Diastasis recti (DR) is a common condition where the two vertical bands of abdominal muscle, the rectus abdominis, separate. This separation occurs due to the thinning and stretching of the midline connective tissue, the linea alba, often resulting from increased intra-abdominal pressure during pregnancy. The goal of corrective exercise is not simply to “close the gap,” but to restore tension and function to this stretched connective tissue. Understanding the foundational approach to core activation is necessary before attempting specific movements to ensure safe and effective repair.
Understanding Diastasis Recti
Diastasis recti involves the widening of the gap between the left and right sides of the rectus abdominis muscles. This separation happens along the linea alba, the band of tissue that runs down the center of the abdomen and connects the two muscle halves. During pregnancy, hormonal changes and the expansion of the uterus place significant strain on this tissue, causing it to stretch and lose elasticity.
A noticeable symptom is a visible bulge or “pooch” in the abdomen, which is often more prominent when straining or contracting the abdominal muscles, a phenomenon known as coning or doming. Other symptoms can include lower back pain, poor posture, and pelvic floor issues, such as incontinence. For a simple self-check, lie on your back with knees bent and lift your head slightly. Placing fingers perpendicular to the midline, just above or below the belly button, can reveal the width of the gap; two or more finger-widths is often considered an indication of diastasis recti.
Foundational Approach to Core Restoration
Effective repair focuses on the deepest layer of the core, the transverse abdominis (TA), rather than the superficial muscles. The TA acts like an internal corset, wrapping around the abdomen and connecting to the linea alba. When activated correctly, the TA pulls the abdominal wall inward and generates tension across the linea alba, which is the mechanism of functional recovery.
Before initiating movement, diaphragmatic breathing should be mastered to establish a connection with the deep core. This involves inhaling deeply to allow the ribcage to expand, and then fully exhaling while gently drawing the belly button inward toward the spine. This drawing-in maneuver isolates and strengthens the TA without tilting the pelvis or bracing excessively. Consistent TA activation is a prerequisite for all subsequent exercises.
The primary goal is to restore the integrity of the connective tissue by increasing its tension and stiffness. This functional approach improves core stability and reduces the doming that accompanies increased intra-abdominal pressure. Engaging the TA before movement ensures that the deep stabilizers support the core throughout daily activities and exercise routines.
Specific Exercises for Repair
Once foundational TA activation is consistently achieved, a progression to gentle movements can begin to integrate the deep core muscle into functional patterns.
Pelvic Tilts
Pelvic tilts are an excellent starting point, performed while lying on the back with knees bent and feet flat. The TA is engaged on the exhale to gently flatten the lower back against the floor, slightly rocking the pelvis backward. Slowly return to a neutral position on the inhale.
Heel Slides
Heel slides further challenge core stability without excessive strain on the linea alba. While maintaining TA engagement, one heel slowly slides out along the floor, extending the leg without allowing the lower back to arch or the abdomen to dome. The leg is then slowly returned to the starting position, alternating sides for controlled repetition.
Modified Bird-Dogs
Modified bird-dogs strengthen the core, glutes, and lower back, provided they are performed with strict attention to form. Starting on hands and knees, the TA is braced before slowly extending one leg straight back, keeping the hips level and the spine neutral. Once mastered, the opposite arm can be extended simultaneously with the leg, ensuring no rotation or arching occurs in the lower back.
Wall Push-Ups
Wall push-ups, or similar modified push-ups, can be used to strengthen the upper body and integrate TA bracing into larger movements. Standing a comfortable distance from a wall, the TA is engaged before pushing away, maintaining a straight line from head to heels. The resistance should be low enough to prevent any coning or bulging of the abdomen, ensuring the core remains supported throughout the movement.
Crucial Movements to Avoid and When to Seek Expert Guidance
During the initial stages of recovery, it is necessary to avoid movements that significantly increase intra-abdominal pressure and cause the abdominal wall to bulge outward. The most commonly cited movements to avoid include traditional crunches, sit-ups, and full planks, as these place excessive strain on the already stretched linea alba. Twisting exercises and heavy lifting performed without proper core support should also be temporarily avoided.
The goal is to prevent the visible doming or coning that indicates the intra-abdominal pressure is pushing the organs and tissue through the muscle gap. When performing any exercise, individuals must constantly monitor their abdomen for this outward pressure, modifying the movement immediately if it occurs. Even seemingly simple actions, like sitting straight up from a lying position, should be avoided by rolling to the side first and using the arms to push up.
While self-guided exercise is helpful, there are clear indications for seeking consultation with a physical therapist specializing in pelvic health or postpartum recovery. A specialist can provide a tailored program and use tools like real-time ultrasound to ensure the TA is activating correctly and the linea alba is effectively tensioning.
When to Seek Expert Guidance
Professional guidance is advised if you experience:
- Abdominal separation wider than two or three finger-widths.
- Persistent lower back pain.
- Pelvic floor dysfunction.
- Lack of progress after several months of dedicated exercise.