Diastasis Recti Physiotherapy

What is actually separating

The two long "six-pack" muscles run down the front of the tummy, joined in the middle by a band of connective tissue called the linea alba. As the uterus grows, that band stretches and the muscles move apart. That's a normal adaptation, not an injury. After birth the gap narrows over the following months, but in many women it doesn't close completely.

How common is it? Studies suggest more than half of women still have some separation at six weeks after birth, and around a third at a year. It happens after caesarean births as well as vaginal ones.

How we assess it

A proper assessment looks at more than finger widths. Lying on your back with knees bent, you lift your head slightly while we check the gap at the navel, above it and below it. Then we look at what matters more: whether the tissue in the gap firms up under your fingers or sinks away, whether the tummy domes or bulges along the midline when you move, and how you breathe and brace when you lift.

We also check for an umbilical or other hernia. If there is one, or if the separation is very wide, we'll recommend a surgical opinion alongside physiotherapy.

Why tension matters more than the gap

For years, the aim was simply to narrow the gap, and crunches were banned for life. Research has since shown that the tension in the linea alba, its ability to stay taut when you load it, is a better guide to how well the abdominal wall is working. Some women with a moderate gap have excellent function; some with a small gap don't. So we train the abdominal wall to generate tension and handle load, and we measure progress by function as much as by centimetres.

The rehabilitation plan

• Stage 1: connection

  Breathing with the diaphragm, deep abdominal and pelvic floor activation, and learning what the midline feels like when it's working.

• Stage 2: loading

  Heel slides, dead bugs, bird dogs, side-lying and modified side planks, progressed as long as the midline stays controlled.

• Stage 3: real life

  Squats, lifting, carrying and rotation, the movements you need with a growing baby.

• Stage 4: full return

  Planks, crunch-type exercises and gym or sport, reintroduced when you can do them without doming or symptoms.

What rehabilitation can and can't do

Most women end up with an abdominal wall that works well, even if a small gap remains. We're honest about the limits, though. Loose skin and fat from pregnancy aren't affected by exercise. A very wide separation, a hernia, or ongoing symptoms after a genuine six-month rehabilitation program are reasons to see a surgeon about repair, and physiotherapy before and after surgery helps with that too.

The same core work sits inside our postpartum rehabilitation and C-section rehabilitation programs, and our clinical team has written about diastasis recti after pregnancy and postpartum core rehabilitation.

Signs to get checked

• A ridge or dome running down the middle of your tummy when you sit up or lift
• A soft, bulging tummy months after birth that doesn't firm up when you engage it
• A lump at or near the navel, especially one that appears when you strain
• Back pain, pelvic floor symptoms or a sense of weakness through the middle

Frequently asked questions