Diastasis Recti Rehabilitation

Support for abdominal strength, control and return to activity

Diastasis recti is a widening of the connective tissue between the two sides of the abdominal muscles. It commonly develops during pregnancy as the abdominal wall adapts to accommodate the growing baby and may remain for some time after childbirth.

For some people, the separation causes few or no problems. Others may notice reduced abdominal strength, difficulty controlling pressure through the abdomen or uncertainty about returning to lifting, gym training, running and other exercise.

Diastasis recti rehabilitation focuses on restoring useful abdominal function rather than concentrating only on the size of the gap.

What is diastasis recti?

The abdominal wall contains several layers of muscle that work together to support the trunk and help manage pressure during movement.

The two sides of the rectus abdominis muscles run vertically along the front of the abdomen. Between them is a band of connective tissue called the linea alba.

During pregnancy, this tissue naturally stretches and widens as the abdomen expands. After childbirth, the abdominal wall gradually begins to recover.

When a noticeable separation remains between the two sides of the abdominal muscles, this is commonly referred to as:

• Diastasis recti
• Diastasis rectus abdominis
• DRA
• Abdominal muscle separation

The presence of a gap alone does not necessarily mean that the abdominal wall is weak or that treatment is required.

Assessment should also consider how the abdominal wall functions during movement and exercise.

When diastasis recti rehabilitation may help

An assessment may be useful if you are experiencing:

• A visible separation through the centre of the abdomen
• Doming or bulging during certain movements
• Difficulty engaging the abdominal muscles
• Reduced abdominal strength
• Difficulty returning to exercise after pregnancy
• Difficulty progressing strength training
• Concerns about lifting
• Reduced confidence using the abdominal muscles
• Difficulty controlling the trunk during exercise
• A feeling of reduced abdominal support
• Ongoing abdominal weakness after childbirth

You may also want an assessment simply because you are unsure which exercises are appropriate or how to progress your training.

What happens during your first appointment?

Your first appointment begins with a discussion about your pregnancy, childbirth, symptoms and current physical activity.

The physiotherapist may ask about:

• How long ago you gave birth
• Whether you had a vaginal or caesarean birth
• Previous pregnancies
• Abdominal symptoms
• Pelvic floor symptoms
• Back or pelvic pain
• Your current exercise
• Activities that cause doming or bulging
• Lifting and childcare demands
• Previous gym or sporting activity
• Your goals for rehabilitation

The physical assessment may look at:

• Abdominal muscle separation
• Abdominal wall tension
• Breathing
• Abdominal muscle control
• Trunk strength
• Pelvic floor function where relevant
• Hip and leg strength
• Functional movements
• Lifting
• Exercises you would like to return to

The aim is to understand how your abdominal wall behaves during movement rather than relying on one measurement alone.

Assessing the abdominal separation

The distance between the abdominal muscles may be assessed at different points around the abdomen.

However, the width of the gap is only one part of the assessment.

The physiotherapist may also consider:

• How much tension develops through the centre of the abdomen
• Whether the abdominal wall bulges during movement
• How well you coordinate breathing and abdominal activity
• Your overall trunk strength
• How symptoms respond to increasing load

Two people with a similar amount of separation may have very different levels of physical function.

Treatment therefore needs to be based on more than the gap measurement.

What rehabilitation may include

Diastasis recti rehabilitation is usually exercise-based and gradually progresses towards the physical demands of everyday life.

Abdominal strengthening

Exercises may begin with controlled movements that help you reconnect with the abdominal muscles.

As strength improves, rehabilitation can progress towards more demanding exercises.

This may include:

• Leg movements
• Bridges
• Squats
• Lunges
• Resistance exercises
• Carrying
• Plank variations
• Gym exercises

There is no single abdominal exercise that is suitable for every stage of recovery.

Breathing and abdominal coordination

Breathing changes pressure within the abdomen.

Learning how to coordinate breathing with abdominal activity may make exercises and lifting easier to control.

Treatment may involve practising breathing during:

• Standing from a chair
• Squatting
• Lifting
• Carrying
• Resistance exercise
• Abdominal exercises

The goal is not to keep the stomach pulled in throughout the day.

The abdominal muscles should be able to tighten when required and relax normally afterwards.

Pelvic floor coordination

The pelvic floor and abdominal muscles work together during many everyday movements.

Where appropriate, rehabilitation may include pelvic floor exercises alongside abdominal strengthening.

