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Diastasis Recti Abdominis-Diagnosis, Risk Factors, Effect on Musculoskeletal Function, Framework for Treatment and Implications for the Pelvic Floor

Author(s):

Laura Anne Werner* and Marcy Dayan   Pages 1 - 16 ( 16 )

Abstract:


Background: Diastasis Recti Abdominis (DRA) can occur during pregnancy and postpartum [1-7]. It is defined as an increase of the inter-recti distance (IRD) beyond normal values [8]. The diagnosis of DRA is inconsistent within the literature and varies depending on measurement instrument [9] and activity during measurement (rest versus active curl-up). DRA is characterized by the stretching of linea alba (LA) and contributes to a protrusion of the anterior abdominal wall due to increased laxity in the myofascial system that supports abdominal viscera [10]. DRA has been postulated to affect lumbopelvic support and function due to laxity of the LA and altered angle of muscle insertion [6, 11-13], but recent studies have not confirmed this [5, 7, 14]. Risk factors for the development of DRA have been investigated in pregnancy to 12-months postpartum [4, 5, 7, 15-20]. Objective: Rehabilitation for DRA has been traditionally focused on reducing the IRD, but recent research has proposed that a sole focus on closing the DRA is suboptimal [11]. Results: It is important alongside the rehabilitation of the abdominal wall that there is the consideration of the pelvic floor (PF). In healthy individuals, with the activation of the transversus abdominis, there is a sub-maximal co-contraction of the PF muscles [21-23]. This co-contraction can be lost or altered in women with urinary incontinence [24]. An increase in intra-abdominal pressure without simultaneous co-contraction of the PF may cause caudal displacement of the PF [25]. Conclusion: The aim of this review is to bring the reader up to date on the evidence on DRA and to propose a rehabilitation framework for the whole abdominal wall in DRA with consideration of the impact on the PF.

Keywords:

Physiotherapy, inter-recti distance, diastasis recti abdominis, rehabilitation, abdominal exercise, pelvic floor exercise, pregnancy, postpartum

Affiliation:

Associate at Shelbourne Physiotherapy 100B-3200 Shelbourne V8P 5G8 Victoria, BC, Dayan Physiotherapy and Pelvic Floor Clinic 909-750 W Broadway V5Z 1H8 Vancouver, BC



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