3 Diastasis Recti Abdominis Exercises To Strengthen Your Abdomen & Prevent DRA

Let’s talk about Diastasis Recti Abdominis also known as DRA and the different Diastasis Recti Abdominis exercises you can do to strengthen your abdominal muscles. Whether you just had a baby and you’re settling into a new normal or you had a baby ten years ago, you may have been diagnosed with DRA at some point or another.  Maybe you got treatment for it and it never got better or maybe you have no idea what it all even means for you currently and for your future self. I am here to help you understand a little bit more about DRA and why you may want to seek treatment with a Women’s Health Physical Therapist or a Sports Medicine Practice in NYC.

DRA occurs when the abdominal muscles are separated vertically due to increased pressure on the abdominal muscles such as from a growing fetus. There are other ways that this type of pressure can happen, so it’s not only associated with pregnancy. DRA can also occur in men. It has been related to aging, weight fluctuations, weight lifting and anything that can result in high pressure within the abdominal wall. DRA affects millions of people every year and some studies show that between 50% – 90% of all women who give birth end up with some form of DRA. Typically, you are diagnosed with DRA if you have more than 2 cm of separation between your abdominal muscles while doing a crunch. 

So, why should you seek treatment? You are generating tension in your abdomen all day long — carrying your baby, exercising, going to the bathroom, coughing, sneezing, running and the list goes on and on. While generating this tension throughout the day, you may be predisposing yourself to future issues such as hernias, low back pain, pelvic pain, pelvic organ prolapse, faecal incontinence and urinary incontinence — none of which are fun and or easy to treat. Conservative treatment through physical therapy can help you understand how to generate tension in your trunk and abdominal wall without exacerbating DRA. 

Retraining the abdominal wall can take many forms from fairly simple to complex — the most important thing to keep in mind is that we need synergistic and symmetrical firing of the diaphragm (the muscles that help you breathe), the transverse abdominis (deep abdominal muscle), and the pelvic floor muscles all together to form proper tension in the trunk.

Here are some simple Diastasis Recti Abdominis exercises you can begin at home to work on the firing of these muscles groups — once these are fairly easy to perform individually and synergistically, seek out further guidance through a women’s health physical therapist.  

1. Diaphragmatic Breathing — “Belly Breathing”

You’re breathing as you read this blog post, why do you need an exercise to learn how to breathe better? Because the diaphragm is the most efficient breathing muscle and proper use of the diaphragm helps the pelvic floor muscles to relax and lengthen which is great for the voiding functions of our pelvic floor muscles. Here’s a way to practice “Belly Breathing” Do this for ten breaths. 

1. Lie on your back with your knees slightly bent and head supported. Place one hand on your chest and one hand on your abdomen. This will help you know if you are performing the breath correctly.
2. Breathe slowly through your nose and allow the air to flow into your belly. The hand on your chest should remain as still as possible, while the hand on your abdomen should rise as your belly fills with air. It’s important to note that you are not using your abdominal muscles to push out your stomach, but rather, allowing the air to fill the abdomen.
3. Exhale slowly through your mouth and allow the abdomen to recoil back down to its resting position. The hand on your chest should continue to remain as still as possible.

2. The Kegel 

A Kegel is a pelvic floor contraction and release. It is meant to improve the strength and endurance of your pelvic floor muscles. Finding the right muscles to squeeze can be tricky and using imagery can be helpful. You should feel a pull inwards and upwards towards the crown of your head when you squeeze these muscles properly. Many times, women will do a paradoxical contraction where they are pressing outwards (like you are trying to have a bowel movement) during the kegel and that is not what we are looking for here. You can do this exercise anywhere and everywhere but if you are having a hard time I would recommend starting lying on your back with your knees bent over a few pillows. During the kegel exercise, you don’t want assistance from other muscles in the area like your leg or butt muscles. Hold the contractions for a count of 3-10 secs and relax for at least 3-10 secs between each repetition. Repeat 10x and perform at least 2-5 sets throughout the day. 

3. Transverse Abdominis Isometric Contraction

The transverse abdominis also known as TrA is one of several abdominal muscles and it is the deepest one closest to your spine. Contraction of this muscle produces a corset-like effect on the torso and it functions to stabilize the lumbar spine and pelvis before you attempt to move your limbs. Because it is a fairly small muscle as opposed to the other abdominal muscles like the rectus abdomnis (the 6 pack muscle), it’s often hard to isolate. Interestingly, research shows it may be ineffective to completely isolate this muscle because it generally works in tandem with several other postural muscles. So, why am I encouraging you to learn to how ‘use’ this muscle? Because, you should! Because why not! Knowing how to access this muscle and properly use this muscle in tandem with the rest of your abdominal muscles along with your breath and pelvic floor muscles will decrease the likelihood of your abdominal and maybe an organ or two from protruding through the DrA. Avoiding that protrusion is our main goal! 

So, let’s learn how to connect to the TrA. Of note, there are upper and lower fibers to this muscle and imagery is helpful when connecting to this muscle. For the upper fibers, you want to imagine a line that connects your lower rib cage together. For the lower fibers, you want to imagine connecting a line between your two pelvic bones in the front of your hips. You want to be able to contract the lower and upper fibers together and feel that your belly button either stays in place or falls slightly towards your spine. The spine should be in a neutral position to start and it should remain there — no movement should be happening at the spine whatsoever. You want to hold the contraction for 3-5 secs and release to repeat 10x. If you feel comfortable you can begin to use the breath here. Inhale to release the contraction, exhale to perform and hold the contraction. 

Alright, so you got all 3 Diastasis Recti Abdominis exercises down and now it’s time to put them all together. Connecting the breath, to the abdomen and pelvic floor. Inhale, relax the belly, relax the pelvic floor. Exhale, contract the pelvic floor and gently allow the TrA muscle to engage slowly and progressively until the TrA and pelvic floor muscles reach maximum contraction at the end of your exhalation. Remember to pull up towards your cranium. Hold this for a second and then release to repeat. 

After you’re able to coordinate these muscles properly, it may be time to visit a Women’s Health Physical Therapist to discuss ways you can progress these exercises and return to doing all the things you love. 

References: 

• Kn SS. An Overview of the Studies on Diastasis Recti Abdominis in Postpartum Women. Journal of Gynecology and Womens Health. 2019;14(5). doi:10.19080/jgwh.2019.14.555900.
• Spitznagle TM, Leong FC, Dillen LRV. Prevalence of diastasis recti abdominis in a urogynecological patient population. International Urogynecology Journal. 2006;18(3):321-328. doi:10.1007/s00192-006-0143-5.
• Benjamin D, Water AVD, Peiris C. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014;100(1):1-8. doi:10.1016/j.physio.2013.08.005.