What is Abdominal Separation AKA DRAM?
by Khoa Pham
Abdominal separation also know as Diastasis Rectis Abdominis (DRAM) is commonly overlooked after giving birth. A DRAM is a separation down the middle of the abdominal muscles, see picture below. It is important to get a DRAM assessed because it can increase your risk of having low back issues, hernias and pelvic instability later in life.
What causes a DRAM?
DRAMs can be affected by factors such as:
- Hormonal changes
- Weight gain
- Abdominal muscle weakness and
- Abdominal muscle stretching due to growth of the baby.
It can also affect men who have placed excessive stress on their abdominal muscles.
How can a DRAM cause lower back issues?
A simple explanation of how a weak core (caused by a DRAM) can result in lower back issues is:
When the Transverse Abdominis (TA) is not activated properly, there is less support for the ligaments and bony structures of your back when you’re doing day-to-day things. This increases your risk of injury. The TA is one of your most important core muscles, it lies below the six-pack muscle and wraps around your back to support it like a corset.
Is a DRAM treatable?
Yes, Physiotherapists are able to treat DRAMs. Physiotherapy management for DRAMs usually begin with a period of wearing a compression brace to support the abdominals and to facilitate the healing process. Your Physio will then give you gentle core activation and pelvic floor exercises as well as treatment to correct low back/pelvic posture. Exercises causing excessive tension over the superficial abdominals for example, sit-ups or crunches, are avoided.
When patients are able to assume the correct pelvic posture and can activate the deeper core muscles, more challenging core exercises are given. These exercises are pilates-based on the mat or reformer. One of my personal favourites is the “dead bug”. This exercise can be progressed in various ways depending on your level.
1)Starting position: Hands up in the air, hips and knees forming 90 degree angles to each other.
2) Lower leg from starting position and tap heel onto the ground. Then return leg back to the starting position.
To increase intensity:
1) Incorporate heel taps with opposite arm movement.
2) Extend the legs further out prior to touching the heel to the ground.
3) Opposite arm movement with extended heel taps.
If you’ve given birth recently or suspect that you may have a DRAM, spare yourself the possibility of having further issues down the track and get this looked at by one of our experienced clinicians.