Diastasis recti (DR) is the separation of the rectus abdominis muscles, commonly known as the “six-pack” muscles, along the midline of the abdomen. This condition primarily affects postpartum individuals. Non-surgical repair focuses on restoring the function and tension of the connective tissue, the linea alba, which is stretched rather than torn. This approach utilizes targeted movements to rebuild core stability and manage the internal pressure that contributes to the separation.
Understanding Diastasis Recti
Diastasis recti is defined as a widening of the gap between the left and right sides of the rectus abdominis muscles, caused by the thinning and stretching of the linea alba. A separation greater than two finger-widths is generally considered a diastasis. The goal of non-surgical intervention is to improve the tension and firmness of the linea alba.
Individuals can perform a simple self-check by lying on their back with knees bent and feet flat. Gently lifting the head and shoulders slightly allows the fingers to probe the midline of the abdomen for a gap. Checking the width and depth offers an initial assessment. However, a professional diagnosis from a healthcare provider is recommended to confirm the condition.
Core Principles of Non-Surgical Repair
The foundation of repairing diastasis recti lies in mastering intra-abdominal pressure (IAP) management, which starts with proper breathing. The core is conceptualized as a canister, where the diaphragm forms the lid and the pelvic floor forms the base. Diaphragmatic, or 360-degree, breathing encourages the core to expand laterally and posteriorly upon inhale, avoiding excessive forward pressure.
This breathing technique is paired with activating the deep core muscles, specifically the Transversus Abdominis (TA). On a full exhale, the TA should be gently engaged, felt as a subtle inward pull or “zipping up” motion from the pubic bone toward the navel. This controlled muscle engagement provides stabilizing tension across the linea alba.
Postural awareness is equally important, as misalignment prevents the core canister from functioning efficiently. Maintaining a neutral posture involves stacking the rib cage directly over the pelvis, avoiding the tendency to thrust the ribs forward or tuck the hips under. Correct alignment ensures the diaphragm and pelvic floor are positioned optimally to work in synergy, allowing the deep core muscles to engage effectively.
Specific Targeted Exercises and Movements
Rehabilitation begins with low-load movements that focus on isolation and coordination of the deep core muscles, starting from the most supported positions. The primary goal is to perform each exercise while maintaining TA engagement and preventing any doming or coning along the midline. A guided TA contraction, or abdominal bracing, is the first step, often practiced while lying on the side or back with knees bent.
Once the foundational brace is mastered, exercises like the Pelvic Tilt can be introduced. While lying supine, the individual gently flattens the lower back to the floor by tilting the pelvis, coordinating the movement with an exhale and TA engagement. Heel Slides are another restorative movement, where one heel is slowly slid away from the body on the exhale, ensuring the lower back remains stable.
Progression occurs gradually, beginning with movements in a supine position and advancing to quadruped (hands and knees) or seated positions only when core stability is maintained. Gentle bridging exercises can also be performed, lifting the hips slightly while focusing on glute and TA engagement. Any sign of “coning,” which is a noticeable ridge forming down the midline, indicates the abdominal wall is overloaded and the exercise should be regressed.
Activities and Habits That Hinder Recovery
Healing requires avoiding activities that aggressively increase IAP or place undue strain on the weakened linea alba. Traditional abdominal exercises involving spinal flexion, such as crunches, sit-ups, and V-ups, must be avoided in the initial phases. These movements force the rectus abdominis to contract, pushing the internal organs outward and worsening the separation.
Planks and push-ups, while excellent for core strength, can create excessive IAP and should be modified or skipped until significant healing has occurred. Similarly, heavy lifting or straining, including during bowel movements, must be approached with caution and careful core engagement. The key rule is to avoid any movement that causes the abdomen to visibly bulge, cone, or dome.
Even daily habits require modification, particularly the method for getting in and out of bed. Instead of “jackknifing” straight up, which puts massive pressure on the midline, the safe technique is the “log roll.” This involves rolling the entire body as a single unit onto the side, then using the arms to push the torso up to a seated position, minimizing abdominal strain.
Timeline, Expectations, and When to Consult a Specialist
Recovery from diastasis recti is a gradual process that demands consistency. Noticeable functional improvements often appear within six months of dedicated work, but complete resolution of symptoms and core function can take 6 to 12 months or longer.
A pelvic floor physical therapist (PFPT) is the most qualified professional to guide non-surgical repair. A PFPT provides an individualized assessment, creates a targeted exercise program, and offers hands-on techniques and biofeedback to ensure the correct deep core muscles are activating. They are also skilled in addressing related issues, such as low back pain or pelvic floor dysfunction.
A specialist should be consulted if the gap is wider than three to four finger-widths and shows no improvement after several months of consistent work. Other indicators that non-surgical methods may be insufficient include persistent pain, signs of a hernia (a noticeable lump near the separation), or accompanying symptoms like urinary incontinence or pelvic pressure that do not resolve. These signs suggest a need for professional medical evaluation.