We talk a TON about connective tissue when it comes to a Diastasis Rectus Abdominis (DRA) and the rehabilitation of a DRA. We’ve learnt that the size of the “gap” in a DRA is not as important as how responsive the connective tissue is to exercise and progressive loading.
In DRA rehab we look for ways to “wake up” the connective tissue. As I’m sure you can imagine, when someone is pregnant and their belly has expanded to accommodate a growing human, both their muscles and connective tissue become stretched. When a tissue is greatly stretched and held in an elongated position for a lengthy period of time the tissue itself becomes less responsive to stimuli. Postpartum connective tissue can become lengthened, thinner, less stiff, more compliant and less responsive to exercise and progressive loading.
We have a TON of connective tissue in our abdomens for very good reasons. Connective tissue is the tough stuff of our core cannister, tougher and more rigid than muscle tissue. Our spine is the only bone that connects our thorax to our pelvis. Along with intra-abdominal pressure, we need abdominal connective tissue to provide strength and rigidity in lieu of skeletal architecture in order to withstand tensile forces.
Connective tissue is a force transmitter: when a load is placed on the abdomen, rather than one area trying to handle the load, the load is spread out through the connective tissue of the abdomen. This prevents mechanical failure of the tissues. We want this connective tissue to be good and stiff as the load will be transferred through the stiffest route. The hardier the connective tissue, the more successful the transfer, decreasing injury to the surrounding tissues.
Massage Therapy can work as a first step in the rehabilitation of a DRA. Did you know that connective tissue is a sensory organ. The mechanoreceptors in your connective tissue respond to certain stimuli. The connective tissue in your abdomen responds very well to slow sustained contact and pressure. This type of hands-on application helps to wake up your connective tissue. What is Massage Therapy but the focus on down-regulating the nervous system through mechanical techniques focusing on a slow application of sustained contact and pressure?
It is not only the slow sustained contact that can help rehab a DRA, but it is also the Massage Therapist’s ability to:
Decrease connective tissue adhesions
Identify and treat trigger points in muscle tissue
Help re-align the postpartum body and deep core cannister
Identify and treat restrictions in primary and secondary muscles of respiration.
All of these treatment goals allow the muscles to fire better, promote a more responsive connective tissue matrix and through alignment and optimal respiration, facilitates the deep core cannister to operate in a healthy synergistic pattern.
Applied correctly, Massage Therapy can therefore be used as a successful foundational treatment modality to rehabilitate a Diastasis Rectus Abdominis. This will allow for greater success in the exercise portion of the rehabilitation potentially creating a postpartum DRA which is functional in nature.
References: Munira Hudani PT: Diastasis Rectus Abdominis Online Course and Programs
Stephanie Maxwell is a Registered Massage Therapist, a Pre and Postnatal Fitness Expert and a Certified Yoga Teacher. She is located in Winnipeg, Manitoba and treats her Massage Therapy clients at Wolseley Wellness Centre in the heart of the Wolseley neighborhood.