Diastasis recti is a common condition where the two large vertical bands of the rectus abdominis muscle separate along the midline of the abdomen. This separation occurs due to the stretching and thinning of the linea alba, the connective tissue that runs down the center of the stomach. While this abdominal stretching is a natural adaptation during pregnancy, a gap of two finger-widths or more that persists postpartum is typically considered diastasis recti. Understanding the timing for exercise is important for safely managing and strengthening the core.
How to Self-Assess Diastasis Recti
Before beginning any core recovery program, check the degree of separation. Lie on your back with your knees bent and feet flat on the floor. Relax your abdominal muscles completely and place your fingers horizontally across your midline, just above your belly button.
Gently lift your head and shoulders a few inches off the floor, as if starting a small crunch. Feel the edges of the rectus abdominis muscles contract toward the center. Use your fingertips to feel for a gap between the two muscle bellies and measure the width of this space in finger-widths.
Check for the gap at the belly button, three fingers’ distance above it, and three fingers’ distance below it, as the separation may vary. If you feel a gap of two finger-widths or more, or if you notice a visible doming or bulging of the abdomen, this suggests the presence of diastasis recti.
Immediate Postpartum Core Management
In the immediate postpartum period, the focus should be on passive management and foundational core activation rather than formal strengthening. The body is undergoing significant healing, and excessive pressure on the abdominal wall can worsen the separation. Avoid any movement that causes the abdomen to dome or bulge along the midline.
Proper body mechanics for daily activities prevent undue strain on the linea alba. When getting out of bed, always use the “log roll” technique: roll onto your side first, then use your arms to push yourself up to a seated position. This modification prevents the sudden, forceful contraction of the rectus abdominis muscles.
Foundational core activation begins with deep diaphragmatic breathing. Inhale deeply, allowing the breath to expand the rib cage three-dimensionally. Exhale fully with a gentle draw of the belly button toward the spine. This subtle engagement activates the transverse abdominis, the deepest abdominal muscle, which stabilizes the core.
Timing and Safe Progression of Formal Exercises
Formal, progressive strengthening exercises begin after the initial six-to-eight-week postpartum period, pending clearance from a healthcare provider. The goal of early exercise is to strengthen the deep stabilizing muscles, primarily the transverse abdominis, without creating outward pressure on the stretched connective tissue. Exercises must be performed without causing any coning or doming of the abdominal wall.
Safe initial exercises include gentle movements like pelvic tilts, where you subtly flatten your lower back against the floor. Heel slides, performed by extending one leg along the floor while maintaining core engagement, are another starting point. These movements focus on isolated muscle control and stability, gradually building the foundation for more demanding work.
Exercises that generate high intra-abdominal pressure should be strictly avoided in the early stages, as they can worsen the separation. These include traditional spinal flexion movements such as crunches and sit-ups. Any exercise that causes pain or visible abdominal bulging is an indicator to stop and regress the movement.
Until the core has significantly healed and the gap is resilient, avoid:
- High planks
- Push-ups
- Bicycle crunches
- Heavy lifting
When to Seek Professional Physical Therapy
Professional intervention is necessary if certain indicators are present. A referral to a pelvic floor physical therapist should be considered if the abdominal separation measures three or more finger-widths, suggesting the need for more targeted assessment and rehabilitation.
Professional guidance is also recommended if you experience persistent symptoms that interfere with daily life, such as chronic lower back pain or hip pain. If you have been consistently performing safe core exercises for about 12 weeks without noticing improvement in the gap or your symptoms, a physical therapist can adjust your program.
The presence of concurrent pelvic floor symptoms is another strong reason to seek specialized physical therapy. These symptoms include:
- Urinary incontinence
- Pelvic heaviness
- Difficulty with bowel movements
A physical therapist provides a comprehensive assessment and designs a personalized exercise program. They focus not only on the abdominal gap but also on the coordinated function of the entire deep core unit, which includes the diaphragm and the pelvic floor. Physical therapy is the recommended first-line treatment.