Diastasis recti (DR) is a common condition where the left and right sides of the outermost abdominal muscle, the rectus abdominis, separate along the midline of the abdomen. This separation is caused by the stretching of the fibrous connective tissue that runs vertically between the muscles, known as the linea alba. While most frequently seen in the postpartum period, DR can also occur in men and children due to factors like significant weight gain or improper core training. The result is often a visible bulge or “pooch” that can lead to symptoms like lower back pain, poor posture, and pelvic floor dysfunction. While surgical repair is an option for severe cases, non-surgical methods focusing on targeted core rehabilitation are often successful in restoring function.
Understanding and Identifying Diastasis Recti
Diastasis recti involves the widening of the space between the abdominal muscles, which is primarily caused by excessive intra-abdominal pressure pushing outward on the linea alba. Pregnancy is the most common cause, as the growing uterus puts sustained outward pressure on the abdominal wall. However, improper lifting techniques or intense abdominal exercises can also be culprits. The separation is measured by the width of the gap between the muscles; a gap wider than two finger-widths is considered diagnostic.
You can perform a preliminary self-assessment using a simple finger test. Lie on your back with your knees bent and your feet flat on the floor. Place your fingers horizontally across your midline, either just above or below your navel, pointing toward your pelvis. Next, gently lift your head and shoulders a short distance off the floor, as if beginning a small crunch.
As you lift your head, feel the two bands of the rectus abdominis muscles tighten around your fingers. Gently press down to feel the space between the muscles, noting both the width and the depth of the separation. Repeat the process at the navel, and then a few inches above and below it, as the separation can vary along the midline. If you feel a separation of two fingers or more, or notice a noticeable bulging or doming of the abdomen during the test, seek professional confirmation from a physical therapist or doctor.
Core Principles of Non-Surgical Repair
The foundation of non-surgical repair focuses on restoring the function of the deep core muscles and managing intra-abdominal pressure. The primary goal is to improve the tension and integrity of the linea alba and the overall core system, not just reduce the width of the gap. This is achieved by specifically activating the transverse abdominis (TA), which acts like a natural corset for the trunk.
Learning to engage the Transverse Abdominis (TA) is a crucial step in the recovery process. This muscle is activated through specific breathing and bracing techniques. One technique involves lying on your back with knees bent, taking a deep breath in to allow the belly to relax and expand. As you exhale fully, gently draw your belly button inward toward your spine, feeling a gentle tension or firmness under your fingers just inside your hip bones.
This gentle contraction should be felt low in the abdomen and must be done without tensing the outer “six-pack” muscles or holding your breath. The goal is to hold this subtle engagement for several seconds while maintaining normal breathing, gradually increasing the duration and repetitions. Incorporating this TA activation, or abdominal bracing, into movements like heel slides and pelvic tilts helps to reinforce the core without worsening the separation.
Maintaining optimal posture and alignment throughout the day is another important principle. A slumped or overly arched posture can place unnecessary strain on the abdominal wall and the linea alba. By standing and sitting with a neutral spine—shoulders relaxed, head lifted, and a slight inward curve in the lower back—you encourage the deep core muscles to engage naturally. This constant awareness helps to minimize the pressure pushing outward on the abdominal wall during daily activities.
A specialized Women’s Health Physical Therapist is highly recommended for creating a customized recovery plan. They can use tools like real-time ultrasound to ensure you are correctly activating the deep core muscles. A physical therapist will also integrate pelvic floor exercises, which are closely linked to core stability, and progress your movements safely as the healing occurs.
Movements and Habits to Avoid During Healing
To protect the healing linea alba, avoid any activity that forcefully increases intra-abdominal pressure, causing the abdomen to bulge or dome outward. This bulging motion, often called “coning,” signals that the pressure is too great for the connective tissue and can worsen the separation. Therefore, traditional abdominal exercises like full crunches, sit-ups, and twisting movements must be avoided entirely.
Standard planks, push-ups, and exercises involving heavy overhead lifting should also be avoided until the deep core is functional and healed. These movements create intense forward pressure on the abdominal wall that weakened tissue cannot manage. Focus instead on controlled, gentle movements that encourage deep muscle activation without causing the abdomen to visibly strain.
Daily activities require modification to prevent unnecessary abdominal strain. Avoid the “jackknife” motion of sitting straight up from lying down, as this puts significant pressure on the linea alba. To get out of bed safely, use the “log roll” technique: roll onto your side, keeping your trunk straight, and then use your arms to push your body up into a sitting position while lowering your legs off the bed.
Simple actions like coughing, sneezing, or laughing also generate high levels of intra-abdominal pressure. When these actions are unavoidable, gently brace your core by drawing the belly button inward or hugging a pillow for external support. Additionally, avoid holding your breath while lifting any object, and consciously exhale during the effort to help manage internal pressure.