Diastasis recti (DR) is a common condition involving the separation of the rectus abdominis muscles, the paired vertical muscles often called the “six-pack.” This separation occurs when the linea alba, the connective tissue that runs down the center of the abdomen, stretches and widens. While this stretching is a natural adaptation, particularly during the later stages of pregnancy, the resulting abdominal wall laxity can persist long after childbirth. Natural healing focuses on non-surgical techniques designed to restore the functional integrity and tension of the linea alba.
Identifying the Abdominal Separation
Identifying diastasis recti begins with a simple self-assessment, often called the “finger test.” To perform this, lie on your back with your knees bent and feet flat on the floor, placing one hand behind your head for support. Place the fingers of your opposite hand, pointing toward your pelvis, onto your midline just above the navel.
Gently lift your head and shoulders a short distance off the floor, engaging the abdominal muscles. This position allows you to measure the gap between the two sides using the width of your fingers. A separation of two or more finger-widths, or approximately 2 centimeters, is generally considered to be diastasis recti.
Beyond the width of the gap, assess the depth and tension of the connective tissue beneath your fingers. A wide but shallow separation, meaning you feel resistance quickly, may be less concerning than a narrower gap where your fingers sink deeply into soft tissue. This tissue tension indicates the functional capacity of the deep core to stabilize the midline. Check the width and depth at the navel, above the navel, and below the navel, as the separation can vary along the length of the linea alba.
Rebuilding Core Connection Through Movement
Rebuilding the functional connection of the core muscles starts with proper breathing mechanics. This foundational work focuses on the transverse abdominis (TrA), the deepest layer of abdominal muscle that acts like an internal corset around the midsection. Engaging the TrA helps to manage the pressure within the abdomen and draw the separated muscles closer together, restoring tension to the stretched linea alba.
Foundational Breathing
The most effective technique is diaphragmatic or 3D rib breathing, which emphasizes inhaling into the sides and back of the ribcage rather than pushing the belly outward. As you exhale, gently draw the navel toward the spine, consciously activating the TrA muscle. This controlled exhalation and core engagement is crucial for regulating intra-abdominal pressure (IAP), preventing the outward pressure that can further strain the midline.
Connecting this breathing to the pelvic floor is essential, as these two muscle groups work in coordination. The synchronized contraction of the pelvic floor and the TrA upon exhalation enhances core stability and supports the healing process. Consistent practice of this coordinated breath in various positions builds the muscle memory necessary for daily function.
Postural Alignment
Maintaining optimal postural alignment is another element in reducing the strain on the abdominal wall. When standing or sitting, positioning the ribcage directly over the pelvis helps prevent the abdominal muscles from being chronically lengthened or shortened. Poor posture, such as a swayback or excessive forward leaning, can increase IAP and place stress on the compromised linea alba.
Focusing on a neutral spine position ensures that the core muscles are in an ideal position to activate and support the trunk. Even small adjustments to the way you stand, sit, and move throughout the day can significantly impact how your deep core system manages pressure. This consistent postural awareness reinforces the work done during specific exercises and helps sustain the tension across the midline.
Specific Gentle Exercises
Once foundational breathing is established, gentle, low-impact movements can be introduced to strengthen the deep core without causing bulging or doming. The pelvic tilt is an excellent starting exercise, performed while lying on the back with knees bent. This movement involves gently tightening the abdominal muscles to flatten the lower back slightly against the floor, holding for a few seconds to engage the lower abdominals and promote better posture.
Heel slides are another safe and effective exercise that targets the TrA while introducing controlled movement. Lying on your back with your core gently engaged, slowly slide one heel along the floor until the leg is extended, then return it to the starting position. The focus must remain on maintaining a stable pelvis and an engaged core throughout the entire range of motion, preventing any arching in the lower back.
Toe taps are a progression that requires more control and core strength. Starting with both legs in a tabletop position, you exhale and gently lower one foot to tap the toe on the floor. If the abdomen bulges or the form breaks down, the exercise should be modified or postponed until sufficient TrA strength is achieved. These gentle, controlled movements are designed to strengthen the core from the inside out.
Activities That Hinder Natural Healing
For healing to occur, avoid specific movements and activities that increase intra-abdominal pressure (IAP) beyond what the weakened linea alba can manage. Any action that causes the abdominal wall to visibly bulge, dome, or “cone” along the midline should be avoided immediately. This outward pressure strains the already stretched connective tissue, which can prevent the separation from narrowing and may even worsen the condition over time.
Traditional abdominal exercises that involve spinal flexion, such as crunches and sit-ups, are among the most detrimental movements. When the shoulders lift off the ground, it is nearly impossible to prevent the abdominal muscles from pushing forward, which directly exacerbates the separation. Similarly, full planks, push-ups, and exercises that require aggressive twisting or lifting both legs simultaneously from a supine position should be modified or avoided until the core has fully recovered.
Heavy lifting, especially overhead lifting or carrying heavy objects without proper core bracing, also increases IAP significantly. When performing necessary lifts, such as picking up a child or groceries, you must exhale and engage the deep core to manage the pressure safely. Even daily movements require modification, such as using the “log roll” technique to transition from lying down to sitting up. This technique involves rolling onto your side first and then using your arms to push yourself up, thereby avoiding direct strain on the midline.
Recognizing When Professional Help is Needed
While many cases of diastasis recti improve with self-management and targeted exercises, professional guidance is sometimes necessary. A Pelvic Floor Physical Therapist (PFPT) is a specialist who can provide a precise assessment of the separation, including the functional quality of the linea alba and the coordination of the deep core muscles. They can confirm whether you are activating the TrA and pelvic floor correctly, which is often difficult to gauge on your own.
You should seek professional help if you experience persistent symptoms that do not improve after several months of consistent, targeted exercise. Other indicators include chronic low back, hip, or pelvic pain, as well as symptoms of pelvic floor dysfunction, such as urinary incontinence or a feeling of heaviness in the pelvis. A PFPT can create a personalized and progressive recovery plan, addressing any underlying postural or muscular imbalances that hinder healing.
In rare instances where the separation is severe, or if an umbilical hernia is present, a medical professional may discuss surgical options. This surgical repair, typically an abdominoplasty or “tummy tuck,” is generally considered a last resort when non-surgical methods have failed to restore functional core strength. However, even in cases leading to surgery, physical therapy is often recommended both before and after the procedure to maximize functional recovery and stability.