Diastasis Recti (DR) is a common condition involving the separation of the rectus abdominis, the outermost abdominal muscles, at the linea alba, a band of connective tissue running vertically down the midline of the abdomen. It most frequently affects women during or after pregnancy due to the stretching of the abdominal wall and associated hormonal changes. Physical therapy (PT) is widely considered the primary, non-invasive treatment approach for restoring functional strength to the core. This specialized rehabilitation focuses on reactivating deep core muscles to improve abdominal integrity and reduce associated symptoms.
Identifying Diastasis Recti
Diastasis Recti is officially defined as a gap between the two sides of the rectus abdominis muscle measuring 2.7 centimeters or greater. The condition often causes a noticeable bulge or “pooch” that protrudes from the center of the abdomen, especially when engaging core muscles. Increased pressure within the abdominal cavity, typically from pregnancy, is the main cause of connective tissue stretching.
A simple self-check, the “finger width” test, can estimate the separation: lie on your back with knees bent, lift your head slightly, and place fingers horizontally across the midline. If you can fit two or more fingers into the space, the separation is considered DR. A physical therapist or physician can provide a more accurate assessment using tools like ultrasound.
Physical Therapy as the Primary Treatment
Physical therapy is the foundation of treatment for Diastasis Recti, offering a structured, personalized path to recovery. The goal of a PT program is to restore the functional integrity and stability of the entire core system, addressing deficits like lower back pain, poor posture, and pelvic floor dysfunction. Treatment begins with a comprehensive assessment to determine the extent of separation and identify related weaknesses.
The therapist creates a customized exercise program focusing on training the deep core muscles, most notably the transverse abdominis. This deep muscle acts like an internal corset, providing stability and support to the abdominal wall. Education on proper body mechanics is also integrated into the treatment plan.
Learning how to correctly lift objects, move from lying to sitting, and maintain appropriate posture prevents movements that can worsen the separation. The therapist guides the patient through a gradual progression of exercises, ensuring muscles are challenged without causing excessive pressure or doming.
Core Strengthening Techniques
Core strengthening focuses on activating deep stabilizing muscles while minimizing strain on the compromised linea alba. A fundamental technique is diaphragmatic breathing, which coordinates the movement of the diaphragm, transverse abdominis, and pelvic floor. This intentional pattern encourages proper core engagement, the first step toward rebuilding strength.
Specific exercises target the transverse abdominis without causing the abdominal wall to bulge or cone. Initial movements include gentle pelvic tilts and abdominal bracing, which are isometric contractions designed to activate the deep core muscles. The therapist progressively introduces movements like heel slides, toe taps, and glute bridges, challenging core stability while maintaining a neutral spine.
It is important to know which exercises to avoid during initial recovery, as some traditional core movements can exacerbate the separation. Exercises that create excessive intra-abdominal pressure are generally avoided until functional strength is regained. These include:
- Traditional crunches
- Sit-ups
- Full planks
- Heavy lifting
Posture correction and body mechanics training are also integral, teaching the patient to maintain alignment during everyday tasks.
When Physical Therapy is Insufficient
While physical therapy is highly effective for the vast majority of cases, non-surgical treatment may be insufficient in severe situations. This typically occurs when the muscle separation is four finger widths or more and has not improved functionally after a dedicated PT regimen. The depth of the separation and laxity of the connective tissue are also factors in determining functional impairment.
Diastasis Recti may sometimes be accompanied by an umbilical hernia, where internal tissue protrudes through a weak spot in the abdominal wall. When functional issues—such as chronic lower back pain, significant core weakness, or persistent bulging—severely impact quality of life, surgical consultation becomes necessary.
The surgical option for repairing the muscle separation is typically an abdominoplasty, or “tummy tuck.” This procedure involves surgically bringing the separated rectus abdominis muscles back together and suturing them along the midline. Surgery is considered a final option after conservative treatments, like physical therapy, have been thoroughly attempted.