DRAM or abdominal separation in the post natal period

Diastasis Rectus Abdominus or DRAM is often related to pregnancy or the post natal period. It essentially refers to the space that’s formed between the rectus abdominus (6 pack muscle group) due to the growing abdomen with pregnancy.

Let’s talk anatomy first:

The rectus abdominus muscle runs vertically through our abdomen and is split in the middle by a sheath of tissue known as the linea alba. It is the linea alba during pregnancy that thins and stretches slightly to accommodate the growing fetus. After birth, this tissue remains in a slightly stretched state, meaning the support around the abdomen may be compromised.

What do we look for?

Now most women will have an increased intra-rectus distance (space between the rectus muscle) after pregnancy. We look and feel the tension of the linea alba particularly with increases in intra abdominal pressure to determine how good the body is at managing pressures. Sometimes when pressure’s aren’t maintained well, we can end up with the force pushing out through the linea alba often referred to as coning or doming.

This coning or doming means that we aren’t managing pressure’s well in the abdomen. Our abdominal muscles and pelvic floor all connect to create our core, and when one is still healing, it can create increased pressures onto the pelvic organs or pelvic floor muscles. The aim of pressure management is to minimise the chance of prolapse (you can read more here), support bladder and bowel function, and allow for safe return to exercise.

How do we stop the doming?

We’ve got a surprising amount of abdominal muscles, not just the rectus abdominus, but also internal and external obliques and the transverse abdominus. When we can have a good contraction of all these muscles, then increases in intra abdominal pressure (like during a sit up), will often have less doming. Everyone will find activating these abdominal muscles a little different, which is why having a trained professional assess your abdomen after birth is greatly important.

This video shows a great example of doming occurring without any deep abdominal activation, and how it changes once correct activation occurs prior.

Exercises to get our abdominal muscles working like they should:

Contrary to popular belief crunches can often be a good place to start. Like we discussed earlier, if we can get a good contraction of all our other abdominal muscles, and have minimal doming, it can load the linea alba. By loading the linea alba over time, it can help to strengthen and minimise the chance of doming. In some people this can result in the rectus abdominus muscle group coming closer.

Some other great exercises which you may be prescribed  are light pilates exercises focusing on breathing and the deep abdominal muscles. These are prescribed depending on your current level of function and activation.

If you’re wanting to return to exercise, no matter how long ago you had your baby, you can book in to see Rani here.