by Samah Elomari, women's health physiotherapist
Abdominal separation or DRAM (diastasis of rectus abdominis muscle) is such as hot topic at the moment! It’s so exciting seeing so much more awareness both online and within the health community. Unfortunately though, with that comes a whole lot of misinformation…especially when it comes to what we define as a ‘normal’ separation.
First, you need to know a little about your rectus abdominis, otherwise known as the ‘six pack’ or ‘abs muscle’. Your abs (yes, they’re there even if they’re not visible yet!) extend from the rib cage and travel vertically to attach into your pubic bone. The two strips of the rectus abdominis muscle are connected via the linea alba, a thick structure of connective tissue. This connective tissue is like bands of elastic fibres running down the midline of the entire abdomen.
The linea alba stretches in every woman during pregnancy! This is a normal phenomenon and in fact why the linea alba exists!
The linea alba is a firm structure. During pregnancy however, its fibres relax and soften. That means that as your baby grows, the uterus pushes against the abdominal wall and cause the linea alba to stretch. New mums will often ask about the distance between the abdominal muscles where this stretching has taken place. It is still common practice to have a physio in hospital come around, measure this and exclaim "wow, your separation is only 3 cm wide ( or insert any other number)". This can invoke fear or that something has gone wrong throughout the pregnancy, but really it has not. Remember, the linea alba has served its purpose here to give your growing baby room to grow.
So how wide is the linea alba normally?
A study was carried out on 150 women between the ages of 20 to 45 years who’d never been pregnant. They found that the normal width of the linea alba in this population was:
- up to a 1.5cm at the breast bone
- up to 2.2cm at 3 cm above the belly button and
- up to 1.6cm at 2cm below the belly button
The linea alba has a width to it for everybody, even women who are not pregnant, and men too. Which means that even if there is a small separation postnatally, the softening of its fibres means you will feel that separation on assessment. With all the misinformation out there, it can be scary to think something abnormal is going on.
If you’re concerned about an abdominal separation during pregnancy or after having your baby, come in for a postnatal check-up with one of our women’s health physiotherapists. We can help to train all of your belly layers, and talk through the correct strategies with breath and postural muscle control to assist with healing of the linea alba and your belly separation! This is an important step early on before jumping in on back to your regular exercise routines.
Reference: Beer, G. M., Schuster, A., Seifert, B., Manestar, M., Mihic‐Probst, D. and Weber, S. A. (2009), The normal width of the linea alba in nulliparous women. Clin. Anat., 22: 706-711. doi:10.1002/ca.20836