not intended to diagnose or treat any medical condition. Please see your physician for medical interventions.
Welcome to the blog of Viking Strength Sports! We recently asked followers on Facebook what types of questions and subjects they were interested in seeing on the blog. This week, we are looking at a condition known as (DR) or diastasis recti abdominis (DRI) - a persisting weakness, a bulging appearance around, above, and sometimes below the umbilicus (bellybutton), and an abnormal gap on the midline of the abdominal wall. We'll discuss the basic structure of the abdominal muscles, common causes of DR, and explore the current treatment methods in use.
The musculature of the abdomen is actually composed of four distinct muscles types, as
described in a 2018 surgical journal: the internal and external obliques (which run at a diagonal along both sides of the abdomen, furthest from the midline), the transverse abdominis muscles (which lay horizontally across the abdomen), and the rectus abdominis muscles (which run vertically across the abdomen, on either side of the midline, parallel to the linea alba, a structure of collagen fibers that divides the abdominal wall vertically) (Nahabedian, 2018, p. 147). Together, these muscles help to maintain an
upright posture, protect vital organs and structures of the abdominal cavity, and act in conjunction with other muscles to help you exhale, sing, cough, use the bathroom, to name a few (Michalska, Rokita, Wolder, Pogorzelska, & Kaczmarczyk, 2018).
The abdominal muscles are put even further to the test during pregnancy and childbirth. As a fetus grows, hormones signal numerous changes within the body, affecting metabolism, blood circulation, ligaments and joints. The uterus grows to accommodate the growth of fetus and placenta, which triggers anatomical adjustments to the woman's spine, pelvis, and core muscles. As this occurs, the rectus abdominis muscles stretch, weaken, and shift away from the linea alba, leaving the characteristic bulging appearance of DR. Aside from the cosmetic distortion, DR can also cause discomfort with movement, and if the weakness is severe enough, can lead to hernia (Nahabedian, 2018, p. 149).
While this condition is most commonly found in pregnant or postpartum women, and is even
more likely after multiple pregnancies and after delivery by cesarean section, it can also occur in both men and women after significant weight loss, after open abdominal surgery, or in connection with certain genetic disorders (Michalska et al., 2018, p. 98).
According to a paper published in 2017 by Mommers et al. (2017), approximately 2/3 of
postpartum women will experience a spontaneous recovery from DR within the twelve month period following delivery. For the remaining third of postpartum women, as well as patients with DR caused by other factors, treatment is needed to help resolve the physical and cosmetic effects. This can run the gamut from physical therapy/exercise to abdominoplasty. Assessing the severity of the condition takes into account several factors, including the symptoms present, the patient's age, the condition that preceded the development of DR, and measurement of inter-recti distance (IRD) – the width-wise measurement of the gap, taken across the linea alba by palpating the space, by measuring with calipers or a tape measure, or through imaging studies such as ultrasound, CT scan, or MRI (Michalska et al., 2018, p. 98).
Although some studies have been conducted to explore non-surgical treatment of the condition, researchers have concluded that more study is needed to evaluate a specific protocol of exercises with the greatest effect (Michalska et al., 2018, p. 99). The exercise approach may include exercises that strengthen and stabilize the core muscles such as Pilates, exercises to strengthen the transversus abdominis muscles and/or rectus abdominis muscles, including “drawing-in” movements, planks, and certain types of curls or sit-ups, and practicing everyday movements such as lifting and proper posture.
Devices like postural aids, binders, splints, corsets, Tubigrip compression bandages, and taping are ususally used in conjunction with exercises. The eighteen week, four-part Tupler Technique program combines exercises, splinting, “developing transverse awareness with activities of daily living,” and “getting up and down correctly” (Tupler, 2018).
There are conflicting ideas on the best physical therapy exercises, as described by Michalska et al. – either focusing on training the transversus abdominis muscles using “drawing-in” exercises, or on attempting to strengthen the weakened rectus abdominis muscles using abdominal crunch exercises (2018). The former school of though prohibits crunches, curls, and sit-ups, so as to avoid potentially widening the IRD, while some data showed that the latter “consistently produced a significant narrowing of the IRD” (Michalska et al., 2018, pp. 99-100). The Polish study concluded: “It seems that the optimal strategy in the DRA therapy is combining the activity of the two kinds of abdominal muscles, but it still needs to be confirmed” (Michalska et al., 2018, p. 100).
A 2018 study, published in 2019 in the journal Physiotherapy Theory and Practice, involved
thirty-two early post-partum women with DR, observing changes to “inter-rectus distance measured using ultrasound, body image, pain, urogynecological symptoms, and function measured using questionnaires, and trunk flexion strength and endurance measured using clinical tests” (Keshwani, Mathur, & McLean, 2019). Compared to the non-treated subjects, the participants were treated with exercise therapy, abdominal binding, or both. The combination therapy group and the abdominal binding group showed improved body image at the end of the study period, and the combination therapy group also experienced
an improvement in trunk flexion strength (Keshwani et al., 2019). Despite these promising results, the authors of the study still concluded that “further preliminary investigation is recommended” (Keshwani et al., 2019). Clearly, although diastasis recti is a common condition with a range of severity and symptoms, its treatment can be complex and may well require a multi-faceted approach. More data are needed to support treatment methodologies. With this in mind, your physician is the best person to approach to start
developing a plan to treat DR. The studies and websites referenced in this post are listed below if you'd like to do some reading on your own.
Thanks for reading, and we'll see you in the next post!
Keshwani, N., Mathur, S., & McLean, L. (2019). The impact of exercise therapy and abdominal
binding in the management of diastasis recti abdominis in the early post-partum period: a pilot
randomized controlled trial. Physiotherapy Theory and Practice. doi:
Michalska, A., Rokita, W., Wolder, D., Pogorzelska, J., & Kaczmarczyk, K. (2018). Diastasis
recti abdominis -- a review of treatment methods. Ginekologia Polska, 89(2), 97–101. doi:
Mommers, E. H. H., Ponten, J. E. H., Al Omar, A. K., de Vries Reilingh, T. S., Bouvy, N. D., &
Nienhuijs, S. W. (2017). The general surgeon's perspective of rectus diastasis. A systematic
review of treatment options. Surgical Endoscopy, 31(12), 4934–4949. doi: 10.1007/s00464-
Nahabedian, M. Y. (2018). Management strategies for diastasis recti. Seminars in Plastic
Surgery, 32(3), 147–154. doi: 10.1055/s-0038-1661380
Tupler, J. (2018). Tupler Technique Treatment for Diastasis Recti. Retrieved January 22, 2020,