For how common it is, diastasis recti (DR) is a condition that's surprisingly misunderstood. In short, DR is what it's called when your abdominal muscles separate — specifically, the two sides of your rectus abdominis (your "six-pack muscles").
Separated stomach muscles occur as a result of too much pressure inside the abdomen (intra-abdominal pressure). That's why it's extremely common during pregnancy.
As your pregnant belly grows, it puts pressure on the connective tissue in the middle of your tummy called the linea alba. Over time, the linea alba stretches, causing the two sides of your rectus abdominis to separate, explains Kasia Gondek, PT, DPT, CSCS, a women's health physical therapist at Femina Physical Therapy.
"When you gain weight in any other instance of life, you don't pick where. When you are pregnant, in 9 months you gain 30 pounds or so, and that's centralized through your core. Because of this, there is a level of separation that will occur," says Kristie Alicea, CPT, a pre/postnatal fitness specialist and founder of ABC Fit Collective.
However, pregnant people aren't the only people who are affected by DR. Abdominal separation can occur in people of any gender, especially those who carry a lot of visceral fat in the belly area, have poor core engagement or hold too much pressure in their abdomen during heavy lifting, Alicea says.
Fortunately, you can help minimize and repair abdominal separation with diastasis recti exercises. But first, here's how to test for DR and common signs to look out for.
Do I Have Diastasis Recti?
"When you have DR during pregnancy, it will present as a bulge with an increase in intra-abdominal pressure that goes from the ribs to the pubic bone — which is along the line of the linea alba," says Heather Jeffcoat, DPT, pelvic floor physical therapist and owner of Femina Physical Therapy and Fusion Wellness Physical Therapy in Los Angeles.
"This would be seen with lying on your back and lifting your head or with upright weightlifting as well."
Distended stomach muscles after pregnancy, a belly bulge or pooch or even a visible gap in between the two sides of the abdominals are all signs of separated stomach muscles that you likely won't notice until after delivery.
When the stretching and separation of the rectus abdominis is extreme, it also throws off your ability to connect with and use your core. That means your abdominals, diaphragm, back muscles and pelvic floor muscles won't be able to effortlessly work together to generate force during everyday movements.
"In people who have DR that is not well-managed, I often find that when doing exertion and lifting, they may push forces downward onto their pelvic floor muscles or they may bulge their abdominal wall outwards," Gondek explains.
"Both of these scenarios can contribute to the development of low-back pain, pelvic organ prolapse, stress urinary incontinence (peeing when lifting, coughing, sneezing) or a combination of these in the long-term if left untreated."
How to Test for DR
Here’s the standard way to check for abdominal muscle separation. If you had a vaginal birth, you should wait three days after your labor to perform the self-check for diastasis recti. If you had a C-section, you should wait six weeks, or until your incision has healed. (Check out this video for a visual.)
- Lie on your back with your knees bent and your feet flat on the floor.
- Slowly lift your head and shoulders off the ground just an inch or two, like you’re doing a very tiny crunch.
- Maintain this position as you press one hand along the center of your rectus abdominis, just below the sternum. Slowly walk your fingers down the center of your abdominals, until you get about 2 inches below your bellybutton.
- You should be able to feel a soft area or small gap between the two sides of your abdominal muscles. Measure how many finger widths you can fit in this gap between your abdominal muscles. One finger width is normal, but two or more confirm that you have DR.
Mild to Moderate DR: If you have about three finger widths or less of separation, and mild to moderate depth (you can’t press very far down and feel some tension in the tissue when you try), your DR is technically mild to moderate. You can start taking postnatal exercise classes or work with a pre/postnatal certified trainer to slowly ramp up ab muscle exercises to start strengthening the area and fixing the separation.
Severe DR: A separation wider than 3 fingers or a smaller separation that’s very deep (the fingers sink right in and there is no tension) are both signs of more severe diastasis recti. You should avoid doing any abdominal work until you see a pelvic floor physical therapist who is qualified to work with people who need more extensive physical therapy to heal DR.
If you are unsure whether you have diastasis recti, a doctor can perform a physical exam to confirm the condition.
The 10 Best Diastasis Recti Exercises to Correct Ab Separation
Abdominal separation can be treated surgically, but it's generally recommended only in severe cases. Most times, diastasis recti can be reduced through exercise.
Because some ab separation is a natural part of pregnancy, it can't be completely prevented. But doing pregnancy-safe diastasis recti exercises can engage your deep core muscles, such as your transverse abdominis and pelvic floor, to help minimize it.
