Diastasis Recti - Current Perspectives

You’ve seen or heard of diastasis recti all over the internet or social media. If you are hoping to become pregnant, currently expecting, or recently given birth, diastasis recti has made it into your feed at some point by now. Unfortunately, it is terrifying to most women. But it shouldn’t be! Let’s discuss why and what the current research has to say about diastasis recti abdominus (DRA).

According to a review published by Skoura et all in 2024, “diastasis recti abdominis (DRA) is a connective tissue condition characterized by a separation of the two rectus abdominis (RA) muscles along the linea alba (LA) due to stretching and thinning.”  Basicallying, your 6-pack muscles widen and the tissue between them thins and the severity of this varies widely. 

During an abdominal contraction, you may see separation that looks like a bulge or a depression through the midline of the front of your abdominal wall. The prevalence of DRA varies between 66 and 100% in the final trimester of pregnancy and up to 53% within 24 hours of delivery.  If natural resolution is to occur, it is typically reported during the first 8 weeks postpartum and then spontaneous resolution plateaus. However, some researchers suggest that recovery might still be ongoing at 6 months postpartum, and, despite limited research, DRA is found to be present in 36% of women at 12 months postpartum (Skoura). 

If the prevalence of DRA is so high, why are we so afraid of it? Also, what can we do to minimize or mitigate diastasis during and after pregnancy?

The verdict is still out on the best and most effective way to manage diastasis recti. You will certainly see programs, accounts and providers promising “closure of the gap” as you scour the internet for answers. However, it’s important to understand that there is NO fool proof method of DR closure - yet.

However, there are exercises that research consistently agrees are helpful in generating tension through the linea alba, minimizing abdominal distention, and promoting functional strength and stability. 

Here is what we know can be helpful: 

Transverse Abdominus Contraction or Inner Unit Recruitment: 

Lie on your back with knees bent. Using your index and middle fingers just inside of your front pelvic bones, feel for the transverse abdominus. Draw in your abdomen and contract the TA muscle while performing relaxed breathing. You can “imagine you are pulling your pelvic bones together in a straight line”. Try to hold the contraction for 3-5 seconds as you exhale and relax your TA as you inhale.

Multifidus: 

Lie on your back or side-lying with a neutral spine and imagine a line that connects the left and right sides of the posterior pelvis. Contract the multifidus to try to draw together your left and right halves along this line (back of pelvis) Be sure to have relaxed breathing, and contract multifidus during exhalation. No anterior tilting of the pelvis, flexion of the hips or movement of the thorax and lower back should be noted.

Pelvic Floor Engagement:

Best to seek assessment from a pelvic floor physio to ensure proper function 

Diaphragm Breathing: 

During pregnancy, the diaphragm is displaced upwards approximately 5 cm to accommodate for the increasing size of the uterus.  As a result, the work placed on the diaphragm increases and compensatory strategies such as using accessory muscles are noted.

Given the changes to the diaphragm during pregnancy, it is recommended that during the prenatal, early post-partum and late-postpartum periods, a tension-free diaphragmatic breathing pattern should be taught.  This means that during inhalation, the diaphragm should descend downward and the sides of the rib cage should expand outwards. This helps ensure a good working relationship between the pelvic floor and the diaphragm.

Lifting and Posture: 

During the prenatal, intrapartum, early and late postpartum periods, it is important to avoid movements that create repeated increases in intraabdominal pressure (think straining or bulging out). Education on posture and body mechanics should include activities such as: lifting/carrying objects, rolling to the side to get up while using the arm to push up, avoiding straining on the toilet, maintenance of a neutral spine alignment with both dynamic and static postures and placement of one foot higher than the other when standing for prolonged periods of time (think foot inside lower cabinet when washing dishes).

Should we bind?

Although it may be nice in the immediate postpartum period, non-elastic abdominal binding has been shown to increase pressure on the bladder or downward pressure onto the pelvic floor. If going to utilize binding or support, it should be initiated immediately and only until the 8 week postpartum mark when you can generate enough tension through the linea alba on your own. 

Bottom Line: Researchers now agree that the ability to generate tension in the LA is crucial for abdominal wall function and is more important than complete DRA closure. Most importantly, patient functionality, neuromuscular control, and muscle capacity to achieve force and form closure may be of greater clinical value. Systematic reviews support utilizing TA contractions in DRA rehabilitation programs, combined with upper and lower extremity exercises, trunk rotations, and functional training in various loading positions.