Diastasis of the rectus abdominis muscles (DRA), or separation of the abdominal wall, is different from abdominal or umbilical hernia. The linea alba, or the connective tissue that connects the rectus abdominis (8 packs), thins which leads to laxity of the abdominal muscles.
It is seen in men and women and despite the lack of supportive evidence, it is considered to be a significant contributor to chronic back pain . In the study by Doubkova et al.(2018), 77% men and 45% of women with DRA had experienced low back pain.
Also, pelvic related issues, such as incontinence, pain and organ prolapse, have also been shown to be related to poor abdominal support. In this article more than 66% of women (average age of 52) who presented with DRA also had support related pelvic floor dysfunction.
When the abdominal muscles function optimally, they support the abdominal organs, maintain proper posture and create stability for the pelvis and spine. This perfect design achieves the proper abdominal pressure that is needed to maintain bowel/bladder function and preserve continence with higher impact tasks such as lifting, jogging, coughing, sneezing and laughing. While there is conflicting reports and minimal scientific support of the direct connection between DRA and low back pain and pelvic issues, clinically and functionally speaking, these symptoms are often seen along with the presence of DRA.
DRA is most commonly associated with pregnancy and some believe that up to 100% of pregnant women experience some degree of abdominal separation during pregnancy. Even though most women show improvement in their pelvic related issues in the early postpartum phase, one third of women who experienced urinary incontinence immediately postpartum and improved, experience urinary incontinence 5-7 years later. This was explained to be related to poor movement strategies that they adapt to due to poor abdominal support. Read more here.
In recent years, there has been a flood of information (not all correct) on what to do about the abdominal bulging that many men and women experience with movement and/or activities that increases the abdominal pressure. There have been many exercise regiments that mainly focus on closure or approximation of the DRA.
In this study available treatment methods were analyzed and it was concluded that there is not one method that showed significant change in the signs and symptoms of DRA. Tension of the linea alba is needed to transfer force across the abdominal muscles in presence of tasks that increased intra-abdominal pressure (i.e. jogging, lifting, coughing, or sneezing). Ultrasound imaging has shown that when the deepest layer of abdominal muscles activate before a task is done, the proper tension is created and therefore less stress is transferred to low back and pelvic organs. This translates to improvement in symptoms of low back pain, pelvic pain, incontinence and pelvic organ prolapse.
Many experienced pelvic floor physical therapists utilize their musculoskeletal expertise along with state of the art technology (real time ultrasound) to train men and women who suffer from pelvic related issues or those who may not have responded to traditional low back rehab protocols.