What is Diastasis Recti (DRAM)?

Diastasis recti — often called DRAM for short or ‘Mummy Tummy’ — occurs when there is separation of the abdominal muscles and reduced tension of the surrounding connective tissue as a result of having a baby.

To be exact, the linea alba (the line of connective tissue down the centre of your abdominals) becomes stretched, and your rectus abdominus muscles are displaced as a result. In pregnancy, the linea alba must soften and expand as the uterus grows to accommodate baby. This pushes the abdominal muscles apart, lengthening them and often making them weaker. The amount of separation varies from one woman to another and becomes more pronounced for most women in their 3rd trimester.

It is important to note that while Diastasis Recti is most common in pregnant women, it can affect men, children and post-menopausal women, especially after surgery, injury or large amounts of weight gain.

Checking for DRAM:

After you have had your baby, you can check for diastasis with this simple technique:

• Lie on your back with your legs bent and your feet flat on the floor.
• Raise your shoulders off the floor slightly and look down at your tummy.
• Using the tips of your fingers, feel between the edges of the muscles, above and below your belly button.
• See how many fingers you can fit into the gap between your muscles.
• Check along from the bottom of your sternum to the front of your pubic bone.

The separation between your stomach muscles will usually go back to normal by the time your baby is eight weeks old – this is when we know that the most spontaneous recovery happens.

If the gap is still obvious at eight weeks, the muscles may still be long and weak, putting you at risk for a number of issues such as low back pain, incontinence and bloating. We would recommend that you come and see one of our Womens’ Health Physiotherapists as early as possible post-baby to optimise this recovery.

Commonly, a Diastasis Recti is seen as a peak or a ridge with movement e.g. getting out of bed. Other signs and symptoms include the reporting of a small rounded tummy, bloating, loose skin, and a higher risk of incontinence, back pain and pelvic organ prolapse.

The different types of Diastasis Recti:

As depicted by the graphic below, there are different types of Diastasis Recti depending on the length and location of the separation. During an assessment, your therapist will be able to assess and diagnose the type of Diastasis Recti and be able to tailor your rehabilitation to give you the most optimised recovery.

How do we assess DRAM?

One of our specialist physiotherapists will provide you with an individualised assessment and treatment plan.

First, we will ask you a few questions about your pregnancy history and current lifestyle. This will help us to form a clear picture surrounding your Diastasis Recti – why it has occurred and why it is continually not improving.

We will then have a look at your posture, movement patterns and finally assess your tummy. Similar to what is outlined above, we will be looking at degree of separation of the abdominals as well as skin quality and factors such as doming of the tummy.

We will then look at the level of activation of your core and potentially add in some movements to assess your stability at the hips, pelvis and core. This will give us the recipe for how we can work together to re-build that connection through your core and re-tension through the linea alba.

How do we treat DRAM?

Your physiotherapist will most likely prescribe you pelvic floor and core strengthening exercises, similar to that of Pilates, to get you on your way to recovery.

We will address any issues such as tight, overactive muscles that can ‘block’ some muscle activations, build on your foundational core control and then add in movements to make the exercises functional and relatable to your everyday life.

It is also important that we address secondary symptoms of a Diastasis Recti, such as continence control and lower back pain if needed.

How to activate through your pelvic floor:

At KB Physio we like to call it the ‘wink and zip’. Wink through your back passage and zip the connection forward to your pubic bone. Then try to take this connection up towards your belly button. Remember we are trying to gently tighten the tummy muscles and not grip on for dear life.  You can feel for this activation by placing your finger-tips slightly inwards from the bones at the front of your hips, activate and you should feel a gentle lifting.

If you aren’t feeling a connection, try gently drawing your tummy muscles away from the waistband of your trousers or imagine you are tightening a few notches on a low-slung belt.

Try holding this connection, whilst breathing normally, for 10 seconds, let everything go, and repeat 10 times. You can then add 10 quick pulses with a full relaxation of the muscles in between each set.

As well as targeted exercises, there are a number of things you can do to help give your diastasis the best chance of healing:

What else can help:

• Stay well-hydrated.
• ‘Eat to heal’ – nourish your body with a well-balanced diet, filled with plenty of fibre, to help keep digestion as smooth as possible and avoid constipation.
• Let others help with lifting – you are not weak, you’re wise!
• Getting out of bed by rolling onto your side first and pushing up to avoid a lot of pressure through the abdominals
• Make time for rest and self-care activities so that your body can prioritise healing
• Attending a regular Pilates class with a trained diastasis instructor – here at KB we run a weekly ‘Mummy and Me’ class
• Do regular pelvic floor exercises and keep breathing throughout. Practise in sitting, standing and lying down.
• Keep working at it – it takes time and consistency.

What to avoid:

• Heavy lifting
• If you to bend forward and lift, activate through your pelvic floor and deep tummy muscles (see above) to help provide stability through your centre
• Strenuous activities that cause your tummy to bulge out. This includes heavy impact activities such as trampolining, high-load abdominal work such as sit ups / crunches / planks, repetitive twisting dynamic activities such as tennis / squash.
• Straining to open your bowels
• Carrying children on one hip – limit time and swap sides!

Remember – it takes time to improve:

Improvement won’t happen overnight. It took nine months to make a baby, so keep this in mind if things aren’t happening as fast as you wanted them to. It is normal for your body to change after pregnancy, so try to avoid the pressures of getting your ‘pre-baby body’ back and focus on getting your core functional so you can enjoy life to the fullest.

If you suspect that you have a diastasis and would like to see one of our specialist physiotherapists, please contact reception and claim your complimentary consultation now.

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Mend The Gap Workshop

We are running a ‘Mend the Gap’ workshop here at the clinic on 15th June, 3-5pm. This is ran by our Womens’ Health team and targeted specifically for women who suspect or know they have a diastasis.

You will be lead through a 2-hour workshop to help you understand how to heal and recover your tummy gap. This will include an individual assessment and rehabilitative class built to improve the connection in your entire core.

Book now by calling our client care team on 0114 327 2080 or email hello@katiebellphysio.com. Tickets cost: £25.

*Limited places available