A woman’s body goes through significant anatomical and physiological changes during pregnancy. Among them are changes in the abdominal wall that occur at the linea alba: the connective tissue that connects the two sides of the rectus abdominis muscles at the midline. In some cases, this can lead to something called diastasis recti.
Diastasis recti (DR) can bring up some concerns. You or your client might be worried about the long-term impacts of diastasis recti, such as its effects on core strength, ability to play certain sports, or the appearance of her abdomen. If you’re a coach, your client might ask you about prevention, healing, and whether she can continue with her current exercise program or other activities (including strength training).
Importantly, a diagnosis of DR does not mean you or your client is “broken”, nor is she alone. DR is very common: in fact almost 100 percent of pregnant women will develop some degree of diastasis recti by the third trimester, and pretty much every woman will have a diastasis of greater than 16 millimeters by weeks 35 to 39 of her pregnancy.1 The difference is that, for some women, abdominal separation persists months after pregnancy. (More on that below.)
If you or your client have DR (or your client thinks she might), it can help to gain a better understanding of what diastasis recti is, and how to work with it.
In this article, we’ll cover some frequently asked questions, including:
- What is Diastasis Recti?
- What Does Diastasis Recti Feel Like?
- Does Everyone Get Diastasis Recti During Pregnancy?
- Can You Assess Diastasis Recti?
- Can Diastasis Recti Be Prevented During Pregnancy?
- Can Diastasis Recti Heal Postpartum?
- Four Ways You Can Help Clients With Diastasis Recti
What is Diastasis Recti?
Colloquially, diastasis recti has been called “the gap” between a woman’s abdominal muscles. This is also known as the inter-recti distance (the distance between the left and right sides of the rectus abdominis).
During pregnancy, the linea alba softens and becomes more lax to accommodate for a woman’s growing belly. This means the connective tissue widens, and the rectus abdominis muscle bellies (the right and left sides of this muscle group) move wider apart to allow the abdominal wall to expand as the pregnancy develops. This is a normal physiological process that allows the baby to grow.
What Does Diastasis Recti Feel Like?
Some women with diastasis recti struggle to feel their abdominal muscles working during their workouts. While every woman’s experience of diastasis recti is different, you may hear women describing their belly as feeling “hollow” “disconnected” or like a “popped balloon” due to lack of tension. They may also notice their belly “coning” “doming” or looking like a “loaf of bread” as it pushes through the gap in their rectus abdominis muscles.
If they touch their belly they may say it feels “squishy” “mushy” “hollow” or “spongy” as they press down into the gap.
In our experience, the biggest complaint among women with diastasis recti is the appearance of their abdomen and feeling as though they still look pregnant. Many women with diastasis recti report lower body image satisfaction and a poorer physical perception of themselves.2
Does Everyone Get Diastasis Recti During Pregnancy?
As mentioned, research has shown that up to 100 percent of pregnant women have a diastasis recti of more than 16 millimeters in their final trimester.1 It’s a natural response to growing a baby, since the linea alba stretches to better accommodate the growing fetus.
But when it comes to diastasis recti postpartum, that varies enormously from woman to woman.
A 2016 study found that at six weeks postpartum, 60 percent of women still had a diastasis recti, and after one year, that number dropped to 32.6 percent, with widths ranging from two fingerbreadths (mild) to more than four fingerbreadths (severe). This means that 1/3 of women still had a diastasis after one year, although almost all of those were classified as mild.3
Can You Assess Diastasis Recti?
For qualified professionals — such as GGS Certified Pre- & Postnatal Coaches — it is within scope of practice to do a manual palpation and assessment of diastasis recti (unless otherwise stated in your local, provincial, federal, statewide, or national regulations).
While a full discussion of how to assess diastasis recti is beyond the scope of this article, there are a few things to keep in mind.
Some physiotherapists or trainers will use calipers or real-time ultrasound machines in clinical and research settings to measure inter-recti distance. Chances are, though, you won’t have access to these tools in a gym setting. So while it’s not as precise of a measurement as one would get with an ultrasound or calipers, manual palpation has good intra-tester reliability and can be very effective for assessing and monitoring a client’s diastasis over time.4
In other words, while ultrasound imaging is a more precise method for measuring the inter-rectus distance, the finger-width technique remains the most accessible and widely used in both clinical and training settings.
