Changing the way we think about early postpartum physiotherapy management of diastasis of the rectus abdominis muscles (DRAM) and the potential for improved patient outcomes

Ms Eloise Simpson1

1South West Healthcare, Warrnambool, Australia

Diastasis of the rectus abdominis muscle (DRAM) is a common condition during late pregnancy and early postpartum periods where the abdominal muscles separate along the midline. At present, the vast majority of physiotherapists report treating DRAM using transverse abdominis (TrA) training. However, a growing body of evidence is developing to suggest an alternative, rectus abdominis (RA) training, may be more effective in reducing the abdominal muscle separation that characterises DRAM in the early post-partum period. A recent single-centre, randomised controlled trial with longitudinal assessment found that an RA exercise program was more effective than the standard TrA program over a 12-week window following vaginal delivery.

In addition to the statistically significant outcomes, a number of important observations were made based on feedback from this study’s patient sample. These included:

  • A higher prevalence of DRAM than is generally reported
  • Improved compliance and outcomes when incorporating infant’s ‘tummy time’ into the mother’s program. This has important treatment compliance implications.
  • Increased sensitivity in screening for pelvic floor dysfunction compared with non-physiotherapy-based postpartum appointments.

As the majority of people will experience DRAM following childbirth, there is a strong case to be made for physiotherapy involvement across the early postpartum period to be part of routine care. Furthermore, evidence increasingly supports a change from the current standard physiotherapy management for DRAM, and for use of a standardised postpartum pelvic floor screening tool.


Eloise works in regional Victoria across both outpatient hospital and private practice settings. Her practice areas include musculoskeletal, women’s health and antenatal education. Having completed her graduate certificate in musculoskeletal physiotherapy at La Trobe University in 2019, she has commenced research at South West Healthcare aiming to improve outcomes in the postpartum population. She has recently been awarded a new and emerging researcher grant by the Western Alliance to continue research in this area.

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