What is it?

RAD is a gap between the rectus abdominis (six-pack) muscles. As the abdomen grows during pregnancy, it stretches the connective tissue and the rectus abdominal muscles. The muscles have not torn apart! The trunk and abdominal muscles have a role in posture, stability and movement and when they aren’t functioning properly, then this can lead to poor posture and even low back pain.

What causes it?

The connective tissue between the muscles are weakened and softened from pregnancy hormones and the physical stretching, when making room for baby. RAD can occur from 14 weeks gestation and increases until delivery. Risk factors for RAD include maternal age, babies with large birth weight, multiples or multiple pregnancies in a short period.

Prevention

Antenatal exercise and posture retraining is important during pregnancy can prevent the incidence of RAD. Walking, antenatal hydrotherapy and Pilates are safe exercise options during pregnancy, when carried our by a qualified instructor. Changes in weight distribution and carrying extra weight in pregnancy can alter your abdominal strength. Exercise helps maintain abdominal strength, tone and flexibility to prevent the risk of a large RAD.

Assessment

  • RAD’s can be measured by ‘fingers width’, which has proven to be reliable.
  • Real time ultrasound is also used by Physios in outpatient clinics.

Treatment

  • Active exercises can reduce the width of RAD after birth.
  • Postnatal assessment and education by a Women’s Health Physio can be commenced whilst you are still in hospital.
  • Lower abdominal (transverse abdominis) and pelvic floor muscle exercises are the most important exercises.
  • Passive support garments (Tubigrip and corsets) are advised for women with a RAD > 2 fingers width.
  • Natural resolution of the RAD occurs from day 1  to 8 weeks postnatal, thereafter recovery plateaus.

TIPS

  • Watch out for any ‘doming’ (bulging of the abdominal contents through the gap).This is a serious issue if not treated properly with conservative management. 
  • For the first 6 weeks after birth, you should roll onto your side when getting out of bed, to preserve the connective tissue and abdominals from stretching further.
  • Avoid the ‘sit up’ movement for a minimum of 6 weeks, particularly when getting out of bed.
  • If you are experiencing lower back pain after pregnancy, it may be due to RAD and lack of trunk support. Seek help from a Women’s Health Physio.

 

Book a ‘6 week post natal check’ with a Women’s Health Physiotherapist to have your RAD and pelvic floor muscles assessed with a real time ultrasound. 

Amber Whiteford,

Physiotherapist, APAM

Clinical Pilates Physiotherapist

Southcare Physiotherapy, Perth

(Open 7 days – 08 9332 2132)

www.southcarephysiotherapy.com.au

References

Benjamin D.R, van de Water A.T.M. [Effects of exercise on diastasis of the rectus abdominus muscle in the antenatal and postnatal periods: a systematic review.] Elsevier 2014. Physiotherapy 100 (2014) 1–8. http://dx.doi.org/10.1016/j.physio.2013.08.005

Mesquita L.A, Machado A.V, Andrade A.V. [Physiotherapy for reduction of diastasis of the recti abdominus muscles in the post partum period]. Rev Basil Ginecol Obstet 1999;21:267-72. (Portugese)

Hsia. M,Jones. S. [Natural resolution of the rectus abdominus diastasis. Two single case studies]. Aust J Physiotherapy 2000;46:301-7.

Chiarello C.M, Falzone L.A, McCaslin K.E, Patel M.N, Ulery K.R. [The effects of an exercise program on diastasis recti abdominis in pregnant women]. Journal Women’s Health Physical Therapy 2005; 29:11-6.

Zappile-Lucis M. [Quality of Life measurement and physical therapy management of a female diagnosed with diastasis recti abdominus]. Journal Women’s Health Physical Therapy 2009; 33:22.