DIASTASIS RECTI: A PHYSIOTHERAPISTS GUIDE TO DIAGNOSIS , TREATMENT AND RECOVERY

Introduction: Beyond the "Mom Pooch" – Understanding Abdominal Separation

As a physiotherapist specializing in postpartum recovery and core rehabilitation, I’ve seen countless patients frustrated by a stubborn abdominal bulge that won’t disappear with diet or exercise. The culprit? Diastasis recti (DR), a misunderstood yet highly treatable condition affecting up to 60% of postpartum women—and surprisingly, many men and athletes as well.

Unlike general weight gain or muscle weakness, diastasis recti involve a structural separation of the rectus abdominis muscles, leading to core instability, back pain, and even pelvic floor dysfunction. The good news? With targeted rehabilitation, most cases improve significantly without surgery.

Section 1: What is Diastasis Recti? A Structural Perspective

Anatomy of the Abdominal Wall

The rectus abdominis ("six-pack" muscles) are two parallel muscle bands connected by the linea alba, a fibrous midline structure. Under excessive intra-abdominal pressure, this tissue thins and stretches, creating a gap—typically measured at the umbilicus, above, or below.

Clinical Definition

A separation of ≥2.7 cm (about two finger-widths) is generally diagnostic, though functional deficits (core weakness, doming) matter more than the gap size alone.

Who Develops Diastasis Recti?

Population	Prevalence	Contributing Factors
Postpartum women	30-60%	Hormonal changes, fetal growth, delivery
Men	10-15%	Obesity, heavy lifting, poor exercise form
Newborns	Common	Prematurity, weak abdominal musculature

Section 2: Causes and Pathophysiology – Why Does It Happen?

Primary Mechanisms

1. Hormonal Influence

• Relaxin and progesterone increase ligamentous laxity, reducing linea alba tensile strength.

2. Mechanical Overload

• Pregnancy: The expanding uterus exerts ~20-40 mmHg pressure on the abdominal wall.

• Chronic straining (e.g., constipation, COPD) repetitively stresses the midline.

  
  

3. Faulty Movement Patterns

• "Open-scissor" posture (rib flare + anterior pelvic tilt) exacerbates separation.

• Compensatory strategies (e.g., breath-holding during lifts) spike intra-abdominal pressure.

High-Risk Scenarios

• Multiparous pregnancies (risk increases with each birth)

• Macrosomia (large baby >4 kg)

• Polyhydramnios (excess amniotic fluid)

• Poorly managed intra-abdominal pressure (e.g., CrossFit, weightlifting without core coordination)

Section 3: Complications of Untreated Diastasis Recti

Musculoskeletal Consequences

• Lumbar instability → Chronic low back pain (78% of DR patients report this)

• Pelvic floor dysfunction → Stress incontinence, prolapse

• Reduced athletic performance → Compromised force transfer in running, lifting

• Aesthetic and Functional Concerns

• Abdominal doming (visible bulge during exertion)

• Failed traditional ab workouts (crunches widen the gap)

Section 4: Physiotherapy Management – A Stepwise Approach

Phase 1: Motor Control Re-Education (Weeks 1-6)

Goal: Restore neuromuscular connection to the transverse abdominis (TVA) and pelvic floor.

Key Exercises:

1. Diaphragmatic Breathing

• Supine, knees bent. Inhale to expand ribs laterally, exhale to engage TVA + pelvic floor.

• Cue: "Imagine zipping up a tight pair of jeans from pelvis to ribcage."

2. Pelvic Tilts

• Gentle posterior tilts to activate deep core without straining linea alba.

3. Heel Slides

• Maintain TVA engagement while sliding one leg out slowly.

Phase 2: Progressive Loading (Weeks 6-12)

Goal: Integrate dynamic movements while maintaining tension across the linea alba.

Key Exercises:

1. Dead Bug Progression

Start with bent knees → progress to straight legs as control improves.

2. Side-Lying Clamshells

Strengthen obliques to support midline closure.

3. Standing Pallof Press

Anti-rotation training to reinforce core stability.

Phase 3: Functional Integration (3+ Months)

Goal: Return to high-level activities (running, lifting) with proper pressure management.

Advanced Techniques:

• Ballistic movements (e.g., medicine ball throws) with exhale bracing

• Dynamic planks (only if no doming occurs)

When to Refer for Surgical Consultation

• Gap >4 cm persisting beyond 12 months of rehab

• Symptomatic ventral hernia

• Severe functional limitations (e.g., inability to perform ADLs)

Conclusion: A Call to Action

Diastasis recti isn’t just a cosmetic concern—it’s a functional deficit requiring targeted rehab. As physiotherapists, our role is to:

1. Educate patients on pressure management.

2. Prescribe individualized, progressive programming.

3. Empower long-term core resilience.

For Clinicians: Always assess DR in postpartum and athletic populations—it’s frequently missed!

For Patients: Skip the crunches. Start with breath work, and commit to the process. Your core can recover.