What is Diastasis Recti Rehabilitation?

 What is it? A Diastasis recti is a gap, or separation, in the linea alba, which is the tissue that runs down the midline of the rectus abdominis (i.e. “the 6-pack” muscle). This commonly occurs during/following pregnancy, secondary to stretching of that region. This separation can also occur in men.How to test

1. Lie on your back with your knees bent, and feet flat on the floor
2. Place two fingers at the belly button region where that midline of the abdomen is (linea alba).
3. Lift your head off the floor and perform a movement similar to a small crunch, where you lift your shoulders slightly off of the mat.
4. Move your fingers side to side slowly to feel for a gap between the muscles. If the separation that you feel is greater than 2 cm, or two fingers width, the test is positive.
5. You can repeat this above and below the belly button region

Treatment: Physical therapy and core strengtheningThe primary treatment for a diastasis recti is strengthening the core musculature, specifically the transverse abdominis (TrA), while resting the rectus abdominis (“6 pack” muscle”). During and after pregnancy, it may be helpful to inquire with a professional regarding safe core exercises. However, gentle activation of the TrA with an abdominal draw, and diaphragmatic breathing, may be a good start.Abdominal BindersAnother treatment that is commonly used in conjunction with physical therapy and core strengthening is an abdominal binder. Abdominal binders are used to help approximate the edges or “close the gap” to promote tissue healing during the time you are working to strengthen the TrA. An abdominal binder is NOT used to replace the function of the transverse abdominis and is not an alternative to exercise. If you have questions about specific binders, please reach out to your physical therapist who will help you determine what would be best for you.Things to avoid if you have a DR:Although the abdominals need strength, you should not be performing abdominal exercises that increase intra-abdominal pressure, isolate the rectus abdominis, or cause more bulging. For example, exercises like crunches, sit ups, and heavy lifting should be avoided. At Stability, you can work with a therapist during Pilates that can help you safely activate the core while avoiding certain movements.References:

1. Michalska A, Rokita W, Wolder D, et al.  Diastasis recti abdominis - a review of treatment methods. Ginekol Pol. 2018;89(2):97-101.
2. Fernandez-Fernandez, A. “The Obstetric Patient”. Powerpoint Presentation; 2021. Fort Lauderdale, FL.
3. Keshwani N, Mathur S, McLean L. The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial. Physiother Theory Pract. 2021 Sep;37(9):1018-1033.

Author information: Jessica Hutchens, PT, DPTSarah Klein PT, DPT