"The approach to take when training your core in pregnancy should focus on endurance, low force over longer periods of time," Jeffcoat adds. "It's really what our bodies need most to adapt to postural changes over time."
Avoid moves that involve crunching or twisting your rectus abdominis, such as sit-ups, which can worsen and aggravate the separation. You also want to avoid activities that involve holding your breath, like the Valsalva maneuver, because it can cause excess intra-abdominal pressure.
Another important part of diastasis recti rehab is learning how to breathe during exercise, Alicea says. This will allow you to engage your core in a gentle way and work up to more intense abdominal work as you get stronger.
Here are a handful of diastasis recti exercises that Alicea and Jeffcoat recommend to improve abdominal separation. Just make sure you resume your workouts slowly after giving birth; listen to your body and don't push yourself too hard.
If you experience coning — which is when the middle of your abdominals bulge outward — stop whatever exercise you're doing. That's a sign you're not properly engaging your core and are making DR worse. You may just not be ready for that specific exercise — so skip it, and focus on ones that don't cause your belly to bulge.
1. 360 Belly Breathing With Criss-Cross Hands
This is a great diastasis recti exercise for engaging your pelvic floor muscles and learning how to use them. It's a basis for your workouts throughout postpartum and beyond.
- Start in a seated or standing position with your ears over your shoulders and shoulders over your hips. Take a big inhale and expand your belly. Place your hands on the sides of your abdominal muscles.
- As you exhale, pull your bellybutton in and pelvic floor muscles up while using your hands to wrap the right and left side of your abdominal muscles gently toward one another.
- This exercise can be done while pregnant and it is also a great way to help alleviate DR postpartum.
2. Supine 90/90 Transverse Abdominis Hold
The goal of this exercise is to build transverse abdominis endurance, Jeffcoat says. "If your back hurts, you are not stabilizing properly or are fatigued and should rest."
- Lie on your back with your heels on the ground and your pelvis in a neutral position (small space in your lower back and level pelvic landmarks in the front as shown in the video). Keep your rib cage in contact with the floor.
- Take a deep breath in, exhale and draw in your pelvic floor and your transverse abdominis. Lift each foot off the ground one at a time, bringing your legs to a tabletop position. Place your hands by your sides on the ground.
- Start with 5-second holds and work up to 60-second holds over time.
- Continue to breathe through the hold, then release and return to the starting position.
3. Standing March
Great during pregnancy and postpartum, this move not only helps with core engagement and stability, but it helps improve posture and balance.
- Starting in a tall standing position, inhale while allowing your belly to expand.
- As you exhale, draw one knee up toward your chest while maintaining neutral alignment (shoulders over hips). You can place your hands over your belly to better connect your mind to the muscle.
4. Supine March
This exercise serves as a great prep for exercises that involve an abdominal and pelvic brace. It strengthens your deep core muscles, including your transverse abdominis and diaphragm, as well as your pelvic floor.
- Lie on your back with your heels on the ground and your pelvis in a neutral position (small space in your lower back and level pelvic landmarks in the front as shown in the video).
- Take a deep breath in, exhale and draw in your pelvic floor and your transverse abdominis (your deep corset).
- Then, lift each leg up one at a time to a tabletop position as you continue to engage your pelvic floor and transverse abdominis muscles.
- Alternate your breath so that you are inhaling one direction of the march and exhaling in the opposite direction.
To progress, go from a neutral spine to a pelvic curl, Jeffcoat says.
- Inhale to prepare and then exhale and tuck your hip under as you engage your pelvic floor and abdominal muscles and lift your hips toward the sky.
- Alternate your breath so that you are inhaling one direction of the march, exhaling the opposite direction.
- Keep your pelvic landmarks level as in the video.
Optional: Add a resistance band to the sequence. "With the band, focus on pulling your shoulders away from your ears," Jeffcoat says.
5. Inverted Quadruped Heel Press
This move works the glutes and builds transverse abdominis endurance, thanks to the quadruped position, Jeffcoat says.
- Set yourself up on your elbows and knees as pictured, knees bent to 90 degrees, ankles flexed, with your glutes facing up to the ceiling.
- Contract your deep core and pelvic floor muscles as you exhale and press your heel up.
- Perform 10 to 20 repetitions, followed by 5 to 15 pulses, followed by a 5- to 10-second hold, as in the video.
- Repeat on the other side.
