What is Diastasis Recti?
Diastasis recti is a condition characterized by a separation of the rectus abdominis muscles—the “six-pack” muscles—along the linea alba, the connective tissue that runs vertically down the middle of the abdomen. It occurs most commonly postpartum, due to the stretching and thinning of the abdominal wall during pregnancy, but can also affect men and non-pregnant women.
During pregnancy, the growing uterus puts pressure on the abdominal wall, causing the connective tissue to weaken and the two sides of the rectus abdominis to move apart. This is a natural adaptation, but in some cases, the tissue does not return to its original tension after birth, leading to a visible gap or bulge in the midline of the abdomen.
This condition is not just cosmetic. Diastasis recti can significantly affect core strength, spinal stability, posture, and overall pelvic function. If not addressed, it can contribute to lower back pain, pelvic floor dysfunction, digestive issues, and even hernia formation.
The degree of separation can vary. A diastasis is generally diagnosed when the gap between the muscles exceeds 2.7 cm (about two finger widths). It is usually assessed by a qualified physiotherapist using manual palpation, ultrasound imaging, or a calibrated measurement tool.
Contrary to popular belief, not all abdominal exercises are beneficial for this condition. In fact, many conventional core workouts—like crunches, sit-ups, and planks—can worsen the separation if done too early or incorrectly. That’s why a targeted, evidence-based rehab program is essential for proper recovery.
The good news is that diastasis recti can often be reversed or significantly improved with guided exercise therapy. With the right approach, the linea alba can regain its tensile strength, and the abdominal muscles can realign and function efficiently again.
Who Is at Risk and Why?
Women in the late stages of pregnancy are the most commonly affected group, but diastasis recti is not limited to postpartum individuals. It can also occur in:
- Multiple pregnancies or pregnancies with large babies
- Women over 35 giving birth
- Short-statured individuals with a narrow torso
- People with weak core muscles or poor postural habits
- Men with central obesity, where excessive abdominal pressure causes similar separation
- Athletes or bodybuilders performing repetitive or forceful abdominal strain
Other risk factors include:
- Genetic predisposition (weaker connective tissue)
- Excessive weight gain during pregnancy
- High-impact or incorrect abdominal exercises during or after pregnancy
- C-sections or repeated abdominal surgeries, which may weaken the fascia
In some cases, diastasis recti may go unnoticed due to mild symptoms, while in others it may lead to obvious abdominal protrusion, discomfort, or instability in movement.
Understanding who is at risk is crucial for early identification, prevention, and personalized rehabilitation.
Understanding Core Anatomy
To fully grasp the implications of diastasis recti, it’s important to understand the structure of the core muscles and how they work together to support the body.
The core is made up of more than just abdominal muscles. It includes:
- Rectus abdominis: The front muscle known for its “six-pack” appearance. It plays a key role in trunk flexion and intra-abdominal pressure.
- Transverse abdominis: The deepest abdominal muscle, wrapping around the torso like a corset. It is essential for spinal stability, postural control, and core activation.
- Internal and external obliques: Located on the sides of the torso, these muscles assist in rotation, lateral flexion, and spine stabilization.
- Pelvic floor muscles: These muscles support the bladder, uterus, and bowels. They work closely with the transverse abdominis and diaphragm to maintain core pressure and organ function.
- Multifidus and erector spinae: Deep back muscles that maintain spinal alignment and provide postural support.
- Diaphragm: The main muscle for respiration, which also plays a crucial role in core stabilization through pressure regulation.
In a healthy body, these muscles form a functional unit that supports the spine, enables efficient movement, and stabilizes the pelvis during walking, lifting, and bending.
When diastasis recti is present:
- The connection between the left and right sides of the rectus abdominis is weakened
- The core cannot properly engage, causing a loss of intra-abdominal pressure
- Compensations occur in the lower back, hips, or pelvic floor, increasing the risk of injury
Therefore, a successful rehabilitation plan must not focus solely on closing the gap, but also on retraining the coordination and timing of core muscle activation.
Only when the transverse abdominis, pelvic floor, and diaphragm work in harmony can true core function be restored post-diastasis.
Common Symptoms to Watch For
While some cases of diastasis recti are visible and easily identified, others present with subtle symptoms that may go unnoticed for months. Early detection is key to effective management.
The most common symptoms include:
- Visible abdominal bulge or doming, especially when doing a sit-up motion or lifting the head from a lying position
- Soft or hollow area along the midline of the abdomen
- Lower back pain, due to lack of core support and poor spinal alignment
- Pelvic floor dysfunction, such as urinary incontinence or a feeling of heaviness
- Poor posture, particularly an exaggerated lumbar curve
- Instability during movement, difficulty transitioning from sitting to standing or rolling over
- Digestive discomfort or bloating, especially after meals or physical activity
- A sensation of “coning” or “tenting” during abdominal engagement
Some women also report:
- Weakness or fatigue during simple tasks like carrying the baby or standing for long periods
- Hip or pelvic pain, often caused by compensation mechanisms in the kinetic chain
- Delayed postpartum recovery, especially if combined with pelvic floor issues
If any of these symptoms are present, it’s advisable to consult a women’s health physiotherapist for proper assessment. Remember, early intervention leads to better outcomes.
Note: The following treatment recommendations are provided by a certified physiotherapist and kinesiologist and are intended solely for informational support in the management of the stated condition. Each case is unique – it is advised to consult a qualified doctor or physiotherapist for an accurate diagnosis and development of an individualized treatment plan.