When assessing your client for diastasis recti, it’s critical that you get her consent to touch her abdomen and do the assessment.
To learn all the details about diastasis recti and how to assess your client, check out our Pre- & Postnatal Coaching Certification.
Can Diastasis Recti Be Prevented During Pregnancy?
The question of whether diastasis recti can be prevented through exercise has been explored in several studies, but the findings are inconclusive due to the limited quality and small sample sizes of the research conducted. While there’s currently no strong evidence to suggest that specific exercises can effectively reduce the risk of developing diastasis recti, exercise remains beneficial for numerous other health reasons, such as improving cardiovascular health, supporting mental well-being, and maintaining overall muscle strength and function.
Though we lack definitive research pinpointing exercises that could prevent diastasis recti, we also don’t fully understand what factors may exacerbate it during and after pregnancy. It’s believed that genetics and the number of pregnancies a woman has had likely contribute to the condition.
Even without significant research to back it up, we believe it may still be prudent to avoid or modify exercises that cause significant doming or bulging along the linea alba during pregnancy and the early postpartum period.
Here are three ways you help monitor your client for excessive doming or bulging during exercise:
- Look for doming along the linea alba. If she’s wearing a snug-fitting top, you’ll usually be able to see it.
- Touch the linea alba and feel for bulging or irregularities (e.g., like the linea alba is sticking out more than the rest of her belly). Do this only if she expressly consents to having you touch her.
- Listen to your client if she tells you she notices a bulge in her abdomen with certain movements or activities.
If you notice excessive bulging or doming, there are numerous ways you can modify the exercise to decrease the difficulty and help your client better handle the intra-abdominal load.
Here are a few:
- Decrease the load to reduce intra abdominal pressure
- Decrease the volume (sets x reps) to decrease fatigue
- Increase the rest period to decrease fatigue
- Cue a different breathing strategy to better handle the intra abdominal pressure
Let’s say your client is doing 3 sets of 8 push-ups with 90 seconds rest in between, and you notice excessive doming or bulging during her push-ups.
Can Diastasis Recti Heal Postpartum?
Diastasis recti has traditionally been diagnosed based on the distance between the two sides of the rectus abdominis muscles, leading many to define ‘healing’ as closing this gap. However, our understanding of diastasis recti has shifted over time.
Today, the emphasis is less on narrowing the gap and more on addressing the loss of connective tissue density and the ability to generate tension in the linea alba. This change in focus highlights the importance of restoring overall function and strength across the abdominal wall rather than just closing the gap.
Clinically, when discussing “healing” from diastasis recti, the primary goal is to regain optimal function of the abdominal wall. But beyond this clinical perspective, the concept of healing can vary widely from person to person. For some postpartum women, healing might mean returning to their pre-pregnancy exercise routine, such as lifting heavy weights, which requires a strong and functional abdominal wall. For others, it might simply mean feeling confident and comfortable in their body, whether that’s fitting into certain clothes or feeling at ease with their appearance.
So, can diastasis recti be healed postpartum?
The extent of recovery and the time required for healing can depend on various factors, including genetics, age, the number of pregnancies, and the specific characteristics of the diastasis, such as its width and depth. Personal goals also play a significant role in defining what healing looks like.
The encouraging news is that targeted exercise can significantly improve the strength and function of the abdominal wall, particularly when the exercises are realistic, progressive, and well-suited to the individual’s needs. Keep reading to learn how you can support your clients with diastasis recti in their postpartum fitness journey.
Five Ways You Can Help Clients With Diastasis Recti
1. Listen, Validate, and Empathize
Pregnancy and the postpartum period bring about profound physical, mental, and emotional changes, and it’s essential that your clients feel heard and understood during this time. By genuinely listening to your client’s experiences and acknowledging her challenges, you lay the groundwork for a trusting relationship where she feels supported. This is also an opportunity to dispel common myths about diastasis recti, such as the idea that it can be prevented by specific exercises, that her core will always be weak, or that she’ll never return to the activities she enjoys.
