Diastasis recti (DR) is a common condition resulting from the stretching and separation of the two vertical bands of abdominal muscle, the rectus abdominis, during pregnancy. This separation occurs along the midline connective tissue, the linea alba, which thins and widens to accommodate the growing uterus. While DR is a normal physical adaptation, the separation often persists postpartum, causing a visible “pooch” or functional core weakness. Recovery involves rebuilding the deep core musculature through targeted, safe movements and postural awareness to restore abdominal integrity.
Identifying the Separation and Severity
Identifying the separation and its severity begins with a self-assessment. Common signs of DR include a persistent abdominal bulge, lower back pain, and core instability. A visible “doming” or “coning” down the center of the abdomen when sitting up or straining strongly indicates diastasis recti.
To perform the self-check, lie on your back with knees bent and feet flat. Place your fingers, palm down, just above your belly button. Gently lift your head and shoulders a few inches off the floor while exhaling. This contracts the rectus abdominis, allowing you to feel the gap between the two muscle bellies.
Measure the width by noting how many fingertips fit horizontally into the space; two finger-widths or more is considered DR. Assess the depth, noting if your fingers sink in easily or if the underlying connective tissue feels firm. Check the separation at, above, and below the navel, as the gap varies along the midline.
Foundational Core Strengthening Techniques
Healing the separation requires strengthening the transverse abdominis (TA), the deepest abdominal layer. The TA acts like a natural corset, wrapping horizontally around the torso to stabilize the spine and draw the separated muscles closer. Techniques must use low-pressure exercises that encourage the connective tissue to regain tension without causing the abdominal wall to bulge or dome.
Diaphragmatic Breathing
The most fundamental exercise is diaphragmatic breathing, coordinating breath with core engagement. Lie on your back with knees bent, placing one hand on your chest and the other on your abdomen. Inhale deeply, allowing your ribs to expand and your belly to rise slightly. As you exhale, gently draw your abdominal muscles inward, imagining a subtle cinching action around your waistline. This controlled exhale encourages the TA to contract without excessive force.
TA Activation and Progression
Once breath coordination is mastered, progress to specific TA activation exercises. Perform a basic abdominal brace by placing fingers just inside your hip bones. As you exhale, gently pull the lower abdomen upward and inward, holding the contraction for a few seconds while breathing shallowly. The movement should be subtle, creating slight tension under your fingertips while the upper abdomen remains soft.
This gentle bracing can be incorporated into pelvic tilts, performed while lying on your back with bent knees. Engage the TA, then flatten your lower back against the floor by slightly tilting your pelvis upward. Heel slides are another effective progression: maintain the abdominal brace while slowly sliding one heel along the floor to straighten the leg, then return it.
Postural Awareness
Maintaining proper posture is a simple, effective daily healing practice that aligns the core and reduces strain on the linea alba. When standing, avoid thrusting the rib cage forward or excessively arching the lower back. Maintain a tall spine with relaxed shoulders and the deep core gently engaged. This constant, subtle engagement during daily activities reinforces exercise work.
Movements and Activities to Avoid During Recovery
Movements that increase intra-abdominal pressure can impede healing or worsen the separation by forcing tissues outward against the weakened linea alba. Any exercise causing the abdomen to visibly “dome” or “cone” down the midline must be avoided until core function is restored. This visual cue signals that the deep core muscles cannot manage the pressure effectively.
Traditional exercises that place forceful strain on the rectus abdominis are unsafe. These movements encourage forward bulging, working against the goal of drawing the muscles together.
- Full crunches and sit-ups
- Double leg lifts
- Holding a plank or performing push-ups (due to downward pressure)
- Heavy lifting without proper core engagement
- Deep backbends or twisting movements involving resistance
It is important to adjust how you transition from lying down to sitting up. Avoid sitting straight up, which mimics a crunch and causes doming. Instead, use the “log roll” technique: roll onto your side first, then use your arms to push your torso up to a seated position. This mindful change protects the recovering abdominal wall.
When to Seek Professional Guidance
While self-management is often successful, professional guidance aids complete recovery in certain situations. A physical therapist specializing in women’s health can accurately assess the separation and evaluate deep core and pelvic floor function. They provide a personalized, progressive exercise program, which is more effective than a generic routine.
Professional intervention is highly recommended if the separation measures three finger-widths or wider, or if persistent symptoms occur. Consult a specialist if you experience chronic lower back pain, pelvic pain, or difficulty controlling your bladder six months postpartum. These symptoms often indicate a deeper issue with core dysfunction and pressure management requiring expert assistance.
If the separation is severe, non-responsive to months of physical therapy, and accompanied by functional impairment, surgery may be an option. The procedure, typically an abdominoplasty, physically stitches the rectus abdominis muscles back together. Physical therapy is still recommended both before and after surgery to ensure the deep core muscles function correctly for long-term stability.