Diastasis recti (DR) is a common condition characterized by the separation of the rectus abdominis muscles, the two parallel bands of muscle that run down the front of the abdomen. This separation occurs when the connective tissue joining them, called the linea alba, stretches and thins. DR is most frequently observed in women during and after pregnancy, with over 60% experiencing it by the third trimester. Increased pressure from the expanding uterus and hormones that soften connective tissue contribute to this widening. Healing is often achievable through targeted rehabilitation and lifestyle modifications.
Assessing the Condition and Measuring the Gap
Determining the presence and severity of diastasis recti is the first step toward a recovery plan. A simple self-assessment, often called the finger-width test, can be performed at home. To check, a person lies on their back with knees bent and feet flat, then gently lifts their head and shoulders just enough to engage the abdominal muscles. Fingers are placed horizontally along the midline, typically around the belly button, to feel for a gap between the muscle edges.
If a separation of two finger-widths or more (about 2 centimeters) is felt, it indicates diastasis recti. Professional assessment by a healthcare provider or specialized physical therapist may use palpation or more precise tools like measuring tape or an ultrasound. The measurement of the inter-recti distance (the width of the gap) and the depth are both important factors that influence the healing pathway.
Core-Specific Physical Therapy and Rehabilitation
Physical therapy is the primary non-surgical approach for healing diastasis recti, focusing on restoring core function. Traditional exercises like crunches are avoided because they can worsen the separation by increasing outward pressure. Instead, the focus is on strengthening the deep stabilizing muscles, primarily the transversus abdominis (TvA), which acts like an internal corset. Activating the TvA helps manage intra-abdominal pressure, providing stability and allowing the connective tissue to heal.
A specialized physical therapist guides the patient through a structured progression of exercises, starting with basic core activation. This often begins with diaphragmatic breathing, where the patient exhales while gently drawing the navel toward the spine to engage the TvA. Initial exercises are gentle and low-load, such as pelvic tilts and heel slides, performed while lying on the back to promote core control without excessive strain.
As core function improves, the physical therapist introduces more challenging movements and functional exercises. The patient must consciously exhale and engage the deep core before any exertion to prevent doming or coning of the abdomen. Consistent activation of the TvA and the pelvic floor muscles improves the integrity of the abdominal wall and reduces the width of the separation. This program improves stability and mitigates symptoms like lower back pain.
Essential Lifestyle Adjustments for Healing
Supporting rehabilitation requires adjustments to daily activities that minimize strain on the healing abdominal wall. The most important change is avoiding movements that cause the abdomen to bulge or “dome” outward, which increases intra-abdominal pressure. This includes avoiding “jackknifing” straight up out of bed or a chair, replacing it with the “log roll” technique. The log roll involves rolling onto the side first, then using the arms to push the body up sideways while keeping the spine neutral.
Careful attention to lifting techniques is also necessary, especially for new parents. When lifting, one should brace the core and exhale, keeping the object close to the body to reduce strain. High-impact exercises, like running, jumping, and traditional abdominal exercises such as crunches and full planks, are avoided because they forcefully push against the linea alba. A supportive garment or belly wrap may be temporarily used during activity in the early stages of recovery, but it must provide gentle compression to avoid weakening the muscles.
When Surgery Becomes Necessary
Surgery may be considered when the separation is severe (typically four to five centimeters or more) or when non-surgical methods have not restored sufficient function after a year of consistent therapy. Surgical repair is a definitive method for closing the gap and is often performed as part of an abdominoplasty, commonly known as a “tummy tuck.” The procedure involves suturing the stretched linea alba connective tissue together along the midline, a process called plication.
This surgical intervention restores functional core strength and stability, in addition to addressing the cosmetic appearance of the persistent bulge. The recovery timeline for surgery is significantly longer than for physical therapy, often involving several weeks of restricted activity. Although surgery provides permanent physical closure, the patient must still follow a structured rehabilitation program to strengthen the repaired wall and ensure long-term stability.