Q: Are my stomach muscles tearing? No, it is a DRAM.
The acronym DRAM stands for Diastasis Rectus of the Abdominal Muscles which means separation of the abdominal muscles. This is a normal part of every pregnancy and an essential process to occur to stop the muscles from tearing. The ligament that runs down the centre of your stomach is called the linea alba. This ligament widens to accommodate for the increasing size of your stomach.
The normal size of a linea alba is 1-1.5cm in width which is about one finger. This can increase massively during pregnancy and after pregnancy 3-4 fingers is common in the first few weeks. Most DRAMS naturally recover after giving birth and take around 6 weeks to do so. Many women will have their stomach muscles assessed after giving birth and then at the 6 week mark. If the DRAM is not reducing naturally then performing some static abdominal contractions can be helping and then slowing progressing into some abdominal control exercises (see dead bug section in glossary). The most important thing to remember is that having functionally strong abdominal muscles is much more important that the 'separation closing' and there are many exercises that help to make your abdominal wall functionally strong again. So try remember these points.
DRAMs are normal.
Your stomach hasn’t torn.
Most separation recover naturally.
With a DRAM though you need to avoid heavy abdominal loading.
This include a crunch, doing a sit up movement to get out of a deep chair or get out of bed.
Q: How do you know if you have a stomach muscle separation?
You can easily tell if there is a separation in your stomach muscles in both standing and lying. In standing lift up your t-shirt so you can see your stomach. Place your hands down by your side and lean backwards. If there is a coning shape in your abdominals (bulging, peaking, abdominal muscles sticking up are other words too) - that is a DRAM - that is a sign to be cautious of heavy abdominal loading. Performing exercises that train abdominal control are great (4PK exercises, kneeling planks on elbows and knees, theraband shoulder extension in standing).
Another more commonly used assessment technique (particularly by Physiotherapists and my preferred method) is to lie on your back and lift up your t-shirt so you can see your stomach. Take one hands and feel the centre of your stomach for the linea alba. See how many fingers width you can fit in between the two ridges of the abdominal wall. The keep your fingers there and lift your head and shoulders up off the floor.
Does the gap get wider or closer?
Is there a difference in the gap above and below the belly button?
Does any coning occur?
If there is one finger width and it feels strong and you can’t push downwards into your stomach then your muscles are recovering well.
Q: What about crunches?
Crunches…. to do them or to not do them? It’s a question I discuss with most women. Well while you’re pregnant crunches aren’t good for two reasons; they involve lying on your back and they load the rectus abdominus muscle. Having the rectus abdominus muscle very strong pulls on the linea alba and can potentially worsen any abdominal separation present.
After birth, crunches should only be done at the end stages of rehab, once your pelvic floor is strong to withhold the bearing down force caused by a crunch, and once your abdominal muscles have returned to their original position (or best available position). This is usually not until 4+ months postnatal. But don’t worry, my mission is to teach you a pleather of exercises that strengthen your stomach muscles and don’t involve a crunching movement.