Through increased awareness and education, Diastasis Rectus Abdominis, or DRA, is becoming a more widely recognized and treated condition. DRA is a condition in which the linea alba thins and there appears to be a gap between the left and right sides of the rectus abdominis muscles (Read more here). Pilates teachers are perfectly poised to identify this condition and design appropriate workouts for clients who have DRA that at best, will not worsen the diastasis, and at best, will improve it.
But what does improvement mean? Do we hope to close the gap, or do we hope for some other measure of improvement?
While there is no consensus on how to conservatively treat DRA among physicians and women’s health physiotherapists, there is growing consensus and research pointing us to the idea that closing the gap is not a concern as much as improving function, or being able to generate tension along the linea alba. Not all people with DRA’s need to be “treated” any differently than those without, after a careful assessment and some basic instruction about coordinating breathing, TvA, and pelvic floor activation.
Recently, a client who was referred by her massage therapist came to me with great concern because her well-intentioned midwife had told her that she had DRA. She was four months postpartum and was afraid to begin exercising again because of her fear of making the condition worse.
While I was thrilled that her midwife had checked her for DRA, I wish that she had also told her where to go for help (ideally, a women’s health physiotherapist, or a fitness professional with experience in working with DRA) and what she should do. She had given her a list of don’ts: no crunches, no sitting up from lying down without rolling onto her side first, no planks, and no heavy abdominal work.
When I checked my new client’s DRA, I found what I would call a “functional” diastasis. Yes, she had a palpable split between her rectus muscles when she did the basic head-lift task. However, she was able to generate tension along her linea alba with breathing a deep core cues. This is what I define as a “functional diastasis.” When this is the case, we move forward with education about posture, rib cage to pelvic alignment, breathing, and deep core function. You can read more about my approach here.
As we progress in Pilates work, I continually check to make sure that as we increase load, the client is still sufficiently generating tension along the linea alba. Then we can determine which exercises are appropriate, need to be modified, or left for a future date. My goal is to have the client leave that first session feeling confident that she can manage and improve her condition by giving her guidance in choosing appropriate exercises in and out of my studio, and in her activities of daily living.
Empowering our clients with knowledge, and staying up to date on current trends, research, and methods in the fitness and rehab fields, is the providing the utmost service. As awareness and recognition of DRA increases, we as Pilates teachers can help our clients when they come to us for help.