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DRAM

DRAM, Abdominal Muscle Separation After Birth: What it is, and how to recover

DRAM stands for Diastasis of the Rectus Abdominis Muscles, a separation of the two halves of your tummy muscles down the midline. It happens in almost every pregnancy to some degree, as the growing baby stretches the connective tissue (linea alba) that joins the two muscle bands.

For most women, DRAM heals significantly in the first 6 to 8 weeks after birth, and continues to improve over the following months with appropriate exercise. This page explains what DRAM is, how to check for it, and what helps it recover.

What DRAM is, and why it happens

Your rectus abdominis (the “six-pack” muscle at the front of your tummy) runs in two parallel bands, joined down the middle by a strip of connective tissue called the linea alba. In pregnancy, the linea alba stretches and thins to make room for your growing baby, allowing the two muscle bands to move apart.

After birth, the linea alba gradually shortens and strengthens, bringing the muscles back closer together. How quickly and completely this happens depends on:

  • The size of the separation at the end of pregnancy
  • How many pregnancies you have had
  • Your individual tissue quality and genetics
  • How you move, lift, and exercise in recovery

A small remaining gap (1 to 2 finger-widths) is normal and doesn’t typically cause problems. A larger gap or a soft, doming “valley” along your midline when you sit up may benefit from physio guidance.

How to check for DRAM yourself

Step 1. Lie on your back

Knees bent, feet flat on the floor.

Step 2. Place your fingertips just above your tummy button

With your fingers pointing down towards your toes, gently press into the midline.

Step 3. Lift your head and shoulders slightly off the floor

As if starting a small sit-up. Don’t strain.

Step 4. Feel for the gap

Feel for a gap between the two muscle bands, and how wide it is. Check above the tummy button, at the tummy button, and below.

Repeat this check above the navel, at the navel, and below the navel. A separation of more than two finger-widths, or a soft, sinking “valley” along the midline, suggests you may benefit from postnatal physiotherapy.

How to check for DRAM yourself​

Step 1. Lie on your back – Knees bent, feet flat on the floor.

Step 2. Place your fingertips just above your tummy button

Step 3. Lift your head and shoulders slightly off the floor

Step 4. Feel for a gap between the two muscle bands, and how wide it is. Check above the tummy button, at the tummy button, and below.

Repeat this check above the navel, at the navel, and below the navel. A separation of more than two finger-widths, or a soft, sinking “valley” along the midline, suggests you may benefit from postnatal physiotherapy.

What helps recovery, and what to avoid

What helps

  • Good posture. Stand tall, sit tall, distribute weight evenly.
  • Deep breathing. Slow, low belly breathing (not chest breathing) gently engages the deep core.
  • Pelvic floor exercises alongside deep core work.
  • Logroll out of bed. Roll onto your side first, then push up with your arm, rather than sitting straight up.
  • Gentle, progressive exercise. Walking, swimming, postnatal Pilates with someone experienced in postnatal recovery.
  • Time. The tissue needs weeks to months to remodel. Be patient.

What to avoid for now

  • Full sit-ups, crunches, planks, and oblique twists. These can worsen the doming and slow recovery. Avoid in the first 3 to 4 months at least.
  • Heavy lifting beyond your baby. Use good technique when you do lift (close to body, hinge at hips, exhale on effort).
  • Holding your breath under load. Always breathe out on the effort.
  • Doing high-impact exercise before your core and pelvic floor are ready. Running and jumping put significant load on the system.
  • Comparing yourself. Every woman heals at her own rate.

Three exercises to start with

Build a foundation with these three. Do them daily, in addition to your pelvic floor exercises.

1. Diaphragmatic breathing. Lie on your back, knees bent, feet flat. Breathe in slowly through your nose, letting your belly rise. Breathe out slowly through pursed lips, letting your belly soften back. 5 minutes, twice a day.

2. Pelvic tilts. Lie on your back, knees bent. Gently tilt your pelvis so your lower back flattens against the floor. Hold for 3 to 5 seconds, then release. 10 to 15 repetitions.

3. Knee drops (heel slides). Lie on your back, knees bent. With a gentle exhale, slowly lower one knee out to the side a few inches, keeping the pelvis still. Return to centre. Repeat on the other side. 10 each side.

If any of these cause pain, doming, or worsening separation, stop and see a postnatal physiotherapist.

Speak to a postnatal physiotherapist if

You don’t need to live with a significant tummy gap or weakness. Physio guidance is targeted and effective.

  • Your separation is more than 2 finger-widths at 6 to 8 weeks postnatally.
  • You see a soft, sinking valley along your midline when you sit up or strain.
  • You have lower back pain that started or worsened after the birth.
  • You feel a dragging or heaviness in the pelvis, alongside the tummy weakness.
  • Your tummy still looks pregnant at 4 to 6 months postnatally, and you are concerned.
  • You want to return to running, jumping, or heavier exercise and would like a “return-to-activity” assessment.

Your GP or midwife can refer you to the postnatal physiotherapy service.