Diastasis recti (DR) is a common condition where the two parallel abdominal muscles, the rectus abdominis, separate. This separation occurs due to the stretching and thinning of the linea alba, the connective tissue running down the center of the abdomen. While DR frequently occurs during pregnancy due to the growing uterus, it can also affect men and infants. The resulting gap causes the belly to protrude, often described as a “pooch,” and may lead to functional issues like back pain or core weakness. Targeted exercise can often restore the integrity of the abdominal wall.
Identifying the Abdominal Separation
The rectus abdominis muscles are connected by the linea alba, a band of fascia that normally holds the muscles taut. Hormones and physical expansion, especially during pregnancy, cause this tissue to stretch and widen. A gap of 2 centimeters, or approximately two finger-widths, is considered a diagnosis of DR.
Performing the Self-Check
You can perform a simple self-check, often called the “finger test,” to assess the width and depth of the separation. Lie on your back with your knees bent and feet flat on the floor. Place your fingertips perpendicular to your midline, just above the belly button. Gently lift your head and shoulders a small amount, as if starting a crunch, and feel for the ridges of the contracting rectus muscles. Measure how many fingers fit snugly into the gap, and note how deep your fingers sink into the tissue. A separation wider than three or four fingers, or a midline that feels very soft and deep, suggests a more significant separation that warrants professional assessment.
Targeted Exercises for Core Restoration
The primary goal of exercise for diastasis recti is to restore tension to the linea alba by activating the deepest abdominal muscle, the Transverse Abdominis (TVA). The TVA acts like an internal corset, wrapping around the trunk to stabilize the core and support the stretched connective tissue. Engaging the TVA requires focused, low-impact movements rather than high-load exercises common in traditional core workouts.
Diaphragmatic breathing is foundational, as it teaches proper pressure management within the abdominal cavity. Lie on your back and inhale deeply, allowing the ribs to expand while keeping the belly relatively flat. Exhale slowly as you gently draw your navel toward your spine, feeling the TVA contract.
Core Activation Exercises
Simple movements like pelvic tilts are excellent starting points. While lying on your back, flatten your lower back against the floor by slightly tucking your pelvis, maintaining TVA engagement and exhaling. Heel slides are another effective exercise, performed by slowly sliding one heel along the floor. Extend the leg only as far as you can without causing your abdomen to dome or bulge. Focus on exhaling during extension, which helps manage intra-abdominal pressure. Toe taps, where you maintain a tabletop position and gently tap one toe down, challenge the TVA further while ensuring the lower back remains stable.
Movements and Activities to Avoid
Certain exercises must be temporarily avoided because they place excessive, forward-directed pressure on the healing linea alba, which can worsen the separation. Any action that causes the abdomen to “dome,” “cone,” or visibly bulge along the midline is a sign that the intra-abdominal pressure is too high.
Traditional core exercises like crunches, sit-ups, and full planks are common culprits, as they forcefully recruit the rectus abdominis. Intense twisting movements, such as bicycle crunches, or exercises requiring strong forward trunk flexion should also be avoided. High-impact activities like running, jumping, or heavy weightlifting can create too much downward force on the abdominal wall and pelvic floor.
It is also important to practice proper body mechanics in daily life. Avoid straining during bowel movements. Always roll onto your side when getting out of bed or pushing yourself up from a reclined position. When lifting objects, exhale and engage the TVA to stabilize the core before initiating the lift.
When Medical or Surgical Intervention is Necessary
While conservative exercises are the first line of defense, professional guidance should be sought if there is no noticeable improvement after six to twelve months of consistent, targeted physical therapy. A specialized pelvic floor physical therapist can provide an accurate diagnosis using tools like ultrasound and create a personalized rehabilitation plan. They can also address common co-existing issues, such as low back pain or pelvic floor dysfunction.
Surgical intervention is reserved for severe cases where the separation causes significant functional impairment or is resistant to conservative treatment. Symptoms that may indicate a need for surgical consultation include persistent lower back pain, chronic abdominal discomfort, or the presence of an associated hernia.
The surgical procedure to correct diastasis recti is an abdominoplasty, often called a “tummy tuck.” During this procedure, the surgeon manually plicates, or sutures, the stretched linea alba back together. Surgery is typically considered when the separation is 5 centimeters or more, and when the patient has completed a rehabilitation program without success.