Diastasis Recti, Diastasis Recti Abdominis Muscles or DRAM
A Diastasis is a separation of two body parts that are supposed to be together, in this case, it is a separation of the Rectus Abdominis Muscles.
Diastasis Recti is most common in pregnancy and postnatal as well as new born babies, but men also can have a Diastasis Recti too. DRAM may appear during pregnancy with the expanding uterus, and the hormone relaxin that allows for the relaxation and stretching in the tissues of the body. This is more common with women who have multiple pregnancies, multiple birth pregnancies such as twins, a large baby, and a smaller framed woman with a short torso, people with hyper mobility syndrome, and EDS. Diastasis Recti may be made worse with abdominal specific exercises and exercises with excessive increased intra-abdominal pressure.
What are exercises that create excess intra-abdominal pressure? Think planks, full push ups, situps, hovers, and open kinetic chain exercise that require the legs 90/90. Back extension exercises can also separate the abdominals further, creating discomfort for anyone with a Diastasis, as they will feel their abdominals separate with spinal extension work. If doing supine extension work (say over a chi ball) you may also see the abdominals doming or coning.
Technique for abdominal exercises becomes important to recover from a Diastasis Recti.
The introduction of an exercise that increases intra-abdominal pressure should be gauged on the participant being able to keep the two sides of the Rectus Abdominis together.
I find that tactile cueing of the abdominals really helps with this. So when cueing the abdominals use your fingers to draw the two sides of the abdominals together.
When thinking of working the Transversus Abdominis we all know that the TA originates at the back and inserts into the aponeurosis at the front. When you think of your anatomy we know that the insertion moves to the origin. So the cue of drawing the belly in needs to be re-thought. We don’t want the TA to pull the abdominals further apart. So creating your cues to really imagine the work of the Rectus Abdominis drawing in towards each other and less about the Transversus pulling the muscles sideways.
One of the tell tale signs of a Diastasis is doming or coning abdominal muscles.
A Rec-check is a great way to determine the length, width, and depth of the separation and how much damage there is to the connective tissue. This is usually done by feeling the space between the abdominals while doing a sit-up. Two fingers or more is considered a Diastasis of the Rectus Abdominis muscles. It is great to keep a record of this to assess your clients progress. From my own experience, the space can even become smaller in just one session. For more information on the Rec Check click to view to a shortened video from my course How to do a Rec-check.
Usually, after delivery the separation of the Rectus Abdominis will decrease, however for some the connective tissue remains stretched. Having an abdominal separation is not life threatening, but it can cause lower back pain, poor posture and feelings of low self esteem affecting confidence and body image. In some instances the separation may also cause a hernia where perhaps some of the visceral fat may protrude.
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7 Pilates Exercises to assist with DRAM:
- Breath work is so important as the breath can change the pressure through the abdominals.
Make sure the abdominals relax with the inhale. Do the breath work in supine, side lying, seated, 4 point kneeling and standing. Use an exhale to draw the abdominals towards each other. The client can place their hand/s on the two sides of the Rectus Abdominis to draw the two sides together. In 4 point kneeing the instructor can use tactile cues to draw the two sides of the abdominals together. You can scatter breath work throughout the session, but don’t do the entire session focusing on this.
- To progress to ab preps, practice head nods first. Then with the hands resting on the abdominals practice a half curl, or the instructor using tactile cues to draw the two sides of the abdominals together with the exhale. Only lift as far as the abdominals can stay connected. Only do as many where the abdominals stay together. Do not overtire the abdominals.
- Wall push ups. Wall push ups and 4 point kneeling push ups are ok, full plank push ups are not. The instructor can use tactile cues to draw the two sides of the abdominals together with the exhale. Use the inhale to flex the elbows and the exhale to extend the elbows and connect the abdominals towards each other.
- Four point push-ups on the Chair. In a 4 point kneeling position on the floor, side facing to the Wunda Chair pedal, with one hand on the pedal (One heavy spring on 1 or 2) Press the pedal down with an exhale. Progress to the opposite hip and knee extending with the press or even holding the opposite hip and knee in extension. The instructor can use tactile cues to draw the two sides of the abdominals together with the exhale.
- Squats against the wall with the ball. Use an exhale to draw the abdominals towards each other. The client can place their hand/s on the two sides of the Rectus Abdominis to draw the two sides together. Make sure the abdominals relax with the inhale. Use this same idea for Footwork on the Reformer and Footwork on the Chair.
- Knee stretches on the Reformer with a straight back not round back or extended. The instructor can use tactile cues to draw the two sides of the abdominals together with the exhale. Try reversing the breath pattern with the exhale as the hips and knees are extending to create more support for the abdominals.
- Pointer / Quadruped as part of the mat work exercises, reaching the opposite arm and leg away. The instructor can use tactile cues to draw the two sides of the abdominals together with the exhale.
Other than this, the program should focus on exercise with low intra-abdominal pressure until there is a better connection of the abdominals such as:
- Side lying legs on the mat or the Cadillac leg spring
- Supine arm springs on the Cadillac (feet down – so no open kinetic chain work with the legs
- Kneeling or standing arm springs on the Cadillac – no thighs stretch in kneeling and no trunk
flexion with standing squats
- Seated or kneeling arm work on the Reformer (watch for Chariot pulls as this can put excessive pressure on the abdominals – just watch for doming, reduce to single arm chariots and reduce spring tension) No roll downs
- Supine scapular series on the Cadillac – no curl ups
- Lat pulls on the Cadillac with the Push Through Bar
- Calf raisers and prancing on the Chair
- Standing leg press on the chair facing in and side
- Lunges on the Chair
- Scooter on the Reformer
- Hamstring curls on the Chair (watch for doming and reduce spring tension if so)
- Seated triceps and shrugs on the Chair
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By Louise Taube
Course creator of Pregnancy and Postnatal (PDP Approved) and other Pilates Courses.