Diastasis recti

Diastasis recti abdominis (DRA) is a visible separation of the abdominal muscles that some women develop during pregnancy, measured as the interrectus distance.^{1Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 412.} It can affect how the abdominal wall works, particularly rectus abdominis function and rotational torque.^{2Goom, Donnelly and Brockwell, Returning to Running Postnatal, p. 19.} Its link to pelvic floor dysfunction is still debated, though a systematic review found a weak correlation with pelvic organ prolapse.^{2Goom, Donnelly and Brockwell, Returning to Running Postnatal, p. 19.}

Screening and management belong with a suitably qualified professional, such as a pelvic health or musculoskeletal physiotherapist with experience in DRA.^{2Goom, Donnelly and Brockwell, Returning to Running Postnatal, p. 19.} ACSM asks exercise professionals to work with a physical therapist to manage each client’s case.^{1Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 412.}

In practice

• A separated or pendular abdomen and reduced abdominal strength are signs of abdominal wall dysfunction after birth, alongside pelvic floor symptoms.^{3Goom, Donnelly and Brockwell, Returning to Running Postnatal, p. 10.} They’re a reason to suggest a pelvic health assessment.^{3Goom, Donnelly and Brockwell, Returning to Running Postnatal, p. 10.}
• In pregnant women with DRA, head lifts, curl-ups and diagonal curl-ups narrowed the gap, while pelvic floor and drawing-in exercises widened it.^{1Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 412.} ACSM advises these clients to seek physical therapy advice and stick to curl-up and head-lift abdominal work.^{1Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 412.}
• A client can return to running with a diastasis if it’s functional, meaning they can control intra-abdominal pressure and transfer load across the abdominal wall.^{2Goom, Donnelly and Brockwell, Returning to Running Postnatal, p. 19.}
• Doming or sinking at the midline, a lateral shift of the trunk or significant rib flare during load tests, such as an active straight leg raise, suggests load transfer is failing.^{2Goom, Donnelly and Brockwell, Returning to Running Postnatal, p. 19.}