UNDERSTANDING DIASTASIS RECTI: HOW PHYSICAL THERAPY CAN HELP YOU HEAL
Written by Ali Anderson, PT, DPT, CAFS, PCES
Reviewed by Anna McMaster, PT, DPT, PRPC
As a pelvic floor physical therapist, one of the most common concerns I hear from postpartum clients is: "Why does my stomach still look pregnant months after birth?" More often than not, the answer lies in a condition called diastasis recti.
WHAT IS DIASTASIS RECTI?
Diastasis recti (often abbreviated as DR or DRA) is a separation of the rectus abdominis muscles -- the "six-pack" muscles at the front of your abdomen. This occurs when the connective tissue called the linea alba stretches and thins, often due to increased intra-abdominal pressure and stretching of the muscles in order to make room for the baby. While it's most common during and after pregnancy, it can also occur in men or non-postpartum individuals due to excessive abdominal straining or improper exercise technique.
Some separation of these muscles is a normal part of pregnancy -- your body is making room for your growing baby. But when the tissue doesn't return to its original tension after birth, it can lead to ongoing issues like a belly "pooch," lower back pain, poor posture, or even pelvic floor dysfunction.
SIGNS YOU MIGHT HAVE DIASTASIS RECTI
A visible bulge or doming in the midline of your abdomen, especially when you sit up or strain
A soft gap between the abdominal muscles, typically at or above the belly button
A sense of core weakness or instability
Lower back or pelvic pain
Difficulty engaging your core during movement
MANAGING DIASTASIS RECTI: WHERE PHYSICAL THERAPY COMES IN
Here's the good news: diastasis recti can be managed and improved with the right approach, and physical therapy plays a key role.
As a pelvic floor PT, I don't just look at your abdominal separation -- I look at your whole system. That includes posture, breathing mechanics, pelvic floor function, and how you move through daily tasks and exercises. Here's how we help:
Assess the separation and function: We start by measuring the width and depth of your abdominal separation, but more importantly, we assess how well your core can engage. Current research supports this whole-picture approach -- we now understand that the ability of the linea alba to generate tension and resist distortion is what matters most for function, not just the size of the gap itself. A wide separation isn't always problematic; what matters is whether the tissue can support you during movement.
Reconnect your core and breath: We teach you to re-engage your deep core muscles -- especially the transverse abdominis -- in coordination with your diaphragm and pelvic floor. Breathing strategies are often the first step to building tension in the linea alba and improving core stability.
Progressive strengthening: We'll guide you through safe, progressive core strengthening exercises that manage excessive intra-abdominal pressure. Crunches and planks aren't necessarily off-limits forever -- but timing and technique matter.
Functional movement re-training: Whether you're lifting your baby, getting out of bed, or returning to exercise, we help you move in ways that support your healing and prevent further strain.
Address contributing factors: Pelvic floor dysfunction, poor posture, constipation, and improper lifting techniques can all interfere with recovery. We address these holistically to set you up for long-term success.
What many people don't realize is that virtual pelvic floor PT can address most of these concerns just as effectively as in-person care. Through a virtual session, your PT can assess your movement patterns, guide you through breathing and reconnection strategies, and build a progressive plan you work through on your own timeline -- from home. It's something we offer at Amie.
WHEN TO SEEK HELP
If you're a few months postpartum and still noticing a bulge or doming in your abdomen, or if your core just doesn't feel right, you don't have to "wait it out." Physical therapy can help at any stage -- even years after pregnancy.
YOU DESERVE TO FEEL STRONG IN YOUR BODY
Diastasis recti is common, but that doesn't mean you have to live with it. With personalized support and guided movement, healing is absolutely possible.
For personalized diastasis recti support, Amie offers programs designed by pelvic floor PTs for every stage of your journey.
References:
Benjamin, D.R., van de Water, A.T.M., & Peiris, C.L. (2014). Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy, 100(1), 1-8.
Gluppe, S.L., Engh, M.E., & Bø, K. (2021). Women with diastasis recti abdominis might have weaker abdominal muscles and more abdominal pain, but no higher prevalence of pelvic floor disorders, low back and pelvic girdle pain than women without diastasis recti abdominis. Physiotherapy, 111, 57-65.
Lee, D., & Hodges, P.W. (2016). Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study. Journal of Orthopaedic & Sports Physical Therapy, 46(7), 580-589.
Mota, P., Pascoal, A.G., Carita, A.I., & Bø, K. (2015). Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual Therapy, 20(1), 200-205.