How to test for DRAM
` ` Have your client lie on her back with
her knees bent and feet on the floor
approximately hip-distance apart
` ` Place fingers along the linea alba
(midline of stomach)
` ` As client relaxes her abdominal
muscles while lifting head and
shoulders gently off the floor, feel for
a gap or bulge just above or below
the belly button
` ` If a diastasis is present you will feel
the rectus abdominis tightening on
either side of your fingers. If you
cannot feel this muscle contracting
you may need to place more fingers
in the gap between the muscles so
you can measure it more accurately.
In some cases this gap may be more
than 10 fingers-width.
` ` You also need to determine the
condition of the connective
tissue. The deeper the fingers
go towards the spine, the
weaker the connective tissue.
If the gap is larger than two fingers-
width then outer abdominal exercises
should be avoided until the deeper
core and pelvic stability muscles are
strengthened.
Management of DRAM
When it comes to managing DRAM, it
is best to encourage clients to seek a
thorough assessment by a women’s
health physiotherapist, and to create a
specifically tailored exercise program.
Real-time ultrasound is often used to
give instant feedback on the quality of
deep abdominal and pelvic floor muscle
activation. Exercises should focus on
improving core stability, strengthening
pelvic floor muscles and improving
abdominal muscle tone.
In addition to a specific exercise program,
abdominal muscle support (compression
garments) is essential for the
management of DRAM. This combination
of compression and a tailored program
will achieve optimal results.
It is important that the correct type
of compression garment is worn. The
garments that achieve best results have
gentle (medical graded) compression
which promote supporting pressure
to the pelvis, back and abdominal
muscles. This stimulates strengthening
of the abdominal muscles facilitating
muscle recovery.
A garment that is tight and restrictive
should not be worn for recovery
after childbirth, as it places too much
compression on the muscles and does
not allow them to work. This ultimately
causes further muscle weakness.
Training considerations for
clients with DRAM
After ascertaining whether a client is
experiencing DRAM, it is also prudent to
consider the following:
` ` Pre-screening: by conducting a
pre-exercise analysis with your
pre- and post-natal client, you will be
able to identify special
considerations for her exercise
programming and tailor the
exercises appropriately
` ` Work in conjunction with a women’s
health physiotherapist to devise
a safe and effective program.
Exercise precautions
Many traditional exercises increase
the stress on both abdominals and
pelvic floor and can further increase
muscle
separation.
Strengthening
and shortening the rectus abdominis
muscles may increase the chance of
developing a separation in the rectus
muscle. It is best to avoid these exercises
from early pregnancy until well into
the post-natal period. A good way to
assess if an exercise is appropriate is
to consider whether or not it increases
intra-abdominal pressure or involves
impact. If not, then the exercise is most
likely to be safe for the abdominal
and pelvic floor muscles. If your client
notices any muscle peaking (muscles
visibly protruding from the centreline
of the abdomen, with pyramid-like
appearance), the exercise needs to be
modified.
The following exercises should be
avoided when the DRAM (gap) is larger
than two fingers-width:
` ` Abdominal curls
` ` Oblique curls
even incontinence due to the interaction
of the pelvic floor and abdominal
musculature as a stabilising unit.
` ` Pilates 100s
` ` Double leg lifts
` ` Medicine ball rotations
` ` Planks
` ` Push ups
` ` Valsalva manoeuvre
` ` High impact exercise such
as jumping, running, star
jumps and skipping.
While
individual
assessment
is
imperative, the above exercises may be
commenced once:
1. Soft tissue healing is complete
post-childbirth (minimum of 6-12
weeks)
2. DRAM is less than 2cm, and no
muscle peaking is experienced
3. Effective pelvic floor and transversus
abdominus contractions are evident
during the exercise
4. No pelvic or back pain is present.
Safe exercise options
When working with clients with DRAM,
the focus should be on strengthening
from the inside to the outside. The deep
abdominal and pelvic floor muscles are
the priority.
The following is an example of a DRAM-
safe strengthening workout.
SETTING THE CORE
Sitting upright, gently and slowly
engage the pelvic floor and draw in
lower (deep) abdominals (photo 1).
1
Trainer tip: Keep posture upright and
keep upper abdominals relaxed. Breathe
comfortably.
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