Diastasis Recti (DRAM)
by Michelle Wright – post natal exercise specialist
Simply put, this means the splitting of the abdominal muscles, which happens to around 60% of pregnant women.
The fascia that joins the two large abdominal muscle bands running downwards is called the linea alba (see diagram).
In the late stages of pregnancy, the fascia can split to allow more room for the growing baby. There is very little you can do about this, but it is important to diagnose and aid recovery postnatally. Having the rectus abdominus muscles split can compromise the integrity of the core structure and the main impact will be pain around the lower back and pelvic region.
How to diagnose Diastasis Recti (DRAM):
Lie down on your back and bend your knees and keep you feet on the floor. Pressing your fingers firmly into the flesh above the belly button, lift your head and shoulders off the floor. If the Linea Alba has split, it will be easy for your fingers to push through the thick bands of rectus abdominal muscle. Repeat the same procedure below the belly button. If you feel a deeper muscle come up and seal the gap under your fingers, this will be your Transversus Abdominal – one of your true “core” muscles. To measure how far apart the muscles have split place your fingers facing down to your toes and measure how many fingers (representing 1 cm each) fit through the gap.
How to repair Diastasis Recti (DRAM):
To encourage the muscles to knit back together post birth, it is essential that you avoid any crunches, sit-ups or any other exercise that forces your inside through the gap of your abdominal muscles. You can monitor what exercises are compromising your repair by performing the exercise with one hand on the gap and noticing if your insides are being forced through to the outside. These exercises may not be appropriate for you at this stage of your recovery.
Also notice how you get out of bed. Do you force yourself up in a quick sit up movement? If so – you may be further delaying your repair. Learn to roll to your side and push yourself up using your arm strength.
Avoid the over use of obliques as you would see in a strong core twisting exercise. These may also be pulling the muscles apart instead of encouraging them to knit together.
Do focus on activating your transversus abdominal muscle. To activate this muscle requires concentration and often the movements are subtle and you may feel disappointed that you are not working hard enough. Stay with it, you will be rewarded.
The transversus abdominal muscle is always activated when performing correctly a pelvic floor exercise – so another reason to include these exercises post birth!
What to wear:
Sometimes, when diastasis is considerable, your tummy (even if there is very little belly fat) you may remain looking slightly, or even very pregnant. This can be very upsetting to be mistaken as being pregnant, when your baby is in your arms
Splinting the muscles together soon after birth is a great way to not only encourage repair, but help give added support to lower back and lower abdominal muscles. I recommend compression wear as they activate the muscles – due the tension of the fabric on the skin and feel very comfortable.
If you are not sure if you are contracting your pelvic floor or transverses abdominal muscle, or you are unsure of diagnosing you’re your diastasis – usually just one session with a pelvic floor specialist or Women’s Health Physiotherapist will help.
When you return to exercise, ensure you use a fitness professional who understands how to check for diastasis and is able to work with you to repair it, rather than make it worse.