6. Glute Bridge
"Doing glute bridges slowly and with control is an excellent way to help you rebuild and reconnect with your core muscles postpartum as well as strengthen your pelvic floor," Alicea says.
- Lie on your back with your feet hip-distance apart, your heels under your knees and both feet pressing into the ground.
- Lift your hips off the ground to form a diagonal line from your shoulders to the tops of your knees. Placing your hands on your belly will help prompt your core muscles to engage as you tuck your pelvis and press your hips up.
- Lower your hips back down with control.
7. Farmer's Carry
"The farmer's carry is a great exercise to not only help diastasis recti but also prepare a mother for her new activities of daily life such as holding the baby on one side or holding a car seat," Alicea says. "This exercise is great both during pregnancy and postpartum."
- Carry a heavy dumbbell with one hand by your side.
- With your shoulders directly over your hips, keep both sides of your core muscles engaged and walk slowly with a focus on maintaining neutral alignment.
- Once you get to one side of your mat, switch the dumbbell to the other hand and slowly walk back.
8. Heel Slide
"This is a gentle way to reconnect with your core muscles postpartum," Alicea says.
However, this exercise is specific to postpartum and should not be done while in your second or third trimester, Alicea adds. As always, it's important to focus on your breath throughout the entire movement.
- Lie on your back with your heels under your knees. Connect your low back to your mat, making sure there is no space between the two.
- Inhale allowing your belly to expand. On your exhale, slide your heel toward the end of your mat and back on one exhale.
- The exhale should last the entire time it takes to slide your heel away and back to the starting position.
9. Modified Plank to Inversion Crunch
As your core gets stronger, you can build up to doing this modified plank variation. But again, if you notice coning or bulging while doing this exercise, stop altogether and continue to do the other exercises on this list to help you engage your core.
- Start in a sphinx position: Lie on your stomach, with your legs hip-width extended behind you, and your forearms on the ground, elbows stacked under your shoulders.
- Exhale and contract your transverse abdominis and pelvic floor muscles as you push up through your elbows to a modified plank as in the video. Maintain a neutral spine.
- To build endurance, start holding for 5 to 10 seconds and do 5 to 6 reps. Over time, you can build up to doing 1 rep with a 60-second hold.
- From the modified plank position, take a deep breath in, exhale, and perform the inversion crunch by tucking your tailbone under and contracting your abs.
- Then, inhale and release the contraction back to return to a neutral spine.
10. Walking Plank
Sync your breath with movement in this dynamic plank variation to engage your pelvic floor and transverse abdominis. Aim to keep your hips level throughout the movement.
- Start in a high plank, with your pelvic floor and transverse abdominis muscles contracted.
- Keeping those muscles engaged, lower yourself to a low plank position on your elbows, one arm at a time.
- Return to a high plank by lifting one arm up at a time and planting your palm on the floor underneath each shoulder.
- Start with your right arm in the first set, then start with your left arm in the second set.
Diastasis Recti Physical Therapy
While you can typically fix mild-to-moderate ab separation through diastasis recti exercises, more extreme diastasis recti may require physical therapy and pelvic floor physiotherapy to jumpstart the healing process safely.
A qualified physiotherapist can assess your condition and develop an exercise plan that suits your needs.
"The physical therapy approach to a DR is not focused solely on 'closing the gap,' but also in utilizing proper transverse abdominis contraction and pressure management strategies," Jeffcoat says. It's a one-two punch: support the abdominals and decrease excessive strain.
Diastastis recti physical therapy typically works to:
1. Establish a Neutral Spine
"Training in a neutral spine is building a foundation for improving postural strength and awareness," Jeffcoat says. "For a healthy spine, forces are meant to be taken in this neutral position."
2. Build Strength and Endurance in the Deep Core Muscles
Moves like the dead bug and modified plank tap into your transverse abdominis and spine stabilizers while keeping your spine in neutral alignment. However, these diastasis recti therapy exercises only help you avoid coning while performing them.
"If a patient can't control the doming through their midline, I have to modify and give them easier versions and then progress from there," Jeffcoat says. That's why working with a pro is so beneficial: They can analyze your body and give you the right modifications when you need them.
3. Engage the Pelvic Floor
"Postural strengthening also includes coordinating your transverse abdominis contraction with a pelvic floor muscle contraction (Kegel)," Jeffcoat says.
A trained pelvic floor physical therapist will teach you how to properly contract these muscles while also breathing deeply and maintaining alignment as you move.