This can be particularly relevant if you also experience:

• Urinary leakage
• Pelvic heaviness
• Pelvic floor weakness
• Difficulty returning to impact exercise

Pelvic floor rehabilitation should be based on your individual symptoms rather than automatically included because diastasis is present.

Whole-body strengthening

Abdominal recovery does not happen in isolation.

Exercises may also focus on:

• Hip strength
• Gluteal muscles
• Legs
• Back
• Shoulders and arms

Whole-body strength is particularly useful when returning to lifting, carrying, gym training and everyday childcare activities.

Home exercise programme

You may receive exercises to continue between appointments.

The programme can be progressed as your abdominal control and overall strength improve.

Doming or bulging through the abdomen

Some people notice a ridge or dome forming along the centre of the abdomen during certain movements.

This may occur during:

• Getting out of bed
• Sit-ups
• Planks
• Heavy lifting
• Squats
• Overhead exercises
• Other demanding movements

A small amount of visible change does not automatically mean that an exercise is harmful.

However, repeated significant bulging may indicate that the current exercise is more demanding than you can control comfortably.

The exercise may initially need to be modified.

As strength and coordination improve, you may be able to return to the same movement with better control.

Rehabilitation is not only about closing the gap

It is understandable to focus on the distance between the abdominal muscles.

However, successful rehabilitation does not necessarily require the gap to completely disappear.

More useful goals may include:

• Improving abdominal strength
• Creating better tension through the abdominal wall
• Lifting confidently
• Returning to exercise
• Reducing excessive doming
• Improving movement control
• Feeling stronger during everyday activities

A person can regain good abdominal function even if some separation remains.

Deep abdominal exercises

Early rehabilitation may include exercises designed to improve awareness and control of the deeper abdominal muscles.

These exercises can provide a useful starting point, particularly during the earlier stages after childbirth.

However, they are usually not the final stage of rehabilitation.

Once good control has developed, the abdominal muscles need to become stronger during increasingly demanding movements.

The programme should therefore progress beyond very gentle exercises when appropriate.

Moving beyond gentle core exercises

Some people remain on basic breathing or abdominal activation exercises for months because they are concerned that stronger exercise may worsen the separation.

This is not always necessary.

Once the abdominal wall can manage basic exercises comfortably, rehabilitation may gradually introduce:

• Increased resistance
• Larger movements
• Longer lever positions
• Weight-bearing exercises
• More demanding abdominal exercises
• Functional lifting
• Gym exercises

The goal is to progressively increase the amount of force the abdominal wall can manage.

Can I do sit-ups?

Sit-ups are often one of the exercises people are told to avoid when they have diastasis recti.

During the early postnatal period or when abdominal control is limited, they may be too demanding.

However, this does not necessarily mean that sit-ups must be avoided permanently.

If returning to them is relevant to your exercise goals, rehabilitation can gradually build the strength required.

The movement can be modified initially and progressed according to how the abdominal wall responds.

Can I do planks?

Planks can place significant demand on the abdominal muscles.

Early in rehabilitation, a full plank may be difficult to control.

You may begin with alternatives such as:

• Wall-supported exercises
• Elevated positions
• Knee-supported variations
• Shorter holds

As strength improves, the exercise can become progressively more demanding.

The aim is to develop enough capacity to perform the movement well rather than avoiding it indefinitely.

Abdominal strength after pregnancy

Pregnancy affects the entire abdominal wall, not just the space between the rectus muscles.

Even after the gap begins reducing, you may still notice weakness during:

• Lifting
• Carrying
• Exercise
• Getting up from the floor
• Running
• Strength training

Rehabilitation therefore needs to rebuild overall abdominal strength.

This may include exercises that challenge the body in several directions rather than only performing movements while lying down.

Recovery after a caesarean birth

If you had a caesarean birth, abdominal rehabilitation also needs to consider recovery from surgery.

Early rehabilitation may focus on:

• Walking
• Comfortable movement
• Getting in and out of bed
• Breathing
• Gentle abdominal activation

Once the wound has healed appropriately, rehabilitation can gradually progress towards:

• Abdominal strengthening
• Lifting
• Carrying
• Gym exercise
• Running
• More demanding activity

The programme should respect surgical recovery while still progressing when healing allows.

Caesarean scar and abdominal movement

Some people experience tightness, numbness or sensitivity around a caesarean scar.

This may influence how comfortable certain abdominal movements feel.

