Diastasis recti (DR) is a common condition, especially following pregnancy, where the two halves of the outermost abdominal muscle separate. This separation occurs at the midline connective tissue, known as the linea alba. For many individuals, the question of whether high-impact activities like running are safe becomes a significant concern after a diagnosis of DR. While the condition does not automatically rule out running, the body’s ability to manage the forces involved dictates a safe return to the activity. The focus shifts from simply closing the gap to restoring the function and tension of the entire core system.
Understanding Diastasis Recti
Diastasis recti is defined as a widening and thinning of the linea alba, the connective tissue that connects the left and right sides of the rectus abdominis muscles. This stretching creates a gap between the abdominal muscles, which compromises the stability of the abdominal wall. The condition is common, affecting nearly all women in the third trimester of pregnancy as the uterus expands and increases intra-abdominal pressure.
The separation can manifest as a visible bulge or “pooch,” particularly when the abdominal muscles are engaged. A simple self-assessment involves lying on your back with knees bent and gently lifting your head to contract your abs. Placing your fingers horizontally just above or below the belly button, you can feel for a gap and measure its width in finger-widths. While a separation of two or more finger-widths is often considered DR, the depth and tension of the tissue felt beneath the fingers are more important than the width alone.
The Impact of High-Impact Exercise on the Abdominal Wall
Running is classified as a high-impact exercise because repetitive ground reaction forces generate significant stress on the body with each stride. This motion increases intra-abdominal pressure (IAP), which must be effectively contained by the core and pelvic floor muscles. When the linea alba is stretched and weakened by DR, it acts as a less stable containment system for this internal pressure.
The force of running pushes outward against the compromised midline, potentially widening the separation or delaying connective tissue healing. A clear physical sign that the core cannot handle the pressure is “doming” or “coning,” where the middle of the abdomen visibly protrudes during the activity. Symptoms that signal running is unsafe include lower back pain, pelvic pressure or heaviness, and urinary leakage. These indicate a failure of the trunk stability system to manage the load, suggesting a need to pause high-impact exercise and focus on foundational strength.
Guidelines for Safely Resuming Running
A safe return to running requires meeting specific foundational criteria, not just waiting a set amount of time postpartum. Although a minimum of 12 weeks is often recommended for initial healing, you should first be able to walk briskly for 30 minutes without experiencing symptoms like doming, pain, or pelvic heaviness. The core must demonstrate the ability to generate tension across the linea alba, which is the functional goal of DR recovery regardless of the ultimate gap width.
A proper return-to-running program should be gradual, beginning with a walk/run progression to slowly reintroduce impact. This progression involves short bursts of running interspersed with walking, gradually increasing the running duration over time. During the run phases, focus on maintaining good posture (ribs stacked over the pelvis) and practicing proper breathing to manage IAP. Increasing your running cadence, aiming for approximately 170 steps per minute, can also reduce impact forces on the abdominal wall.
Consulting a pelvic floor physical therapist (PFPT) is recommended. They can accurately assess deep core function and design a personalized return-to-sport plan. A PFPT ensures that the pelvic floor and deep core muscles are strong enough to stabilize the trunk against the demands of running, and they can provide specific cues to prevent compensatory movements that strain weakened tissues.
Supportive Core Rehabilitation
Core rehabilitation for DR focuses on restoring the function of the deep stabilizing muscles, primarily the transverse abdominis (TrA). The TrA acts like a natural corset; strengthening it helps cinch the abdominal wall and provide tension to the stretched linea alba. Exercises should prioritize low-load, deep core activation, often taught through specific breathing and bracing techniques.
Gentle movements like pelvic tilts, heel slides, and glute bridges are excellent starting points because they engage the core without creating excessive IAP. Diaphragmatic breathing, which coordinates the movement of the diaphragm and pelvic floor, is foundational for retuning the core system. These exercises help the body learn to stabilize the trunk before progressing to more challenging movements.
Conversely, traditional abdominal exercises that significantly increase IAP should be avoided until the core is fully functional, as they can cause coning and worsen the separation. This includes movements that result in visible doming or strain, such as:
- Crunches
- Sit-ups
- Full planks
- Heavy overhead lifting
The goal is to build a strong, responsive core that can manage pressure effectively in all movements.