During pregnancy we naturally often don’t think much past the day of delivery because the birth of a child is such a monumental event and mentally our focus has to be directed to birthing the baby. However, the postpartum period is a time that is marked by drastic physiological and psychological changes. One of the most prominent physiological changes that occurs during pregnancy and then persists in the postpartum period is the separation of the rectus abdominis muscle, or Diastasis Recti (DRAM). During pregnancy the abdominal wall has to expand to accommodate the growing foetus and it is not uncommon for the gap to persist.
Currently, the gap is classified as DRAM if it measures > 2.2cm. In many women DRAM will resolve naturally in the first 6-8 weeks post-partum. However, research suggests that in around 60% of women DRAM persists beyond that early postpartum period, a number which reduces to around 20% at 6 months postpartum.
Functionally, persisting DRAM may be negatively associated with core and trunk function, urinary incontinence, pelvic/lower back pain and body dissatisfaction. The gold-standard to assess the function of the abdominal wall is real-time ultrasound, however, there are other reliable forms of measures. The assessment may include measuring the distance between the rectus sheaths, rating its depth and tension and the integrity of the linea alba (thin band of connective tissue that separates the two sides of the rectus abdominis).
Based on the findings specific exercises can be devised to strengthen core muscles including pelvic floor muscles, regulate inter-abdominal pressure and “retrain” movement patterns. Pilates-based exercises lend themselves to the postpartum care as they are low impact, safe and specific. We know that the most effective exercises when working to decrease DRAM target the rectus abdominis muscle. Such exercises will involve performing some form of curl up movement.
HOWEVER, it is important to do these exercises with correct form, order of muscle activation/relaxation and breathe work. Therefore, once the postnatal check up within the first 6 weeks has been completed and you are cleared to resume exercising, exercises guided by a DRAM trained physiotherapist are the best and safest way to limit complications and progress appropriately. You will be taught how to pre-activate the deeper stomach muscles to create tension on the linea alba and how to perform an abdominal curl correctly and without pulling on your neck.
Besides specific rectus abdominis work, exercises will generally target pelvic floor, obliques, thoracic mobility (breastfeeding and carrying babies can make us stiff and tense in the upper body), postural alignment and stability for your pelvis and lower back to support you in your postpartum recovery.
In summary, if DRAM is suspected or has been diagnosed seek help from a women’s health or DRAM trained physiotherapist to ensure you receive the correct guidance and maximise your change of a full recovery. Ideally this is commenced in the early postpartum period (< 6 weeks), however, it is better late than never.
Author – Lisa Studach (North Curl Curl & Manly)
Lisa likes a mix of hands-on treatment and exercise prescription. She believes clients need to be able to be given and learn the tools to self-manage their conditions. She has a particular interest (and skill) in Clinical Pilates including pre- and postnatal rehabilitation as well as treating sporting injuries in both children and adults.
Click here to learn more about Lisa.