Once the wound is fully healed, rehabilitation may include:

• Gradual movement
• Scar sensitivity work
• Abdominal strengthening
• Progressive loading

Increasing redness, wound discharge, opening of the wound or worsening pain should receive medical assessment rather than being treated as normal scar tightness.

Lifting your baby

Postnatal life involves frequent lifting, often before abdominal strength has fully recovered.

You may regularly lift:

• Your baby
• A car seat
• A pram
• Bags
• Other children

Rather than trying to avoid all lifting, rehabilitation can help gradually rebuild your capacity.

Treatment may include:

• Squats
• Hip strength
• Carrying exercises
• Abdominal control
• Breathing during lifting
• Progressive resistance

These movements can eventually become more demanding than the loads you regularly manage at home.

Getting out of bed

Rolling or sitting up from bed can cause noticeable abdominal doming during early recovery.

Using a rolling technique may initially make the movement easier.

However, the long-term goal is not necessarily to avoid sitting directly upwards forever.

As abdominal strength improves, rehabilitation can gradually prepare you for a wider range of normal movements.

Abdominal support garments

Some people feel more comfortable using abdominal support clothing or a support garment during the earlier stages of recovery.

Support may provide temporary comfort or confidence.

However, a garment does not strengthen the abdominal muscles itself.

Exercise and gradual physical loading remain important for rebuilding long-term capacity.

If you are unsure whether support is appropriate, this can be discussed during your assessment.

Back pain and diastasis recti

Some people with diastasis also experience back pain.

However, the presence of abdominal separation does not automatically mean that it is the cause of the pain.

Back pain can be influenced by many factors, including:

• Reduced activity
• Lifting
• Sleep
• General strength
• Previous back problems
• Changes in routine after having a baby

If back pain is present, it should be assessed as part of the wider rehabilitation programme rather than assuming that closing the abdominal gap will automatically resolve it.

Pelvic floor symptoms

Diastasis recti and pelvic floor symptoms can occur at the same time after pregnancy, but one does not necessarily cause the other.

Tell your physiotherapist if you experience:

• Urine leakage
• Bowel-control problems
• Pelvic heaviness
• Vaginal bulging
• Pelvic pain

These symptoms can be assessed separately and included within your rehabilitation where appropriate.

Returning to everyday activity

Rehabilitation should eventually help with normal daily life rather than only improving exercises performed in the clinic.

Your goals may include:

• Lifting your baby
• Carrying shopping
• Pushing a pram
• Getting up from the floor
• Household activities
• Gardening
• Returning to work
• Exercising
• Playing with your children

The exercise programme can gradually become more similar to these activities.

Returning to the gym

If you trained before pregnancy, returning to the gym may be an important rehabilitation goal.

You may initially reduce:

• Weight
• Exercise volume
• Range of movement
• Exercise difficulty

The programme can then progress towards movements such as:

• Squats
• Deadlifts
• Rows
• Presses
• Lunges
• Carries
• Planks
• Abdominal exercises

Progress should be based on strength and control rather than avoiding every movement that places demand on the abdomen.

Returning to heavier lifting

Heavy lifting places greater demand on the abdominal wall.

Before returning to heavier loads, rehabilitation may focus on:

• General strength
• Breathing
• Abdominal control
• Lifting technique
• Gradual exposure to heavier resistance

The amount of weight can then increase progressively.

You do not necessarily need to avoid heavier lifting permanently because of diastasis recti.

Returning to running

Running requires the trunk to manage repeated forces while the arms and legs move quickly.

Before returning to running, rehabilitation may consider:

• Abdominal strength
• Pelvic floor symptoms
• Leg strength
• Calf strength
• Single-leg control
• Balance
• General fitness

You may initially begin with walking and strength work before introducing short running intervals.

If you experience pelvic heaviness, leakage, pain or significant difficulty controlling the abdominal wall, additional rehabilitation may be useful before progressing.

Returning to higher-impact exercise

Higher-impact activities can include:

• Running
• Jumping
• Skipping
• High-intensity exercise
• Some sports

These activities require more than isolated abdominal strength.

Rehabilitation may therefore include:

• Squats
• Lunges
• Single-leg exercises
• Jump preparation
• Landing control
• Pelvic floor rehabilitation where required
• Cardiovascular conditioning

The programme should prepare your whole body for impact.

Returning to sport

If your goal is to return to sport, rehabilitation may eventually include the movements required for that activity.

