There are many common misconceptions about how to exercise with a DRAM and quite often you are told a long list of exercises to avoid. What no one tells you about a DRAM, is that to heal it successfully, you have to learn to recruit the many other surrounding muscles correctly. Good posture, breathing techniques, pelvic floor and gluteal muscle activation will all affect how well your DRAM can heal.
So what exactly is a DRAM?
DRAM (Diastasis Recti Abdominal Muscle Separation) is where the connective tissue in the centre of the abdominal muscles, called the linea alba, weakens and thins. This commonly occurs during pregnancy and results in a shift of the abdominal muscles out to the sides. This then leaves an area of weakness at the centre of the stomach often causing abdominal bulging or doming with any movement that increases the intra-abdominal pressure.
Will a DRAM heal?
Often the hormones after pregnancy decrease quickly after your baby’s birth, however the effect on your abdomen takes time to reverse. Diastasis Recti is not painful, however you may feel pain associated with some of the side effects, such as lower back pain from poor posture or lifting something incorrectly. Diastasis Recti will reduce in most women by around 8 – 12 weeks after birth. It is important to have a postnatal assessment with a Women’s Health Physiotherapist to assess for any diastasis and measure the size and depth at different locations along the linea alba. It is important to know the size, however even more important to know how everything else is moving around it!
How to heal your DRAM
During your post-natal physiotherapy assessment, your physiotherapist will often use a Real-Time Ultrasound to check correct Transverse Abdominis (core) muscle activation, pelvic floor muscle activation and correct breathing techniques with certain movements to see the effect the movement has on the DRAM. In some instances having correct Transverse Abdominis muscle activation can improve the diastasis when doing a sit up for example. However, when there is an underlying laxity of the linea alba, doming of the midline and the rectus abdominis muscles bulging out, the deep core muscles are not managing the load of the movement well.
Understanding this concept in YOUR own body is essential and by using this feedback you can successfully guide your exercise and movement choices to improve and heal your diastasis.
What to do if you find you are doming during a movement?
First of all try and slow down the movement so you are able to focus on correct deep abdominal muscle activation with no midline doming. Try using your exhale breath to engage your pelvic floor muscles and gently draw in your deep Transverse Abdominis muscles. If you are able to hold this core position comfortably with no doming throughout the movement then go for it!
If you cannot hold the tension of the deep Transverse Abdominis muscles and you see or feel the midline doming, you can modify your movement by reducing the intra-abdominal pressure that is being placed on your abdominals. For example, switching to single leg instead of double legs in tabletop, reducing the range of motion, bending your knee instead of using a straight leg or even reducing the number of repetitions and focusing on high quality movements instead.
I hope this information has been helpful in clearing up the common misconceptions placed around having a diastasis recti. Defining certain exercises as “diastasis safe” is not always helpful and is very different for every individual. It doesn’t necessarily mean you have to cross sit ups, twists and bicycle crunches off your exercise list! It is never too late to repair your diastasis recti. With correct education and awareness around how well you recruit your Transverse Abdominis, diaphragm, pelvic floor and gluteal muscles to support your linea alba, a diastasis recti is able to be healed, even if it is years after you have delivered your last baby!
The key to improving your DRAM is to start your postnatal rehabilitation slowly, focusing on good quality breathing techniques with a solid connection to your core muscles. DRAM often comes down to how well you control your intra-abdominal pressure with any movement, so once you have the awareness of correct deep core activation, your exercise selection can advance and enable you to achieve your postnatal goals.
Pelvic Fit Physiotherapy
Suite 5, The Bays Hospital Consulting Suites,
262 Main Street,
MORNINGTON, 3931
www.pelvicfitphysio.com.au