Diastasis of the Rectus Abdominus Muscles (DRAM)
WHAT IS IT?
Diastasis of the rectus abdominus muscles (DRAM) is the separation of the ‘six-pack muscles’ (rectus abdominus). It is particularly prevalent during and after pregnancy and can also occur after abdominal surgery. Some men and postmenopausal women can also develop DRAM for reasons outside of pregnancy.
The deep gap running down the centre of a ‘toned’ stomach may or may not indicate a toned, healthy tummy, and instead may be various forms of diastasis. Intra-abdominal pressure applied to this midline muscle – called the linea alba – causes the widening space between the rectus muscles, or the abs, as the linea alba itself thins and widens., This also causes a protrusion of this muscle.
Hormonal changes by relaxin, progesterone and estrogen, combined with uterine growth may cause the stretching of abdominal muscles. Postural changes and loss of the force vector in these muscles may also contribute to the manifestation of DRAM. Lack of abdominal exercise further increases the likelihood of developing DRAM before and during pregnancy. As the woman gives birth, the act of pushing naturally increases the pressure on the intra-abdominal area.
WHY SHOULD I PAY ATTENTION?
DRAM in itself does not cause pain, but its presence, size and duration has been linked to pelvic and lower back pain. It can also lead to the weakening of the pelvic floor, leading to pelvic floor dysfunction. It has been found to weaken abdominal muscles and disturb their functions in lumbo-pelvic stability. This can then cause issues with the pelvic area, back and overall bodily stability in the future if left untreated.
WHEN SHOULD YOU ACT?
There is yet to be a consensus on the method used to measure the gap between abs – calipers, finger widths or ultrasound – and how big the gap should be, but >2cm is generally considered DRAM. Individual personal history and physical examination must also be considered when diagnosing DRAM. Physical examination is usually sufficient, but further confirmation can be made using ultrasound, CT or MRI.
Diastasis is usually diagnostic during post-natal care.
HOW DO I FIX IT?
Consult your physiotherapist or osteopath for more exercise and management programs that specifically target DRAM. In the case of severe functional or cosmetic concerns, consult a plastic or general surgeon for more information.