Postpartum Recovery- Rectus Abdominis Diastasis (RAD)

Postpartum Recovery- Rectus Abdominis Diastasis (RAD)

What is RAD?

Rectus Abdominis Diastasis (RAD) is the separation of abdominal muscles that is commonly seen during pregnancy.

RAD is normal during the late stages of pregnancy as the body must accommodate for a growing baby. However, we don’t want this condition to persist as it may lead to symptoms such as abdominal, pelvic, or lumbar discomfort (1) and reduced abdominal function.

How long does recovery take?

You will initially notice rapid changes that then slow with time.

In the initial 8 weeks following childbirth, significant healing and recovery occur in the abdominal tissues, including the muscles and fascia. Initiating rehabilitation during this period is important to promote recovery and facilitate healing (2).

Research indicates that the recovery process can extend up to six months postpartum for certain women. A long-term strengthening regimen is recommended to maximize rehabilitation outcomes (3).

What is recommended for RAD management?

Physiotherapy is the first suggested treatment for Rectus Abdominis Diastasis (RAD). The physiotherapy treatment is focussed on abdominal strengthening and core stabilisation through exercise-based rehabilitation. With this approach physiotherapy has shown to enhance functionality and alleviate symptoms in individuals with RAD (4).

An example training progression for RAD:

1. Gentle core activation- this can be commenced soon after birth and involves deep core breathing techniques and activation exercises.
2. Core muscle strengthening- abdominal strength exercises are started and gradually progressed, while avoiding any excessive strain/ bracing.
3. Return to function- more dynamic and challenging exercises are added to the program whilst maintaining optimal technique at the core/ pelvis. This stage is guided by the persons individual goals.

The road to recovery will vary for each individual and is influenced by factors such as the method of delivery, lifestyle considerations, and previous level of function.

When should you start rehab?

Physiotherapy to assist with abdominal recovery should commence around 4-6 weeks postpartum.

First, an initial assessment will be conducted to better understand your individual symptoms, preferences, and goals. Your program will then be progressed gradually at follow up appointments, and your RAD and goals reviewed along the way.

For any inquiries regarding the management of RAD before or after childbirth, you can reach out to Continence and Pelvic Health Physiotherapist Emma via email at emma@aspirephysiobunbury.com.au

Emma can assist you with a wide range of pelvic health related issues, for further information see the Pelvic Health section on our website.

References

1. Jessen, M. L., Öberg, S., & Rosenberg, J. (2019). Treatment Options for Abdominal Rectus Diastasis. Frontiers in surgery, 6, 65.

https://doi.org/10.3389/fsurg.2019.00065

 

2. Mota, P. G. F. d., Pascoal, A. G. B. A., Carita, A. I. A. D., & Bø, K. (2015). Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual Therapy, 20(1), 200-205. https://doi.org/https://doi.org/10.1016/j.math.2014.09.002

 

3. Carlstedt, A., Bringman, S., Egberth, M., Emanuelsson, P., Olsson, A., Petersson, U., Pålstedt, J., Sandblom, G., Sjödahl, R., Stark, B., Strigård, K., Tall, J., & Theodorsson, E. (2021). Management of diastasis of the rectus abdominis muscles: recommendations for swedish national guidelines. Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 110(3), 452–459. https://doi.org/10.1177/1457496920961000

 

4. Skoura, A., Billis, E., Papanikolaou, D.T. et al.Diastasis Recti Abdominis Rehabilitation in the Postpartum Period: A Scoping Review of Current Clinical Practice. Int Urogynecol J 35, 491–520 (2024). https://doi.org/10.1007/s00192-024-05727-1