Diastasis of the Rectus Abdominus Muscles (DRAM) - What is it?
Diastasis of Rectus Abdominus (DRAM) is a separation of the connective tissue joining the two strips of muscles down the middle of the abdomen. This is also known as abdominal muscle separation. As the foetus grows, the abdominal wall muscles and their connective tissue attachments stretch to accommodate the growing foetus. Diastasis of Rectus Abdominus (DRAM) occurs when the linea alba, the connective tissue joining the two rectus muscles, widens and splits. This separation can affect the stability of the trunk and may contribute to pelvic floor dysfunction, back and pelvic pain during pregnancy post-natally.
The abdominal wall has 3 layers of muscle. The most superficial muscle layer is the external oblique, the middle layer is the internal oblique and the deepest layer is the transverses abdominis muscle. Diastasis of the Rectus Abdominus (DRAM) can affect the function of all of these muscles of the abdominal wall as their connective tissue contribute to the linea alba. Stable tendinous attachments are required for the abdominal muscles to transmit forces in the desired direction. The disruption of these attachments of the abdominal musculature reduces this ability of the abdominal muscles to stabilise the spine.
DRAM can have a number of implications for the post natal woman. Alterations of a muscle’s angle of insertion will change the muscles function. Changes in rectus abdominis length, width and angle of insertion seen after delivery, which are associated with a reduction in the ability to stabilise the lumbopelvic area (Gilleard & Brown, 1996). A separation persisting after 4 weeks post-natally is likely to disrupt the function of the abdominal musculature. This may be a factor in persistent post natal lumbar, pubic symphysis and sacroiliac pain and even incontinence due to the interaction of the pelvic floor and abdominal musculature as a stabilising unit.
Management of Diastasis of the Rectus Abdominus (DRAM)
Two out of three women experience a separation of the rectus abdominis muscle, the long muscle located in the middle of the abdomen, during their pregnancy. The combination of abdominal weakness, hormonal changes, weight gain, and abdominal wall stretch exerted by your growing baby, can cause muscle separation along the centre-line of the abdomen. This separation predisposes to back-ache, injury, pelvic girdle pain, pelvic floor dysfunction and hernias.
Many traditional exercises such as curl-ups and sit ups increase the stress on both the abdominal and pelvic floor muscles. These are best to be avoided. The focus during the pre and postnatal period should be on the deep abdominal muscles which act as a corset to support the spine. By training these muscles correctly you will improve this support and help regain your figure.
For management of DRAM it is best to seek a thorough assessment by your local women’s health physio along with a specific tailored exercise program. Real-time ultrasound is often used to give you instant feedback on the quality of your deep abdominal and pelvic floor activation. Exercises focus on improving core stability, strengthening pelvic floor muscles and improving abdominal muscle tone.Exercising too strongly or in an incorrect way can further increase muscle separation.
In addition to a specific exercise program abdominal muscle support (compression garments such as SRC) is essential for the management of DRAM. It is the combination of compression and a tailored program which achieves optimal results.
A garment that is tight and restrictive should not be worn for recovery after delivery as it places too much compression on your muscles and does not allow them to work. This ultimately causes further muscle weakness.
Please see a summary of the SRC Recovery Shorts results from our pilot studies where patients were referred by Obstetricians and Physiotherapists.
Please see the Diastasis Rectus Abdominus recovery case study
Womens Health Physiotherapist (Be Active Physio)