Yes, Diastasis Recti Abdominis (DRA) can directly cause or contribute to back pain. This condition is the separation of the two large, vertical bands of abdominal muscle, the rectus abdominis (or “six-pack” muscles). When this separation occurs, core integrity is compromised, destabilizing the entire trunk. If the abdominal wall cannot function as a supportive girdle, stability shifts to the lower back muscles, often resulting in chronic discomfort and pain.
Understanding Diastasis Recti Abdominis (DRA)
Diastasis recti is an increased distance between the left and right sides of the rectus abdominis muscle. This separation is not a tear in the muscle but a stretching and thinning of the connective tissue between them, called the linea alba. The linea alba is a collagen sheath running down the midline of the abdomen, and its loss of tension allows the muscles to drift apart.
The most common cause of DRA is pregnancy, as the growing uterus places immense outward pressure on the abdominal wall. Hormonal changes during pregnancy, such as increased relaxin and estrogen, also soften the connective tissue. While the condition affects up to 60% of women six months postpartum, it can also occur in men and women who experience chronic, excessive intra-abdominal pressure (e.g., from obesity or improper heavy lifting). A separation is considered diastasis recti when the gap measures two finger-widths, or approximately 2 centimeters.
The Biomechanical Link: How DRA Leads to Back Pain
The abdominal muscles are a foundational component of the core stabilization system, acting like a muscular corset that supports the spine. This system, often called the core canister, includes the diaphragm, pelvic floor muscles, deep back muscles, and the transverse abdominis. The primary function of this canister is to regulate intra-abdominal pressure (IAP), which acts as a hydraulic stabilizer for the lumbar spine.
When the linea alba is stretched and the rectus abdominis muscles are separated, the abdominal wall loses its ability to generate sufficient IAP. This compromise means the spine loses its ventral (front-side) support. The resulting instability often forces the muscles of the lower back and surrounding structures to overcompensate for the lack of core strength.
This compensatory strain leads to muscle fatigue, poor posture, and increased sheer forces on the vertebrae and discs of the lower back. Chronic overload on the posterior muscles manifests as persistent low back pain, hip pain, and pelvic instability. The separated muscles fail to anchor the front of the body, leading to a forward shift in the center of gravity and excessive strain on the lumbar region.
Identifying and Confirming DRA
Individuals can perform a simple preliminary check for DRA at home using a palpation test. Lie on your back with your knees bent and feet flat on the floor. Place your fingers, pointed toward your feet, directly on the midline of your abdomen, just above or below your belly button.
Next, gently lift only your head and shoulders off the floor, as if starting a small crunch, keeping your lower back pressed to the floor. As the rectus abdominis muscles contract, feel for the gap between the two muscle bellies. Note how many fingers fit into the space, as well as the depth and tension of the connective tissue.
While the self-check provides a strong indication, a professional diagnosis is necessary to confirm the condition and its severity. A physical therapist or physician can use objective measures like ultrasound or calipers to accurately measure the inter-rectus distance. They can also assess the overall function of the core and determine if DRA is the direct cause of the back pain or if other factors are involved.
Management and Relief Strategies
Targeted physical therapy (PT) is the most effective approach for managing DRA and associated back pain. The goal of rehabilitation is not necessarily to eliminate the gap entirely but to restore tension and functional strength to the linea alba. This is accomplished by focusing on strengthening the deep stabilizing muscles of the core, particularly the transverse abdominis, which acts like a natural internal corset.
Physical therapists guide patients through specific exercises that emphasize proper breathing and core engagement, often starting with simple movements like pelvic tilts and deep core activation. Improving overall posture is a significant component of treatment, as proper alignment reduces strain on the lumbar spine. In early recovery, supportive tools like abdominal binding or taping may be used to provide external support and promote better muscle positioning.
Avoid exercises that significantly increase intra-abdominal pressure and can exacerbate the separation. Traditional abdominal exercises such as crunches, sit-ups, planks, and heavy straight-leg lifts should be avoided until a physical therapist approves them. These high-force movements push the abdominal contents outward, stressing the weakened linea alba and potentially worsening the diastasis.