There are so many things to think about when you are pregnant. Am I eating healthy? Did I take my prenatal vitamins? Is it safe to continue cardiovascular exercise? One area that often gets overlooked is the abdominal muscles. Specifically, what happens to the rectus abdominis muscle, or the “six-pack muscle,” during pregnancy and into postpartum. The rectus abdominis has ligamentous tissue called the linea alba that divides it into that six-pack configuration. As pregnancy progresses and ligamentous laxity increases, the linea alba can separate vertically near the belly button or anywhere along the abdomen. This separation is called Diastasis Rectus Abdominis (DRA) and not only occurs to 66% of women in their third trimester, but is also seen 8 weeks after delivery in 30%. Although this separation can close on its own during the first year postpartum, for many women it does not. As a result, each subsequent pregnancy can cause the DRA to increase, leading to pain from decreased low back and sacroiliac joint stability.
Looking for DRA isn’t a routine check during your prenatal or postpartum doctor appointments, but it is an area that a Physical Therapist assesses. If DRA is present, it will be measured and you will be taught how to self-check the separation to monitor your progress at home. In order to reduce the separation, you will need to isolate the transverse abdominal muscle (the horizontal muscle that lies under the rectus abdominis). You will be taught how to isolate and contract the transverse abdominal muscle, as well as how to perform Kegel exercises, which strengthen the pelvic floor muscles. Together, these are the most important muscles for sacroiliac joint stability and improving their performance is the basic objective when initiating a core stabilization program. Without this ability, core stabilization isn’t effective. Contrary to popular belief, doing sit ups (which works the rectus abdominis) to strengthen your core will actually worsen your DRA and should be avoided.
Whether you have just had your first baby, or your youngest is 20-years old, you may have DRA that has never been identified. That separation can be a cosmetic issue for you, but from an orthopedic standpoint, it is a main contributor to your unexplained back pain, that becomes chronic. If you do have back pain and/or want to strengthen your abdominals to stabilize your core, then you are an appropriate candidate for a Physical Therapy evaluation. Schedule your appointment today to learn self-management techniques as well as hands-on treatment as needed.