Abdominal muscle separation


Women’s Health Physio for your Diastasis Rectus Abdominus muscle (DRAM)
By Jen Vardy

Much has been written about abdominal muscle separation or diastasis recti abdominus, DRA, DRAM, RAD as it’s commonly known. Unfortunately there is a lot of fear associated with DRAM and a lot of misguided information on what it is and how to best manage it.

The latest evidence suggests that by the end of the third trimester 100% of pregnant women will have some degree of separation of their rectus abdominus or six-pack muscles. The accompanying thinning and widening of the connective tissue or linea alba in between the six-pack is completely NORMAL in pregnancy. This allows your uterus to expand and your baby to grow. Some women however have more stretch than others which may relate to your maternal age, parity, baby’s birth weight, length of the second or pushing stage of labour, type of connective tissue or hypermobility, but often we don’t have all the answers. Sometime’s women just carry differently and there’s more load on the anterior abdominal wall. Another theory is that if the abdominal wall gives a little then there is less load on the pelvic floor. A DRAM could actually be protective and reduce the risk of pelvic organ prolapse which is pretty cool!

When assessing DRAM we must focus on more than the interrecti distance. The IRD is the distance between the two inside edges of the six-pack muscle but the ‘gap’ does not tell us about your function or how your tissues perform or deform under load. We need to assess the amount of give or stretch of the linea alba and whether you can generate tension in the gap. It is the inability to transfer tension or load that will leave you feeling weak, unable to get out of bed with your baby or result in either tummy invagination (hollowing) or protruding and doming. 

Postnatal recovery is best guided by a Women’s Health Physio who can assess your DRAM and help you to learn how to develop tension in the linea alba and create the right ‘tension to task’. Your WH Physio will assess your deeper abdominal muscles – transversus abdominus and the pelvic floor as engaging this deeper ‘core’ can help you to improve tension in the linea alba, manage pressure better and tolerate increasing load. Your WH Physio will teach you how to load your rectus abdominus in a progressive way to prevent doming but we also see a lot of women who are not loading enough and still have fear of movement, weakness and dysfunction many months postpartum. WH Physio’s are ideally placed to assess, reassure and prescribe an individualised program for you to help you get back to sit ups, pilates or crossfit and feel strong again. 

Finally, we must remember that each postpartum journey is individual and while some women are satisfied with getting strong and active others may struggle to accept the changes in their postpartum body. We can help with your goals to improve strength and function but down the track can also support your choice to explore abdominoplasty and repair for improving aesthetics and self-esteem and help to keep you strong while doing so.