Diastasis recti abdominis (DRA) is a common condition, particularly following pregnancy, where the two parallel bands of the outermost abdominal muscle, the rectus abdominis, separate. This separation occurs due to the stretching and thinning of the linea alba, the connective tissue that runs down the midline of the abdomen. While this natural process allows the uterus to expand, if the tissue loses its elasticity, a gap can remain, sometimes causing the abdomen to bulge. Physical therapy is considered the primary non-surgical intervention for managing DRA and restoring functional core strength.
Defining Diastasis Recti and Assessment
Diastasis recti is defined by an abnormal widening of the inter-recti distance (IRD), the space between the left and right sides of the abdominal muscles. Although most often associated with pregnancy due to mechanical stretch and hormonal changes, DRA can also affect men and infants, typically linked to excessive intra-abdominal pressure (IAP) from factors like obesity or heavy lifting. The separation is generally considered DRA when the gap is wider than 2.0 to 2.5 centimeters, or greater than two finger-widths.
Assessment involves measuring the width and depth of this separation. The therapist uses palpation, feeling for the gap along the midline while the patient performs a gentle head lift. More precise methods, such as calipers or diagnostic ultrasound, may be employed to accurately measure the IRD and assess the quality of the connective tissue. This process establishes a baseline for treatment and helps differentiate DRA from other conditions like a ventral hernia.
Core Principles of Physical Therapy for DRA
The goal of physical therapy is to restore tension and functional stability to the entire abdominal wall, particularly the stretched linea alba. This is achieved by strengthening the deep core muscles that act like a natural corset for the trunk, including the transverse abdominis (TA) and the pelvic floor muscles.
A central principle of rehabilitation is the management of intra-abdominal pressure (IAP). Exercises are carefully selected and progressed to ensure IAP is controlled, preventing visible bulging or “doming” of the abdomen during exertion, which can worsen the separation. Postural training is integrated early on to optimize the alignment of the rib cage and pelvis, allowing the core muscles to engage more effectively. The therapist teaches the patient to properly activate these deep stabilizers during movement and breathing to distribute forces safely across the trunk.
Specific PT Techniques and Exercise Guidance
Physical therapy for DRA begins with foundational techniques focused on breath and deep muscle activation. Diaphragmatic breathing is fundamental, coordinating the movement of the diaphragm and the transverse abdominis to pull the abdominal wall inward. This is often paired with gentle pelvic floor contractions to integrate the entire deep core unit.
The therapist introduces specific, low-load exercises to build endurance and strength in the deep core. Common movements include the pelvic tilt, where the pelvis is gently rocked backward to engage the lower abdominals without straining the midline. Heel slides are another staple, requiring the patient to maintain a braced core while slowly extending one leg along the floor. These exercises stabilize the trunk in a neutral position, avoiding traditional crunches or sit-ups that cause the abdominal wall to bulge outward. Bracing or taping the abdomen may be used in early recovery to provide external support and proprioceptive feedback.
Duration of Treatment and Expected Outcomes
The duration of treatment for diastasis recti varies significantly based on the severity of the separation, the consistency of the patient’s effort, and the time since onset. Many individuals begin to see improvements in core function and a reduction in the gap within 6 to 12 weeks of consistent, targeted exercise. Full functional recovery, however, often requires a sustained commitment to the exercise program and integration of proper core mechanics into daily activities.
The primary goal is not always the complete closure of the abdominal gap to a pre-pregnancy width. Success is measured by the restoration of functional core strength, the ability to generate tension across the linea alba, and the relief of associated symptoms like lower back pain or pelvic instability. If symptoms persist and functional goals are not met after a prolonged course of conservative therapy, surgical correction, such as an abdominoplasty, may be considered.