What I Would Do To Minimise DRAM As A Women’s Health Physio

DRAM aka abdominal separation is a completely normal part of pregnancy.

It happens in almost all women after 35 weeks. Where it comes back to is largely genetics based.

However, there are things that we can do to help.

What do I mean when I talk about DRAM?

DRAM - AKA Diastasis Rectus Abdominis Muscles. AKA thinning of the connective tissue between our six pack muscles.

Before we go any further. Yes, you have a six pack.

What would I do in pregnancy?

Understand that separation is a completely normal part of pregnancy and everyone will have some type of separation towards the end of their pregnancy.

In regards to making sure it doesn’t widen too much we actually don’t have any solid evidence for this.

And for some baby positions it does put us at increased risk of separation i.e. transverse bub.

I would however make sure I had good thoracic mobility and ensure my obliques weren’t too tight. This isn’t backed up in evidence however clinically I find it can be helpful. We can go through ways of managing this in clinic.

I wouldn’t stop abdominal training. There isn’t any evidence that strength training increases or decreases DRAM.

It also allows us to keep as strong as possible through the abdomen through pregnancy and carrying that benefit over to postpartum.

What I would do in the early postpartum?

Wear compression. There is some evidence to show that wearing tubigrip can improve the resting positions of abdominal muscles in the early postpartum period.

Side note: the added benefit I hear from women is it allows them to know where they are in space and allows them to feel supported. Whilst this may sound a bit funny, after growing a baby for nine months it can feel strangely discombobulating afterwards when bub is no longer in our bellies.

I would practice diaphragmatic breathing. During pregnancy we may change where we breathe just purely from a lack of space perspective. Practicing diaphragmatic breathing can help to restore normal abdominal pressure mechanics.

I would also do mini abdominal curl ups. This is where you are lying with knees bent and feet flat and slowly peeling shoulder blades off the bed. You can feel the muscles come together when you curl up and then relax back when you curl back down. This isn’t a full sit up, just a very mini sit up. We can show you how to do this at Kin if you are based in Geelong.

After 6-8 weeks I would check in with a women’s health physio and get started on other abdominal muscle strength exercises.

The six pack muscles which contribute to DRAM are only one many abdominal muscles that need to be strengthened again postnatal. Whilst I usually believe that a well planned strength program doesn’t need a whole lot of specific abdominal work. Postpartum is the one time where I truly believe this is absolutely essential.

So if you are after some tips to help improve abdominal separation after pregnancy, we’ve got you.