Top Physical Therapy Approaches
Physical therapy plays a vital role in the rehabilitation of diastasis recti and in restoring functional core strength after childbirth. An effective therapy plan is not limited to closing the gap between the rectus abdominis muscles—it focuses on retraining the entire core system to work synergistically and efficiently.
1. Core muscle re-education
Re-educating the deep core muscles is a foundational step in recovery. The therapy begins with activating the transverse abdominis, the deepest layer of abdominal muscles. This is often done through gentle breathing techniques, pelvic tilts, and engagement of the lower abdomen while lying down.
Therapists teach how to engage the core without bulging or increasing intra-abdominal pressure. Precision is key: each contraction must be slow, controlled, and accompanied by diaphragmatic breathing.
2. Postural alignment training
Proper posture is essential in managing intra-abdominal pressure and preventing strain on the healing tissues. Therapists assess standing, sitting, and transitional movements, correcting:
- Anterior pelvic tilt
- Rounded shoulders
- Forward head posture
This helps distribute loads evenly and supports optimal muscle recruitment.
3. Pelvic floor integration
The pelvic floor works in close coordination with the diaphragm and transverse abdominis. Weakness here often coexists with diastasis recti. Therapy incorporates Kegel exercises, co-contractions, and core-pelvic breathing to improve internal pressure control and continence.
4. Functional movement training
Real-life activities like lifting your baby, standing up, or carrying groceries are retrained using correct mechanics. The therapist guides how to:
- Brace the core before movement
- Exhale during effort (the “blow before you go” technique)
- Avoid compensatory overuse of the back or hips
5. Use of supportive tools
Depending on the severity, therapists may recommend:
- Abdominal binders for temporary support
- Biofeedback devices to improve muscle awareness
- Ultrasound imaging to assess tissue integrity and progress
Consistency with therapy and regular reassessments ensure the approach remains aligned with healing.
Effective Exercises for Diastasis Recti
Here are five clinically recommended exercises that help restore core function while respecting tissue healing. These should always be performed without pain, bulging, or coning of the abdomen.
1. Diaphragmatic breathing
Purpose: Activate the transverse abdominis and regulate intra-abdominal pressure.
How to do it:
- Lie on your back with knees bent
- Place one hand on your chest, the other on your belly
- Inhale through the nose, feeling your belly rise (chest stays still)
- Exhale slowly through the mouth while gently drawing the lower belly inward
Reps: 10 breaths, 2–3 sets daily
Watch for: Movement only in the abdomen—not the chest or shoulders.
2. Pelvic tilts
Purpose: Strengthen deep abdominals and promote spinal mobility.
How to do it:
- Lie on your back with knees bent
- Flatten the lower back gently against the floor by tilting the pelvis backward
- Engage your core as you hold for 3–5 seconds, then release
Reps: 10–15, 2 sets
Watch for: No bulging in the midline; movement should be smooth.
3. Heel slides
Purpose: Engage the core while integrating leg movement.
How to do it:
- Lie on your back, knees bent
- Inhale to prepare
- As you exhale, slide one heel along the floor, keeping the pelvis stable
- Return to starting position and repeat with the other leg
Reps: 10 each leg
Watch for: Stable pelvis, no doming or back arching.
4. Modified dead bug
Purpose: Strengthen core control during opposite limb movement.
How to do it:
- Lie on your back, knees bent in tabletop position
- Inhale to prepare, exhale to lower one arm and opposite leg toward the floor
- Return and alternate sides
Reps: 8–10 each side
Watch for: Abdominal wall stays flat and controlled.
5. Wall push core activation
Purpose: Build isometric core strength in upright posture.
How to do it:
- Stand facing a wall, arms straight, palms pressed into the wall
- Inhale, then exhale and engage your core
- Maintain pressure while bracing for 10 seconds
Reps: 5–8 holds
Watch for: Core activation without rib flare or lower back tension.
Always consult your physiotherapist before beginning, especially if you had a C-section, pelvic floor issues, or are less than 6 weeks postpartum.
How to Support Recovery at Home
Recovery from diastasis recti doesn’t end in the clinic. The home environment plays a crucial role in healing and long-term functional stability.
1. Practice proper posture
Maintain neutral spine alignment while standing, sitting, and breastfeeding. Use supportive cushions if needed and avoid slumping.
2. Modify daily movements
Use the log roll technique when getting out of bed, and brace your core when lifting or transitioning between positions.
3. Avoid contraindicated exercises
Skip high-intensity core moves like sit-ups, crunches, planks, and leg raises until cleared. These increase intra-abdominal pressure and can worsen the condition.
4. Stay consistent with exercises
Incorporate approved exercises into your daily routine. Short, intentional sessions are more effective than long, infrequent ones.
5. Support your healing nutritionally
Eat a balanced diet rich in collagen-supporting nutrients (vitamin C, zinc, protein) to enhance tissue recovery.
5 Most Common Questions About Diastasis Recti Exercises
1. How do I know if I have diastasis recti?
You may notice a gap or bulge along the midline when doing a sit-up. A physiotherapist can confirm this through manual assessment or ultrasound.
2. When can I start exercises postpartum?
Gentle breathing and core awareness can start within days postpartum. Full exercises usually begin around 6 weeks, pending medical clearance.
3. Can diastasis recti heal on its own?
Mild cases may improve naturally, but targeted rehabilitation exercises significantly enhance recovery and prevent long-term issues.
4. Are crunches or planks okay with diastasis?
No. These exercises often increase intra-abdominal pressure and can delay healing. Only include them after professional clearance.
5. Can men have diastasis recti too?
Yes. Men, especially those with central obesity or improper lifting habits, can also develop abdominal separation and benefit from similar rehab protocols.
