Supporting Clients with Diastasis Rectus Abdominis Through Pilates

As Pilates teachers, we are often the first to hear our clients’ concerns about their core. One condition that comes up regularly—sometimes spoken with fear, sometimes with frustration—is Diastasis of the Rectus Abdominis Muscles (DRAM).

Let’s explore what DRAM really is, what causes it, how it impacts both body and mind, and how we can compassionately and effectively support our clients on their journey to recovery.

What is DRAM?

The word diastasis comes from the Greek word meaning “to separate.” In the case of DRAM, it refers to the separation of the two halves of the rectus abdominis muscles (the “six-pack” muscles), caused by stretching or thinning of the connective tissue (the linea alba) between them.

DRAM is usually measured in two ways:

• Width – the horizontal distance between the muscle bellies.

• Depth – how far the fingers can sink into the gap, indicating connective tissue integrity.

It’s important to remember: not all separation is cause for concern. Some DRAM is normal, functional, and does not impair strength or stability. What matters is the tension and resilience of the connective tissue, and how well the core can transfer load.

How Common is DRAM?

• Around 60% of women experience DRAM in the third trimester of pregnancy.

• For many, it naturally heals postpartum, but about 33% continue to have a significant gap 12 months after birth.

• Men can also develop DRAM—commonly from obesity, heavy lifting, chronic coughing, or exercises that overload the abdominal wall.

This means DRAM is not just a “postnatal women’s issue”—it’s a condition that affects many people across different life stages.

Causes of DRAM

DRAM can be caused by multiple factors, often linked to excess intra-abdominal pressure:

• Pregnancy, as the growing baby creates necessary space.

• Hormonal changes, especially relaxin and oestrogen, which soften connective tissues.

• Strenuous or poorly managed abdominal exercises.

• Heavy lifting without proper load management.

• Chronic constipation and straining.

• Obesity or rapid weight gain.

The Emotional Impact

Beyond the physical changes, DRAM can bring emotional distress. Many clients feel self-conscious about their abdominal shape, frustrated by lingering separation, or disheartened if their body feels “weak” or “broken.”

Associated symptoms like lower back pain, pelvic floor dysfunction, or a sense of instability can add to the emotional burden. As teachers, it’s vital we acknowledge this—not with fear-based language, but with empathy and reassurance:
✨ Healing is possible.
✨ A better abdominal structure is possible.
✨ With consistent, safe movement and lifestyle choices, function and confidence can be restored.

Pilates and DRAM: How We Can Help

Pilates offers gentle yet powerful strategies to support DRAM recovery. Here are some guiding principles:

1. Start with Awareness

• Teach clients to feel for tension in the linea alba rather than focusing only on the gap.

• Cue connection over perfection.

2. Safe Exercise Progressions

• Recommended exercises:

  • Heel slides

  • Bent-knee fall outs single, double or with stretch band resistance tied around the thighs

  • Seated or standing breath work with gentle abdominal engagement

  • Modified side planks from forearms and knees

  • Four-point kneeling breath and stability work - no hovers yet due to increase in intra-abdominal pressure

  • Pelvic floor lift and relaxation exercises
  • Use a log roll to transition from sitting to lying on the back

• Avoid early on:

  • Crunches and sit-ups

  • Double leg lifts

  • Traditional planks (until strength is restored)

  • Back extension exercises

3. Abdominal Binding

Gentle binding or support garments can help clients feel more stable in early recovery stages.

4. Slow and Steady Progression

Progress abdominal work gradually. Rushing into advanced exercises can worsen the separation.

5. Cueing the Abdominals

Traditional “draw your navel to spine” or “switch on the transverse abdominis” cues may not always be effective for DRAM. Instead, try:

• Encouraging gentle tension across the midline.

• Using imagery like “zipping up” or “corseting” from the sides of the body in.

• Coaching breath patterns that support pressure management.

Lifestyle and Prevention Tips

Supporting the abdominal wall isn’t just about exercises—it’s also about everyday habits:

• Toilet posture: Use a squatty potty to reduce straining and protect the linea alba and pelvic floor.

• Nutrition: Eat a fibre-rich diet and stay hydrated to avoid constipation.

• Load management: Encourage safe lifting mechanics—bend the knees, exhale on effort, avoid bulging the abdominal wall.

• Posture and breathing: Help clients find upright, lengthened posture and functional breath patterns.

• Getting into and out of bed: Teach clients to use a log roll to get into and out of bed to avoid doming of the abdominals

Maintenance and Long-Term Care

DRAM is not always something that completely “goes away,” but with the right strategies, clients can restore function, strength, and confidence. Regular Pilates practice, mindful cueing, and lifestyle support create lasting benefits.

Empathy First

As Pilates teachers, our role is not just to provide exercises, but to offer a safe, compassionate space where clients feel seen and supported. Healing is not only physical—it’s also emotional. By reminding clients that they are strong, adaptable, and capable, we help them move forward with confidence.

And remember: some DRAM is completely functional. Not every separation needs “fixing.” What matters most is whether your client’s body can support them in the movements of life.

💡 Want to learn how to check for DRAM? In my Pregnancy & Postnatal Pilates course, I teach you how to perform a simple REC CHECK so you can confidently assess and support your clients. Please check out my Pilates for Pregnancy and Postnatal course here.