What is abdominal muscle separation?
What is abdominal muscle separation?
Abdominal muscle separation is a normal part of pregnancy. You have four main abdominal muscles including your rectus abdominis, internal and external obliques and your transverse abdominis muscles. These are joined together down the centre of your stomach by a band of fascia called the linea alba. During pregnancy, a woman’s abdominal muscles begin to separate to allow the baby to grow, this stretches the band of fascia down the centre so that it becomes thinner as the belly grows larger.
Normal abdominal muscle separation during pregnancy.
Following pregnancy, spontaneous healing of the abdominal muscle separation occurs for the first 8-9 weeks, whereby hormones act to create more rigidity in the linea alba and bring the abdominals back together. That said, it is thought that in over half postnatal women, the abdominal muscles don’t come back to their original position after these 8-9 weeks and they therefore require additional treatment to address their abdominal muscle separation. This is known as diastasis rectus abdominis muscle (DRAM).
Postnatally, the abdominal muscles should to return to their prenatal position (left). When they don’t, it is a DRAM ( right).
What causes abdominal muscle separation (DRAM)?
There are many factors that can cause DRAM. Often, it is about the amount of intra-abdominal pressure (IAP) placed on the linea alba during pregnancy. If you think of your linea alba a bit like an elastic band or balloon, when it is stretched, it becomes thinner. Then, if you have increased abdominal pressure when the band is thinner, it is more likely to tear. Common causes of increased abdominal pressure that can increase the risk of this tissue tearing include;
incorrect exercise technique such as belly gripping or flattening the back (take a look at our other blogs and free resources on correct core engagement and pelvic tilt for more information on this),
or even repeatedly getting up off the lounge or bed using your superficial abdominals (as if you’re doing a sit-up) and not getting enough deep abdominal activation.
You can tell if there is increased intra-abdominal pressure as you can usually see ‘doming’ through the centre of your abdomen, especially when you do these movements.
If you are concerned that your current exercise or movement program may increase your risk of DRAM, seeing a women’s health physiotherapist is a great place to get some guidance about this.
Finally, there is also a genetic component to abdominal muscle separation, as everyone’s connective tissue has a differing level of flexibility which means some women are more genetically at risk of a DRAM.
How do you know if your abdominal muscles are separated?
A women’s health physiotherapist can thoroughly assess for DRAM and determine its likely impact. When assessing DRAM, we look for length, width and most importantly depth. Depth tells us about the tension able to be generated through the linea alba which helps with optimal abdominal function. Essentially, it tells us if the linea alba has torn fibres and to what extent, which gives us an indication of healing time and appropriate rehabilitation exercises. Assessing for DRAM is most important during the postnatal period as it is normal during pregnancy.
What is abdominal muscle separation treatment?
Treatment for DRAM includes correct activation of your deep core muscles. Whilst there is a lot of advice that can be found about core activation on “Dr Google”, it is one of the most commonly misunderstood and injury creating issues we see in the clinic. Thus, we strongly recommend you see a women’s health physiotherapist who will show you how to correctly activate your deep core muscles using real-time ultrasound. This is important to help you generate tension through your linea alba as 60% of the fibres of your transverse abdominis muscle connects into the linea alba. Once you know how to control the tension through your linea alba, you can begin abdominal exercises to draw the muscles together. Again, however, it is best to be guided by your physiotherapist for these specific exercises and so that you know exactly how to do them best in your body.
