Abdominal Separation - will my muscles ever come back together?
Abdominal separation, rectus abdominis diastasis (RAD), diastasis rectus abdominis muscle (DRAM) and diastasis rectus abdominis (DRA) are all different ways of saying exactly the same thing. You’ll see them used interchangeably in the literature.
What is it?
The rectus abdominis muscle is the most superficial layer of muscle on our abdomen.
It is our “6 pack”. There are 3 more layers underneath – the external oblique, internal oblique and tranversus abdominis muscles. Transversus abdominis is the deepest layer and, together with the diaphragm, multifidus and pelvic floor muscles, forms our deep core stability unit.
Each of these muscles has a right side and a left side that come together in the front midline. They are joined at this point by a central band of fascia (non-stretch connective tissue), the Linea Alba.
During pregnancy, hormonal changes allow the soft tissues of the body to stretch and
lengthen to accommodate the growing baby. This is a completely normal part of the amazing changes that occur during pregnancy.
In some people this leads to a widening of the Linea Alba – or “abdominal separation”. As I said above, this is a completely normal part of pregnancy that will occur in the majority of women.
You may spot this during pregnancy by noticing a raised “ridge” of soft tissue that pops up along the mid-line of your abdomen when you pull yourself up from leaning back.
After giving birth, as your hormones gradually normalise and the soft tissues tighten back up again, the “abdominal separation” should resolve. However, in approximately 50% of women it is still present until about 3 months post-partum. In about 30% of these women the DRAM will never resolve.
Can anything be done to help it?
Our thoughts have changed significantly over the last few years. What was once thought to be an unresolvable problem (other than by surgery) is now a condition that we can get fantastic functional results with. We have moved away from thinking that the “separation” has to come back to within 1cm width for it to be “normal”.
Instead, we now know that as long as you retrain your deep core muscles (pelvic floor, diaphragm, transversus abdominis and multifidus) to work once more as a coordinated unit, this will create midline tension across the linea alba and provide good functional support.
How do I retrain my deep core?
The most efficient way to retrain your deep core is to have an assessment with a Physio trained in pelvic health and post-natal rehabilitation. You can do this as soon as you feel comfortable doing so post-birth. However, if it has been a number of years since you had your kids and you have never addressed your deep core retraining, it is never too late.
How to check to see if you have a separation:
To check if you have a DRAM, lie on your back with your legs out straight, lift your head and shoulders off the floor to look at your toes, then use your fingers (with them pointing down to your toes) to feel the mid-line of your stomach. If you feel a gap with a soft midline that you can sink your fingers into, you have a “separation” that should respond to treatment.
How to prevent or protect DRAM during and after pregnancy:
Learn how to activate your deep core by getting an assessment and stability programme from a Pelvic Health Physio
Avoid abdominal crunches
Avoid plank exercises, press ups, and any exercises that require heavy abdominal use
Roll onto your side to get up from lying
Use your arms to push you forwards if you have been reclining back in sitting
Avoid heavy twisting activity (such as bad supermarket trolleys!)
When hoovering/mopping do it in a forward/backward motion rather than twisting side to side
When carrying older children/bags try to keep the weight spread equally between left and right sides, or in front of you
Check your abdominals for ridging during any movement/exercise if you are unsure if it is ok to do.