Diastasis Recti Abdominis Muscle (DRAM): What It Is and What You Can Do by Kathryn Melvin Women's Health APA Physiotherapist
Diastasis Recti Abdominis Muscle (DRAM) is a common condition affecting many women during and after pregnancy. It involves the separation of the rectus abdominis muscles along the linea alba, often due to the mechanical and hormonal changes that occur during gestation. While it’s frequently dismissed as a cosmetic issue, DRAM can have significant implications for core function, posture, and quality of life.
What Is DRAM?
DRAM is defined as a separation of the rectus abdominis muscles exceeding 2 cm, typically measured at the umbilical level. This separation results from the stretching and thinning of the linea alba, which accommodates the growing uterus during pregnancy. Although some degree of separation is physiologically normal, persistent or excessive widening can lead to functional impairments.
A 2020 study found that 33% of women still experience DRAM 12 months postpartum (Sperstad et al., 2016). Risk factors include multiple pregnancies, high birth weight, short torso, and connective tissue disorders such as Ehlers-Danlos Syndrome.
Diagnosis and Assessment
DRAM is commonly assessed using palpation techniques, but imaging modalities such as ultrasound offer more accurate measurements. A “Rec-check” is often used in clinical settings to assess the width, depth, and tension of the linea alba.
Conservative Management
Physiotherapy is the first-line treatment for DRAM. Core rehabilitation programs focusing on transverse abdominis activation, pelvic floor coordination, and breathwork have shown promising results. A 2024 randomised controlled trial published by the Australian Physiotherapy Association found that a 12-week exercise protocol targeting pelvic floor and abdominal muscles was safe and did not worsen inter-recti distance during pregnancy (APA, 2024).
Key principles of conservative management include:
• Avoiding exercises that increase intra-abdominal pressure (e.g., sit-ups, planks) in early rehab stages
• Emphasising breath control and postural alignment
• Using tactile cueing and progressive load management
Despite widespread social media content on DRAM, a 2025 analysis revealed that over 60% of posts lacked evidence-based recommendations, underscoring the need for professional guidance.
Surgical Considerations
Surgical repair is reserved for cases with significant functional impairment that do not respond to conservative treatment. According to the Hertfordshire and West Essex Integrated Care Board (2022), surgery may be considered if:
• The diastasis exceeds 3 cm
• Symptoms persist after a six-month trial of physiotherapy
• The condition significantly affects daily function
• The patient is at least one year postpartum and not planning future pregnancies
Both open and laparoscopic techniques have demonstrated positive outcomes, though surgery should not be offered for cosmetic reasons alone.
Final Thoughts
DRAM is common, but it’s not something women should simply accept. With evidence-based physiotherapy and appropriate support, most women can restore core function and regain confidence. If you’re experiencing symptoms or unsure where to start, reach out to a qualified women’s health physiotherapist. Recovery is possible—and it starts with informed care.
References:
• Australian Physiotherapy Association (2024). Exercise for diastasis recti abdominis. [online] Available at: https://australian.physio/inmotion/exercise-diastasis-recti-abdominis [Accessed 18 Aug. 2025].
• Hertfordshire and West Essex Integrated Care Board (2022). Evidence Based Intervention: Diastasis Recti Repair. [online] Available at: https://www.hweclinicalguidance.nhs.uk [Accessed 18 Aug. 2025].
• NICE (2021). Pelvic floor dysfunction: prevention and non-surgical management (NG210). [online] Available at: https://www.nice.org.uk/guidance/ng210 [Accessed 18 Aug. 2025].
• Sperstad, J.B., Tennfjord, M.K., Hilde, G., Ellström-Engh, M. and Bø, K. (2016). Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine, 50(17), pp.1092–1096.