Diastasis recti (DR) is a common condition where the two sides of the outermost abdominal muscles separate along the midline of the body. This separation occurs due to the stretching and thinning of the connective tissue between them, known as the linea alba. While DR is most frequently associated with pregnancy, the resulting gap can lead to a weakened core and various physical symptoms. Physical therapy is widely recognized as the most effective non-surgical treatment for restoring function and stability to the abdominal wall, using targeted methods to address underlying core dysfunction.
What Is Diastasis Recti and How Is It Diagnosed
Diastasis recti involves the widening of the gap between the rectus abdominis muscles, or “six-pack” muscles, which are normally joined by the linea alba. This collagen-based connective tissue stretches when subjected to persistent, increased pressure within the abdomen. Pregnancy is the main cause, as the expanding uterus exerts significant outward pressure. Other contributing factors include rapid weight changes, poor core strength, and incorrect exercise techniques that strain the midsection.
The condition often presents as a visible bulge or ridge running vertically down the middle of the abdomen, especially when engaging abdominal muscles, such as when sitting up or straining. Symptoms frequently include low back pain, poor posture, and general weakness through the midsection. Diagnosis is made by measuring the distance between the two muscle bellies, known as the inter-recti distance (IRD).
A simple self-check involves lying on your back, lifting your head slightly, and palpating for a gap along the midline near the belly button. Clinically, a separation of 2.0 to 2.7 centimeters or greater is considered diagnostic of diastasis recti. Physical therapists or physicians can perform this assessment using finger-width palpation, calipers, or ultrasound for more objective measurement. This assessment helps to rule out a hernia, which may present with a similar bulge.
Principles of Physical Therapy Treatment for DR
The goal of physical therapy for DR is to restore functional tension to the stretched linea alba and improve the overall stability of the deep core. A specialized physical therapist first conducts a thorough assessment to determine the severity of the separation and identify related issues, such as pelvic floor dysfunction. Treatment begins with foundational exercises and education tailored to the individual’s specific needs.
A primary principle is mastering deep core activation, focusing on the transverse abdominis (TA) muscle. The TA is the deepest abdominal muscle, acting like a natural corset to provide stability and support to the torso. Patients learn to contract this muscle gently without excessively engaging the superficial rectus abdominis, which can worsen the separation. This activation is coordinated with pelvic floor exercises, as they form a functional unit that manages intra-abdominal pressure.
Breathing techniques, specifically diaphragmatic or 360-degree breathing, are another foundational element. This involves breathing deeply into the chest, sides, and back, optimizing the function of the diaphragm, TA, and pelvic floor. Coordinating breath with movement is important for managing pressure and reducing strain on the linea alba during daily activities. The therapist also provides training on postural correction and body mechanics.
This training teaches individuals how to move, sit, lift, and carry objects without increasing pressure that might strain the abdominal wall. For example, patients learn to log-roll out of bed instead of performing a traditional sit-up motion. Once the patient demonstrates consistent control, the therapist introduces progressive loading. This phased approach gradually increases the difficulty of exercises, moving from simple static holds to more complex, functional movements that mimic real-life demands while maintaining proper core control.
When to Seek Medical or Surgical Intervention
While physical therapy is highly effective for most cases of diastasis recti, surgery may be considered when a severe separation does not respond to consistent physical therapy after six to twelve months. The primary reason for surgical intervention is typically not cosmetic, but rather to address severe functional impairment.
This functional impairment can manifest as chronic low back pain, significant core weakness that limits daily activity, or an inability to manage pressure effectively. Surgical repair, often performed as part of an abdominoplasty or “tummy tuck,” involves suturing the stretched linea alba back together to restore the integrity of the abdominal wall. Additionally, if the patient has a co-occurring umbilical or ventral hernia, which is a protrusion of tissue through a weakness in the abdominal wall, surgical repair is necessary and is often performed at the same time as the DR correction. Referral to a general or plastic surgeon should be discussed with a doctor when conservative measures fail to alleviate symptoms or when a hernia is present.