Diastasis recti (DR) is a common condition characterized by the separation of the left and right sides of the rectus abdominis muscles (“six-pack” muscles). This separation results from the stretching and thinning of the connective tissue between them, known as the linea alba. While most frequently associated with pregnancy, it is a treatable physical change. Recovery aims to restore the function and integrity of the abdominal wall through targeted, safe movements that strengthen the deep core muscles to manage internal pressure and improve stability.
Understanding Diastasis Recti
The rectus abdominis is a pair of muscles running vertically down the front of the abdomen, joined by the linea alba, a band of fibrous tissue. During pregnancy, the uterus expands, pushing abdominal organs outward and causing a significant increase in internal pressure against the abdominal wall. This sustained pressure stretches and widens the linea alba, leading to muscle separation.
Diastasis recti is typically classified when the gap measures more than two finger-widths (approximately 2.7 centimeters). You can perform a simple self-check by lying on your back with your knees bent and feet flat. Place your fingers, pointing toward your pelvis, on your midline near your belly button. While supporting your head, lift your head and shoulders slightly off the floor, like the start of a crunch, and gently feel for the width of the gap between the muscle ridges. If you feel a separation of two or more fingers, you may have the condition.
Essential Safe Movement Principles
Recovery requires a fundamental shift in movement to control intra-abdominal pressure (IAP) and avoid exacerbating the separation. Movements that place intense, outward pressure on the abdominal wall must be avoided as they can worsen the condition. These high-pressure activities include traditional core exercises like crunches, sit-ups, V-sits, and full planks. Avoiding heavy lifting or any exercise that causes the abdomen to visibly bulge or “dome” down the midline is also important.
Proper body mechanics for daily activities are important for healing. When getting out of bed or standing up from a reclined position, always utilize the “log roll” technique. This involves rolling onto your side first, then using your arms to push yourself up to a seated position while keeping your core relaxed and neutral. This technique prevents the forceful contraction of the rectus abdominis that occurs when sitting straight up. Additionally, exhale with effort during tasks like lifting or pushing, as this helps engage the deep core muscles to manage IAP.
Targeted Core Rehabilitation Exercises
The primary focus of rehabilitation is strengthening the transverse abdominis (TA), the deepest layer of abdominal muscle, which acts like a natural corset to stabilize the trunk. Activation of the TA and the pelvic floor muscles is the foundation of all safe core work. Consistency in these low-impact movements is more beneficial than high-intensity exercise.
Deep core breathing, also known as transverse abdominis bracing, is the foundational exercise. Lie on your back with bent knees and place your hands on your lower abdomen. Inhale deeply, allowing your belly to rise slightly, then exhale slowly while gently drawing your belly button toward your spine without tilting your pelvis. This subtle action engages the deep TA muscle and should be practiced multiple times a day in various positions.
Pelvic tilts are beneficial exercises that connect the deep core to the pelvis. From the same lying position, gently press your lower back into the floor, slightly tilting your pubic bone toward your belly button, and hold the contraction for a few seconds. This movement should be small and controlled, avoiding a large arch or excessive force. The goal is to feel the lower abdominal muscles activate without any coning or doming.
Heel slides build upon this foundation by adding controlled limb movement. Maintain the gentle TA activation from the bracing exercise. Slowly slide one heel away from your body along the floor until the leg is straight, then slowly return it to the starting position, keeping the core engaged. Move only as far as you can without losing the deep abdominal connection or letting your lower back arch off the floor.
As core strength improves, you can progress to exercises like wall squats or toe taps, always ensuring the TA is braced first. For toe taps, begin with legs in a tabletop position (knees bent at 90 degrees over hips) and slowly lower one toe to tap the floor, then return it. This controlled movement strengthens the TA while challenging stability. If you observe the telltale coning of the abdomen during any exercise, you have progressed too quickly or are not properly engaging the deep core.
When Professional Intervention is Necessary
While self-management with safe exercises helps many, some situations require evaluation by a specialized health professional. If your abdominal separation is wide, if you experience persistent symptoms like low back pain, or if you make no noticeable progress after several months of consistent rehabilitation, seek guidance. A pelvic floor physical therapist (PT) is the ideal professional, as they can accurately assess the separation and evaluate the function of the pelvic floor, which works in tandem with the deep core.
Pelvic floor PTs can provide biofeedback and individualized programs tailored to your needs, which is helpful if you struggle to correctly activate the transverse abdominis or if related issues like urinary incontinence are present. In rare cases of severe diastasis recti (defined by a very large separation or a hernia), surgical intervention may be considered. This procedure, typically part of an abdominoplasty or “tummy tuck,” involves suturing the separated rectus abdominis muscles back together in a process called plication. Surgery is considered a last resort when non-surgical methods have failed and functional impairment is significant.