Time and time again I get women coming to see me who are unhappy with the way their abdominal wall looks after having a baby. I get it, I am lucky enough to have had 3 children myself!
Many people have heard of the terms “DRAM” or “Abdominal muscle separation” or even “Abdominal muscle tearing”. The idea of your abdominal muscles tearing is enough to strike fear in anyone. However, what most people don’t realise is that abdominal muscles separation is a normal consequence of pregnancy. DRAM (Diastasis of the rectus abdominis) is the separation of a stretchy band of tissue that runs vertically down from your ribs to your pubic bone and it divides your left and right abdominal muscles. When you are pregnant this band softens and allows the abdominal wall to stretch to accommodate your growing baby…causing no pain or distress to you. It’s actually quite a nifty design really!
Post-partum, that band will firm up and shrink to bring the abdominal muscles back closer together. It is quite normal for the gap to remain at 1-2 cm ongoing after having a baby. Again what most people don’t realise is for the vast majority of people, even with ongoing separation, these muscles can in fact function and look as though they did in the past.
All too often many clients we see have Googled “DRAM” or have been told by health professionals to do a standard “DRAM rehab program” that involves absolutely NO sit-ups, NO heavy lifting and very very light ‘deep abdominal exercises’. Let’s be real here…this advice is given to women who are lifting 4 -10 kg babies, possibly toddlers too, not to mention prams, capsules and 400 bags of shopping (not that we recommend this for your pelvic floor).
These kinds of generic programs containing basic deep abdominal isolation exercises are not going to give you the abdominal muscle strength and definition you are after. At the other end of the spectrum I see people who have been doing high level general core exercises and yet also, their abdominal wall does not look like they would want either. Unfortunately despite their dedication to improving their abdominal wall, they have not been targeting the right muscles and sometimes this can even worsen the look of the abdominal wall.
One of the most important questions I ask patients when I see them for an assessment of their abdominal wall is, “what is the part that concerns you?” 9/10 times it is not the DRAM or the separation that bothers them (because in most people an untrained person will not even notice this), it is in fact, the aesthetics of their abdominal wall, most frequently their lower abdominal area which may bulge a little bit and they comment “I still look 20 weeks pregnant”.
So what is going on here? And how can we fix it?
The answer lies in having a qualified health progressional doing a DETAILED assessment of your abdominal wall (that goes way beyond measuring the width in cm of a DRAM) and giving you a comprehensive rehab program to work on…more on that in our next blog!
Rebecca Liberatore is the Co-Director of Melbourne Pregnancy and Pelvic Floor Physiotherapy (MPPP) in Essendon and Pascoe Vale South. She has worked in the Post Natal Physio Rehab space for over 15 years and is a regular tutor on Melbourne Uni Post Grad Masters of Pelvic Health Course. Rebecca has spent extensive time tutoring and mentoring her team at MPPP to follow her assessment and treatment style.
Book here for any In Person or Telehealth Abdominal Wall Assessment at Melbourne Pregnancy and Pelvic Floor Physiotherapy.