Diastasis recti is a common condition where the outermost abdominal muscles, the rectus abdominis, separate. This widening of the gap occurs at the linea alba, a fibrous band of connective tissue that runs down the midline of the abdomen. Physical therapy is a primary treatment approach for individuals experiencing diastasis recti. This condition frequently affects individuals postpartum, with studies indicating that up to 60% of women may experience it during pregnancy or after childbirth.
What Diastasis Recti Is
The linea alba, a strong fibrous structure made of collagen, stabilizes the anterior abdominal wall. While a certain degree of stretching is expected, especially during pregnancy, it can lose its elasticity, preventing the muscles from returning to their original position.
The primary cause of diastasis recti is excessive intra-abdominal pressure, which stretches the abdominal muscles and connective tissues. Pregnancy is the most common cause, as the expanding uterus and hormonal changes like relaxin contribute to the stretching and weakening of the abdominal wall. Other factors include rapid weight fluctuations, improper core engagement during exercises like sit-ups or heavy lifting, and even genetic predisposition.
Common symptoms include a visible bulge or “pooch” in the abdomen, particularly when engaging the abdominal muscles or trying to sit up, and a soft, jelly-like feeling around the belly button. Some individuals may also experience coning or doming of the abdomen, lower back pain, or a general feeling of core weakness.
Physical Therapy Approaches
Physical therapy addresses diastasis recti by restoring core strength, improving abdominal wall integrity, and alleviating associated symptoms. Therapists tailor treatment to individual needs.
A primary component of therapy involves therapeutic exercises designed to activate deep core muscles, particularly the transverse abdominis, which acts like a natural corset. These exercises aim to strengthen the muscles that support the spine and pelvis, improving overall stability.
Diaphragmatic breathing is a foundational technique taught in physical therapy for diastasis recti. This deep breathing method helps engage the diaphragm, the transverse abdominis, and the pelvic floor muscles, promoting coordinated core activation. By focusing on expanding the lower ribs and belly during inhalation and gently drawing the abdomen inward during exhalation, individuals learn to re-engage their deepest core muscles. This technique helps reduce intra-abdominal pressure and supports the healing process of the linea alba.
Physical therapists also incorporate exercises that integrate pelvic floor activation, recognizing the interconnectedness of the core, pelvic floor, and diaphragm. Strengthening the pelvic floor muscles contributes to overall pelvic stability and supports the abdominal wall, which can help reduce symptoms like lumbo-pelvic pain.
Manual therapy techniques, such as soft tissue mobilization, may be used to address muscle tension and improve blood circulation in the abdominal area. Education on proper body mechanics for daily activities, such as lifting, bending, and getting out of bed, is also provided to prevent further strain on the abdominal muscles and support long-term recovery.
The Physical Therapy Journey
The journey through physical therapy for diastasis recti typically begins with a comprehensive initial assessment. During this evaluation, a physical therapist will visually inspect and palpate the abdominal area to assess the degree of muscle separation. They may use methods such as the “finger-width” measurement or a caliper for a more precise assessment, noting that a gap wider than two centimeters or two finger-widths is often considered significant. Functional movement assessments are also conducted to observe how the abdominal muscles perform during various activities, identifying any compensatory patterns or weaknesses.
Following the assessment, an individualized treatment plan is developed, tailored to the patient’s specific condition and functional goals. This plan typically involves a combination of supervised exercises performed in the clinic and a consistent home exercise program. Supervised sessions allow the therapist to provide real-time feedback, ensuring exercises are performed correctly to maximize effectiveness and avoid worsening the separation. The home exercise program reinforces the in-clinic work, promoting consistent engagement of the core muscles throughout the day.
Patient education is an integral part of the physical therapy journey. Individuals learn about proper posture, safe movement patterns, and activities to avoid that could put excessive strain on the healing abdominal wall.
The typical duration of therapy varies depending on the severity of the diastasis and the individual’s adherence to the program, but significant progress can often be seen over several weeks to a few months. Progress is continuously monitored through re-assessments, allowing the therapist to adjust the treatment plan as strength and function improve.
When to Seek Professional Help
Consult a physical therapist for diastasis recti if a persistent abdominal bulge or “pooch” is noticeable, especially after childbirth, and does not resolve. While some separation is common postpartum, persistent separation at six months affects approximately 39% to 45% of women. Seek professional evaluation if you observe coning or doming of the abdomen during core engagement, or experience chronic lower back, pelvic, or hip pain. Symptoms of pelvic floor dysfunction, such as urinary incontinence or a feeling of pelvic heaviness, also indicate a need for professional help.
These issues are often related to a weakened core and can be effectively addressed through targeted physical therapy. Early intervention is beneficial, as addressing diastasis recti sooner can prevent long-term complications and support recovery. While self-assessment can provide an indication of separation, a qualified healthcare professional, particularly a physical therapist specializing in women’s health, can provide an accurate diagnosis and a personalized treatment plan.