Diastasis recti (DR) is a condition defined by the separation of the rectus abdominis muscles due to stretching and thinning of the connective tissue between them, called the linea alba. This widening can compromise the stability and function of the core. Fixing this muscle separation involves a spectrum of approaches, ranging from highly targeted physical rehabilitation programs to reconstructive surgery. The choice of treatment depends heavily on the severity of the separation, the presence of accompanying symptoms, and the individual’s overall functional status.
Guided Physical Therapy and Exercise Protocols
The primary non-invasive method for addressing diastasis recti involves a specialized regimen of exercises. This conservative approach focuses on restoring the functional integrity of the abdominal wall by strengthening the deep core muscles, rather than the superficial ones. The goal is to create tension in the linea alba, allowing the separated muscles to draw closer together and improve the firmness of the abdominal tissue.
Therapeutic programs center on activating the transverse abdominis (TA), the deepest layer of abdominal muscle that acts like a natural corset around the torso. Exercises often begin with gentle, focused contractions and breathing techniques, such as exhaling while drawing the belly button inward toward the spine to engage the TA. This deep engagement helps to stabilize the trunk and manage the intra-abdominal pressure. Coordinating the TA with the pelvic floor and diaphragm is a core component of this treatment.
As strength improves, the physical therapist will progressively introduce more challenging exercises, such as modified planks, toe taps, and glute bridges, always prioritizing proper form over intensity. The progression is slow and deliberate, ensuring that the corrective tension is maintained without causing the abdomen to bulge or “dome” along the midline. This doming indicates that the pressure is too high and the superficial muscles are overcompensating, which can worsen the separation.
A crucial part of this conservative management is knowing which movements to avoid, as improper exercise can easily undo progress or increase the gap. Traditional abdominal flexion exercises, such as crunches, sit-ups, and intense twisting motions, are restricted because they place excessive strain directly on the stretched linea alba. Similarly, high-impact activities, heavy weightlifting, and exercises that require the body to hyperextend should be strictly limited until sufficient core stability is established.
Some physical therapists may recommend the temporary use of specialized abdominal bracing or belly wraps. These external supports offer gentle compression to help approximate the muscles and provide proprioceptive feedback, encouraging the deep core to activate. However, these wraps are intended as a complement to the exercise program and not a substitute for active muscle strengthening. Success is measured not just by the reduction of the gap, but by the improvement in core strength and the alleviation of related symptoms, such as lower back pain or pelvic floor dysfunction.
Surgical Repair Options
When conservative treatment fails to resolve the separation or when the diastasis is severe, surgical intervention becomes the definitive method for correction. Surgery is typically considered for individuals who have a significant gap, persistent functional impairment, or an associated umbilical or ventral hernia. The procedure used to fix the muscle separation is called plication, which involves surgically stitching the separated rectus abdominis muscles back together at the midline.
Plication reinforces the stretched linea alba and restores the integrity of the abdominal wall, which can significantly improve core strength and resolve symptoms like chronic back pain. The procedure is most commonly performed as part of an abdominoplasty, particularly when excess skin or fat needs to be removed. In this open approach, an incision is made low across the abdomen, allowing the surgeon direct access to tighten the muscles.
Alternative surgical methods include minimally invasive techniques, such as laparoscopic or endoscopic repair, which use small incisions and specialized instruments. These approaches are often preferred when the patient does not require the removal of excess skin and is primarily seeking functional repair. Laparoscopic plication typically involves working from the posterior side of the rectus sheath, while open surgery usually plicates the anterior sheath. Both techniques aim to achieve a durable, long-lasting repair of the abdominal wall.
The decision between an open abdominoplasty combined with plication and a minimally invasive approach is based on a comprehensive assessment of the patient’s anatomy and cosmetic goals. The goal is to create a strong, functional abdominal wall by permanently reapproximating the muscles. Patients are often advised to complete their family planning before undergoing surgical repair, as subsequent pregnancies can potentially stretch the repaired tissue and lead to recurrence of the diastasis.
Posture and Body Mechanics for Daily Support
Effective management of diastasis recti relies heavily on consistent awareness and adjustment of daily posture and body mechanics. These passive, habitual changes are necessary to support the newly strengthened or repaired core and prevent the creation of unnecessary intra-abdominal pressure. Maintaining a neutral spinal alignment while sitting and standing is paramount, as slouching or hyperextending the back puts undue strain on the abdominal tissues.
When sitting, individuals should position their pelvis neutrally and avoid letting the lower back round or arch excessively, which can cause the abdominal wall to strain or bulge. Standing posture requires aligning the rib cage directly over the pelvis, avoiding the common tendency to push the hips forward or let the ribs flare outward. This proper alignment allows the core musculature to provide optimal, low-level support throughout the day.
A specialized technique known as “log rolling” is essential for safely moving in and out of bed or getting up from a reclined position. Instead of sitting straight up, which mimics a crunch and significantly increases intra-abdominal pressure, the individual rolls the entire body onto one side. They then use their arms to push the torso up to a seated position. This technique minimizes the stress on the linea alba and the rectus muscles.
Safe lifting is another major focus, requiring a conscious effort to avoid holding the breath or straining the abdomen. When lifting objects, the person should bend at the knees and hips, keep the object close to the body, and exhale while bracing the core gently before initiating the lift. Avoiding activities that involve intense, forceful exhalation, like heavy straining during bowel movements or excessive coughing, also helps to protect the abdominal wall from damaging pressure spikes.