Diastasis Rectus Abdominis (a.k.a. Diastasis Recti, DRAM, Divarcation Recti, mummy tummy, tummy gap) is a separation of the 2 bellies of the rectus abdominis (6 pack muscles) at the Linea Alba (a band of abdominal connective tissue), with widening and fibrous division of the line alba.
During pregnancy, everything in the abdominal wall was stretched to accommodate our growing baby inside! It has been noted that 100% of pregnancy women had a DRAM at gestational week 35, with 35-39% of women remaining with a DRAM at 6 weeks postnatal. So whilst it is worth noting that while separation of the stomach muscles is completely normal, it should also resolve postnatally.
But what if it doesn’t? What impact will that have? Why is it important?
The first indication to patients that they may have of a DRAM is usually to do with aesthetics. Patient’s may feel they have a ‘mummy tummy’, or that they look bloated or even still pregnant, when they’re 4+ months postnatally. All too often DRAM can be dismissed as purely cosmetic, which is frustrating in itself as this can have huge implications on body image, self – confidence and altogether mental health.
However, the presence of a DRAM is hugely important in the ability to transfer load across the abdominal wall. If the Linea Alba isn’t doing its job, then day to day tasks such as picking your baby up off the floor or putting the car seat into the car, can feel effortful, even painful. This may put you at risk for low back pain, pelvic pain, hip pain, urinary incontinence and pelvic floor dysfunction and these problems may even arise several years following delivery.
So what can we do about it?
When people have diastasis their body learns to continue doing the activities and functions required of the abdominal wall by adapting and using compensatory strategies. These can include over activity and bracing in the oblique muscles, over recruitment of the muscles in the neck, clamping down with the jaw, and over bracing with the hip and lower limb muscles to name a few. While the additional recruitment of muscle groups can facilitate to get the task at hand done, they are not ideal!
First thing is to put our focus on what we have control over. We have control over muscles and we can strengthen them! A Physiotherapy assessment can help to guide you as where to start with this, as rehabilitation for diastasis needs to be individualised, informed and active. An assessment involves a whole body approach, including looking at your posture, breathing, pelvic floor function, pain, discomfort, functional ability, and core recruitment strategies. When assessing the actual diastasis we want to understand the width, depth and length of the diastasis as well as the ability to generate tension and transfer load across the linea alba. We want to individually assess what happens when clients attempt different exercises/movements/activities/functional tasks.
What we need to remember is that the size of the gap doesn’t tell us:
- How strong you are
- How long it will take you to reach your goals
- What you need to spend your time on
With an individualised assessment, we can work with you to establish a rehabilitation programme that progressively strengthens your core. By strengthening the abdominal muscles, this targets the abdominal connective tissue, including the Linea Alba, helping to improve the ability to transfer and manage tension and load. Altogether leaving you feeling stronger and more confident, with better function and ability, and reduced risk of problems long term.
If you’d like to know whether Physiotherapy can help you, why not get in touch with us.
