Diastasis recti is a common condition defined by the partial or complete separation of the rectus abdominis muscles, which are the two parallel bands of muscle commonly referred to as the “six-pack” muscles. This separation occurs because the connective tissue that runs down the midline of the abdomen, known as the linea alba, stretches and widens. This stretching is often a result of excessive outward pressure on the abdominal wall. This article will focus on non-surgical methods, specifically targeted exercise, that can help reduce this separation and restore core function.
Understanding the Abdominal Wall Separation
The most common cause of this abdominal separation is pregnancy, where the expanding uterus and the influence of hormones like relaxin and estrogen stretch the muscles to accommodate the growing fetus. Diastasis recti can also affect men and women who have never been pregnant, resulting from rapid weight changes, improper core engagement during heavy lifting, or performing excessive, unsafe abdominal exercises. Symptoms include a visible bulge or “pooch” that protrudes just above or below the belly button, lower back pain, poor posture, and a feeling of softness or a jelly-like texture around the navel.
Lie on your back with your knees bent and feet flat on the floor, then place your fingers, palms down and pointing toward your feet, directly on your midline near the belly button. Gently lift your head and shoulders slightly off the floor, as if beginning a mini-crunch. If you can fit two or more finger-widths into the gap between the muscle edges, this indicates a separation that warrants attention. A separation wider than two centimeters is considered diastasis recti.
Core Rehabilitation and Targeted Movements
The goal of non-surgical rehabilitation is to restore the function and tension of the connective tissue and the deep core muscles. The most important muscle to engage is the transverse abdominis (TA), which acts like a natural corset, wrapping horizontally around the torso. Activating the TA helps create tension across the linea alba, improving abdominal wall integrity and stability.
The foundational movement is Transverse Abdominal Breathing. Lie on your back with knees bent and feet flat, then inhale deeply, allowing the belly and rib cage to expand. As you exhale, draw your belly button inward toward your spine, focusing on a deep, wrapping contraction of the TA muscle. This contraction should be felt across the lower abdomen, and it is important to avoid pushing the abdominal contents outward.
Once the core connection is established, one can progress to gentle movements like Pelvic Tilts. While maintaining the TA engagement, slowly tilt your pelvis upward, flattening your lower back against the floor. Hold this slight tilt for a few seconds before slowly releasing back to a neutral position. This movement engages the deep core without generating excessive intra-abdominal pressure.
Start in the same position, engaging the TA and pressing the lower back slightly into the floor. Slowly slide one heel forward along the floor until the leg is nearly straight, only going as far as you can without losing the deep core engagement or seeing any doming in the abdomen. Exhale while pulling the heel back to the starting position, then repeat on the opposite side. Consistency in performing these low-intensity, targeted movements is far more effective for recovery than attempting challenging exercises prematurely.
Essential Movements to Avoid During Recovery
Certain exercises must be temporarily avoided because they place undue pressure on the weakened linea alba, which can worsen the separation rather than heal it. The general rule is to avoid any movement that causes the abdomen to visibly bulge, dome, or cone along the midline. This doming indicates that the intra-abdominal pressure (IAP) is too high and is stressing the compromised connective tissue.
Traditional crunches, sit-ups, and reverse crunches are contraindicated during recovery. These movements primarily recruit the rectus abdominis. Exercises involving lifting both legs simultaneously, like double leg lifts or the Pilates 100, generate significant IAP and must also be avoided.
Planks and push-ups, especially in their traditional form, can be problematic due to the high IAP they generate, causing the abdominal wall to tent or bulge. High-impact activities like running, jumping, and certain intense yoga poses like Boat Pose should also be avoided initially, as the repetitive impact and strain challenge core integrity. Instead, modifications like wall planks or exercising against an incline are recommended to safely build strength.
Professional Intervention and Surgical Options
Some cases of diastasis recti require specialized care or surgical intervention. A Women’s Health Physical Therapist (PT) is often the most beneficial resource, particularly if the separation is persistent or if the person is experiencing associated symptoms like lower back pain, pelvic pain, or urinary incontinence. A specialized PT can perform a thorough assessment, create a personalized rehabilitation plan, and progress exercises safely.
Physical therapy can lead to significant functional improvement, but it may not always resolve the cosmetic appearance of a large separation. When a separation remains wide (greater than two to three finger-widths or 2.5 cm) after dedicated rehabilitation, or if a hernia is present, surgical repair may be considered. The procedure, known as abdominoplasty or a “tummy tuck,” involves manually stitching the separated rectus abdominis muscles back together (rectus plication). Surgery is typically reserved for severe cases after conservative, non-surgical methods have been attempted without success.