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What you need to know about Abdominal Separation…

Diastasis, the basics

Diastasis Recti Abdominis, diastasis recti, DRAM, ab separation, diastasis?? These are different names, all used to describe the same concept, abdominal integrity.  Before diving into the ins and outs of Diastasis, it is important to gain an understanding of the anatomy of the abdominal wall. 

The abdominal wall is made up of a combination of muscles, fascia and connective tissue. On a basic level the deepest layer of muscle is the ‘Transversus abdominis muscle”, this is often referred to as the ‘deep core’, it runs from your spine on either side and wraps around to connective tissue at the front, it is cued often using the visual of ‘drawing your belly button into your spine’. The next primary group of muscles are the obliques, internal and external, they are the flashy diagonal muscles. Sitting at the front is your rectus abdominis or 6 pack muscles. Let’s now talk about the linea alba, it is the thin sheet of connective tissue that sits between the 6 pack and is the common meeting point for the abdominal muscles.

It is the linea alba that gets thinned and widened during pregnancy to accommodate for bub growing. This then can result in diastasis rectus abdominis, which is an expected adaptation of abdominal tissues in response to the later stages of pregnancy.  

As a result diastasis is often expected in the early stages of the postpartum period, as abdominal wall muscles and connective tissue recover. The research demonstrates that the prevalence of diastasis decreases with time, reducing from 60% at 6 weeks postpartum, to 32% at 1 year post! In saying that, there is currently no standardized way to diagnose diastasis! Yep, that is right, there is no formal consensus, some clinicians may focus on measuring the width between each 6 pack, using fingers, transabdominal ultrasound or calipers. Other clinicians may focus on what it feels like, strong or soft, and what the pressure does, is it controlled or does it create pressure pockets of doming.  

Which then poses the next question, what is the best way to optimize abdominal recovery and healing. Again, there is no one answer! Research suggests that conservative modalities including strengthening exercise can help to improve outcome measures for diastasis. But which exercises, now that has to be individualized! Depending on what your primary concern is; building strength, improving width, changing doming or just getting some reassurance, will then dictate what is going to be most appropriate for you. 

Having multiple opinions, and not one straightforward answer can be a challenge, but physiotherapists are here to help! 

Liana McMorrow

  • Berg-Poppe, Patti & Hauer, Michaela & Jones, Cassandra & Munger, Mattison & Wethor, Cassidy. (2022). Use of Exercise in the Management of Postpartum Diastasis Recti: A Systematic Review. Journal of Women's Health Physical Therapy. 46. 35-47. 10.1097/JWH.0000000000000231. 

  • Laframboise, F. C., Schlaff, R. A., & Baruth, M. (2021). Postpartum Exercise Intervention Targeting Diastasis Recti Abdominis. International journal of exercise science, 14(3), 400–409.

  • Radhakrishnan, M., & Ramamurthy, K. (2022). Efficacy and Challenges in the Treatment of Diastasis Recti Abdominis-A Scoping Review on the Current Trends and Future Perspectives. Diagnostics (Basel, Switzerland), 12(9), 2044.

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