2. Offer Reassurance and Encouragement
It can be helpful to explain that abdominal separation after pregnancy is normal and most women have it. You can assure your client that having diastasis recti doesn’t mean she did anything wrong (e.g. too much exercise, not enough exercise, too many calories). You can also offer encouragement and explain that most women with DR do really well with a progressive exercise program. Which leads us to…
3. Provide Progressive Exercise Recommendations
Women with diastasis recti often fall into two camps: those who are overly cautious and underload their abdominal muscles, and those who may push themselves too hard, too soon. Finding the right balance is key. There is no “perfect” exercise or exercise regime for postnatal women with DR, with many different forms of exercise having positive results.5,6
Early postpartum, it’s advisable to start with gentler abdominal exercises, especially if the diastasis is significant. As recovery progresses, the focus should shift towards building strength and restoring function.
In the early stages, clients might begin with exercises such as:
- Glute Bridge
- Standing Pallof Press
- Bird Dog
- Alternating Heel Slides
As their strength improves, they may advance to exercises like:
- Single-Leg Glute Bridge
- Tall-Kneeling Pallof Press
- Dynamic Bird Dog
- Dead Bug (Arms Only)
You could also likely add some abdominal curl-ups here. Some experts advise skipping this exercise for fear that it will worsen diastasis recti, but the research seems to show that it thickens the rectus abdominis muscles and does not worsen the inter-recti distance.7
Eventually, they can work towards more challenging movements like:
- Single-Leg Hip Thrust
- Half-Kneeling Pallof Press
- Front Plank with Arm Lift
- Dead Bug (Arms and Legs)
These exercises provide a framework for progressing your client’s program over time, but they’re not the only options. Tailoring the program to your client’s specific needs and abilities is crucial.
4. Watch for Warning Signs and Symptoms
As with pregnancy, it’s important to avoid exercises that cause doming or bulging at the linea alba, as this may indicate that the load is too much for your client to handle effectively.
While research hasn’t definitively shown what might worsen diastasis recti, we believe it may be prudent to avoid overstressing the connective tissue. With your client’s consent, you can monitor this by feeling the area during exercise or observing for visible signs as mentioned above. Your client might also be able to describe any sensations of bulging she experiences.
Begin with lower-level exercises that offer support, and gradually progress to more challenging movements. Exercises in positions like supine, side-lying, or quadruped can provide a stable foundation for many women. Some good starter exercises include glute bridges, supine scapular slides, clamshells, open books, bird dogs, and cat/cow stretches, as well as functional exercise that mimic activities of daily living like bodyweight squats and split squats.
If you notice any bulging or doming, adjust the exercise by reducing the load, decreasing the number of repetitions, altering the angle, or shortening the range of motion. This approach allows your client to build strength within a safe and controlled range.
And if you notice more intense symptoms like:
- Pain (e.g., pelvic pain, low back back, etc.)
- Incontinence (i.e., leaking of urine, feces, or gas)
- Heaviness in her pelvis or bulging in her perineum
- Difficult retaining a tampon or feeling like something is going to “fall out” of her vagina
- Or if she struggles to breathe normally
- Intense pain or a small bulge along the midline of the abdomen that might suggest there is a hernia
…we highly recommend referring her to a professional who can help. Which brings us to number four…
5. Refer to a Pelvic Health Physiotherapist
If your client has a significant diastasis or other concerns, referring her to a pelvic health physiotherapist for a thorough assessment and a tailored physical therapy program is recommended.
A consultation with a pelvic health physiotherapist can empower your client by providing her with a deeper understanding of her body’s function. She’ll receive the tools she needs to recover effectively and confidently return to her daily activities and fitness routine.
To find a qualified pelvic health physiotherapist, consider these resources:
- Australian Physiotherapy Association
- Canadian Physiotherapy Association
- Chartered Society of Physiotherapy (United Kingdom)
- Physiotherapy New Zealand
- American Physical Therapy Association
- Academy of Pelvic Health Physical Therapy
Ultimately it’s important to remember that each woman’s experience with pregnancy, postpartum, and diastasis recti is different. As her coach, your goal is to be empathetic and understanding, and support your client as she works towards her individual goals, whether she wants to achieve certain athletic feats, change the appearance of her body, prepare for a future pregnancy, or something else entirely.