Depending on the sport, this might involve:

• Running
• Jumping
• Rotation
• Throwing
• Changes of direction
• Contact
• Repeated lifting

Diastasis rehabilitation should not remain limited to gentle abdominal exercises if your goal requires much greater physical capacity.

Exercise does not need to look perfect

It is common to become very focused on watching the abdomen throughout every exercise.

This can sometimes make movement feel unnecessarily complicated.

Some monitoring can be useful during rehabilitation, particularly when learning new movements.

However, the longer-term goal is to build enough strength and confidence that you can exercise normally without continually checking your abdomen.

Progressing exercise safely

Progression may involve changing one or more factors at a time, such as:

• Resistance
• Repetitions
• Duration
• Range of movement
• Exercise position
• Speed
• Complexity

A movement that is difficult today may become manageable after several weeks of strengthening.

Exercises therefore do not always need to be permanently labelled as suitable or unsuitable.

Diastasis recti during pregnancy

Abdominal separation commonly develops as pregnancy progresses because the abdominal wall needs to expand.

During pregnancy, rehabilitation may focus more on:

• Maintaining strength
• Comfortable movement
• Breathing
• Pelvic floor function
• Managing exercise
• Preparing for postnatal recovery

The aim during pregnancy is not to try to force the abdominal muscles back together while the abdomen is continuing to grow.

Diastasis recti after more than one pregnancy

Some people notice more abdominal separation following subsequent pregnancies.

This does not mean that rehabilitation cannot improve abdominal function.

Treatment can still focus on:

• Strength
• Tension through the abdominal wall
• Lifting
• Exercise
• Pelvic floor symptoms where present

The number of previous pregnancies does not determine whether rehabilitation can be useful.

Diastasis recti months or years after childbirth

You do not need to be in the early postnatal period to begin rehabilitation.

Some people seek physiotherapy months or years after pregnancy because they:

• Still notice abdominal separation
• Feel weak during exercise
• Have difficulty progressing core training
• Want to return to heavier lifting
• Remain concerned about abdominal appearance or function

Strength and physical capacity can still be worked on even when the separation has been present for a long time.

Appearance and abdominal function

Changes in abdominal appearance after pregnancy can be influenced by several factors, including:

• Abdominal muscle separation
• Skin changes
• Connective tissue
• Body composition
• Muscle strength

Exercise can improve strength and function, but it may not completely change every physical feature of the abdomen.

Rehabilitation should provide realistic expectations rather than promising that exercise will completely close the separation or restore the abdomen to its pre-pregnancy appearance.

Is surgery needed?

Most people with diastasis recti do not automatically require surgery.

Rehabilitation is usually an appropriate starting point when the main concerns relate to strength, exercise or abdominal function.

In some cases, significant persistent separation or other abdominal-wall problems may lead someone to discuss surgical options with an appropriate medical specialist.

Physiotherapy cannot physically repair every abdominal separation, but it can help determine how much function can be improved through rehabilitation.

When further medical assessment may be needed

Not every abdominal bulge is caused by diastasis recti.

Medical assessment may be appropriate if you notice:

• A new localised abdominal lump
• Significant or increasing abdominal pain
• A bulge that is very painful
• Persistent digestive symptoms
• Changes around a surgical scar
• Redness or discharge from a recent wound
• Symptoms that are rapidly changing or significantly different from your usual presentation

A hernia can sometimes occur separately from diastasis recti and may require medical assessment.

Rehabilitation based on your goals

Diastasis recti rehabilitation should reflect what you want your body to be able to do.

Your goals may include:

• Improving abdominal strength
• Reducing excessive doming
• Lifting your baby comfortably
• Returning to the gym
• Performing planks again
• Returning to heavier lifting
• Running
• Returning to sport
• Improving confidence with abdominal exercise
• Feeling stronger during everyday activities

Your rehabilitation programme can be developed around these goals rather than focusing only on reducing the width of the separation.

How long does diastasis recti rehabilitation take?

There is no fixed timeline.

Progress depends on factors such as:

• How long ago you gave birth
• Your current strength
• Previous pregnancies
• Caesarean or other abdominal surgery
• Current physical activity
• Pelvic floor symptoms
• Exercise experience
• The activities you want to return to

Some people may need a relatively short period of guidance before progressing independently.

Others may benefit from longer rehabilitation when returning to heavier lifting, running or sport.

Changes in strength and function can continue even if some abdominal separation remains.