Diastasis Recti: At-Home and Physical Therapy Exercises
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Medically reviewed by Theresa Marko, PT
Diastasis recti is a separation of the rectus abdominis muscle—commonly referred to as the "six-pack"—and thinning of the connective tissue that runs along the middle of this muscle called the linea alba.
While this abdominal muscle separation most commonly occurs as a result of pregnancy, it can affect men or women at any age. The primary treatment for this condition is physical therapy. Less typically, the condition resolves on its own or requires surgical repair.
This article discusses diastasis recti—why it happens, symptoms, and treatment options.
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Why Does Diastasis Recti Happen?
The rectus abdominis is the sizable abdominal muscle often alluded to as "six-pack abs." This muscle is fused in the middle, with a 1- to 2-centimeter (cm) division between the sides. Separation wider than 2 cm is diagnosed as diastasis recti.
Diastasis recti most commonly occurs during pregnancy or as a result of significant weight gain. It can also develop after abdominal surgery.
During Pregnancy and Postpartum
Diastasis recti can occur during pregnancy and after childbirth. As the belly expands, abdominal muscles have to stretch to accommodate this growth, including the connective tissue that holds the two sides of this muscle together. Excess stretching can cause a separation to occur during pregnancy and postpartum.
The exact reason why some pregnant or postpartum people experience diastasis recti while others don't isn't clear. However, there are possible risk factors for developing this condition, such as:
Pregnancy at an older age
Weight gain during pregnancy
High birth weight
Multiple pregnancies
Cesarean section (C-section; surgical delivery)
Diastasis recti often resolves on its own after childbirth, but approximately 1 in 3 women will still have this condition 12 months after delivery.
Outside of Pregnancy
Diastasis recti can affect both men and women outside of pregnancy—typically as a result of excess weight gain (obesity). It can also occur in people who have had abdominal surgery.
Symptoms of Abdominal Muscle Separation
Diastasis recti often causes a protrusion in the belly around the area of the belly button. This can be visible all the time or might only protrude after a person has eaten or drunk. This condition does not typically cause pain.
While this condition often develops during pregnancy, it might not be visible until after delivery.
You can perform a simple test at home, as follows, to determine whether you have a diastasis recti:
Lie on your back on a firm surface.
Bend your knees and place your feet flat on the floor.
Tighten your abdominal muscles and lift your upper body slightly off the ground.
Place your fingers in the middle of your abdominal muscles and gently press. Repeat this above your belly button, at the belly button, and just below it. If you feel a gap, you likely have diastasis recti.
Diastasis recti is typically classified by the number of finger widths that fit in the gap between the sides of your abdominal muscles.
Diagnosing Diastasis Recti
Diastasis recti is primarily diagnosed by a healthcare provider through palpation—gently pressing along the abdominal muscles to feel for a gap. The size of the gap can be measured in finger widths or using a measuring tool such as a ruler. In some cases, ultrasound imaging can be used to confirm the diagnosis and rule out conditions with similar symptoms, such as a hernia.
Effects on the Body
Diastasis recti isn't just a cosmetic issue. This condition can have other adverse effects on the body, contributing to:
Poor quality of life
Weakness of the abdominal muscles
Treatment Options for Diastasis Recti
Treatment for diastasis recti varies depending on the severity of the condition. The condition can resolve independently in some cases—such as after childbirth.
Physical therapy is the primary conservative treatment for diastasis recti. Interventions typically include:
Strengthening Exercises
Strengthening exercises target the rectus abdominis, transverse abdominis, and pelvic floor muscles. You can do some strengthening exercises at home, but proceed cautiously; progressing too quickly can do more harm than good. To reduce your risk of making your condition worse, consult a physical therapist for an individualized exercise program.
Abdominal Supports
Various braces, such as an abdominal binder or the application of kinesiology tape by a physical therapist, are sometimes used to support the abdominal muscles during healing.
A physical therapist might recommend that a person with this condition wear an abdominal brace or support garment early-on in the recovery process to help hold the abdominal muscles in the correct position during daily activities.
Neuromuscular Electrical Stimulation (NMES)
Electrical stimulation can help weak muscles contract during strengthening exercises. This treatment is performed by a physical therapist. Electrodes are applied to the skin to deliver electrical impulses to help muscles contract harder during strengthening exercises.
Surgery
People with severe cases—usually a gap at least 5 cm wide—may need surgery to treat diastasis recti. In less severe cases, you might choose to have surgery for cosmetic reasons.
Diastasis recti surgery can be performed laparoscopically (inserting instruments through small incisions) or with an open procedure, utilizing larger incisions.
Insurance coverage will depend on your insurance plan and whether the surgery is medically necessary.
Related: How to Heal Diastasis Recti With Physical Therapy
Exercises to Try With Diastasis Recti
If you have diastasis recti, talk to a healthcare provider, such as a physical therapist, before beginning a new exercise regimen. Using a poor form or overexerting yourself can worsen this condition. Below are some exercises that a physical therapist may prescribe to strengthen your core.
Abdominal Bracing
Lie on your back on a firm surface.
Bend your knees and place your feet flat on the ground.
Place your hands on your hips with your fingertips resting at the sides of your lower abdominal muscles.
Slowly tighten your abdominal muscles as if pulling your belly button toward your spine. You should feel the muscles under your fingertips tighten. Do not hold your breath.
Hold this position for 10 seconds, then relax.
Repeat 10 times.
Knee Fallouts
Perform the abdominal bracing exercise (above).
Keeping your abdominal muscles tight, slowly drop one knee to the side, then bring it back to the center.
Repeat on the opposite side.
Perform 10 times on each side.
Supine Marches
Perform the abdominal bracing exercise (above).
Keeping your abdominal muscles tight, lift one foot off the ground and lower it back down.
Repeat on the opposite side.
Continue "marching," alternating legs, 10 times on each side.
Bridging
Lie on your back on a firm surface.
Bend your knees, and place your feet on the ground.
Squeeze your buttocks together, and lift your hips off the ground. Keep your shoulder blades in contact with the ground.
Hold for two to three seconds, then lower back down.
Repeat 10 times and work up to three sets in a row.
Exercises to Avoid With Diastasis Recti
Performing the correct exercises with diastasis recti is essential to avoid worsening the condition. Activities that are safe later in the healing process—such as crunches—can put too much pressure on the connective tissue between the abdominal muscles earlier.
The safest way to progress through exercises for diastasis recti is under the supervision of a physical therapist. If you have diastasis recti, avoid any exercises that cause doming. Doming is protrusion of your belly through your abdominal muscles. Examples include:
Crunches
Sit-ups
Planks
Lifting heavy objects or weights
How to Find a Physical Therapist for Abdominal Separation
Physical therapists are trained to treat diastasis recti. You can go to the American Physical Therapy's choosept.com, click the "Find a PT" button, and choose "pelvic health" in the "practice focus" field. You can also find a board-certified women's health specialist by selecting the "find by specialist" field and selecting "women's health."
You may also ask a trusted healthcare provider for a referral. Obstetrician-gynecologists (ob-gyns), medical doctors specializing in treating pregnant people, or a primary care provider (PCP) may be able to refer you to physical therapists in your area who regularly work with people with diastasis recti.
Summary
Diastasis recti is a condition that occurs when the "six-pack" abdominal muscles and the connective tissue holding them together get overstretched. Most commonly, it results from pregnancy. However, it can also develop from obesity or after abdominal surgery in both men and women.
Diastasis recti can resolve independently, but the primary treatment for this condition is physical therapy that focuses on safely strengthening the affected muscles. Less commonly, surgery is required.
Read the original article on Verywell Health.
