How to Heal Diastasis Recti With Physical Therapy

Diastasis recti—or diastasis rectus abdominis, as it is known in medical terms—is a common condition that develops when the two portions of the outermost abdominal (stomach) muscle separate.

This issue typically happens during pregnancy, when the muscle stretches to accommodate a growing baby, but it can also occur in infants or in older men and women as well. Learn how to treat and prevent diastasis recti with physical therapy in the sections below.

An Overview of Diastasis Recti

Diastasis recti occurs when the midline of the most superficial abdominal muscle—called the rectus abdominis—starts to separate. Widening in this area of connective tissue, which is known as the linea alba, can occur for a variety of reasons, including:

• Pregnancy: This happens as the result of the increased pressure that an enlarging fetus places on the wall of the stomach. In fact, it is estimated that 66% to 100% of women experience diastasis recti in their third trimester. People carrying multiple babies or those who are smaller in stature may also be more prone to it.
• Stomach obesity: Those who undergo frequent or rapid changes in body weight, or with a genetic predisposition for this condition, may also be at risk.
• Newborn babies: This form of the condition typically self-resolves.

One of the hallmark signs of diastasis recti is a visible deformity or bulge in the center of the stomach. This bulge can move in and out and is typically made worse by activities that activate the abdominal muscles. Common aggravating actions include:

• Sneezing
• Coughing
• Rolling over in bed
• Lifting

While this condition is frequently painless, it may lead to:

• Abdominal-area discomfort
• Low back pain
• Hip pain in some cases

It can also cause the stomach to feel flabby and your core muscles to seem weak or ineffective.

Diagnosing the Condition

Diagnosing diastasis recti is a relatively straightforward process. Your physician or physical therapist will usually begin by palpating (examining by touch) the midline of your stomach to assess for any bulging or protrusion and to determine the location and severity of the separation. They may also ask you to activate your abdominal muscles to evaluate for any changes that occur when you attempt to activate the rectus abdominis.

In addition, a thorough subjective history is usually taken. During this portion, your healthcare provider will ask you about your pregnancy and labor history, when the symptoms began, and what activities make it better or worse.

In rarer cases, your healthcare provider may also order a computed tomography (CT) scan or an ultrasound to confirm the diastasis recti diagnosis.

How Diastasis Recti Can Be Treated With Physical Therapy

In many cases, diastasis recti self-resolves after your baby is born or when significant weight loss occurs. That said, in many cases, physical therapy (PT) may be necessary to treat this condition. PT uses several different strategies to address the symptoms of this issue. They include:

• Core strengthening: As your abdominal muscles are stretched further and further, they become less effective in providing core stability. Physical therapy can help reduce the separation that occurs in the rectus abdominis by strengthening your stomach muscles. Your PT can also help you target the low back, hip, and diaphragm muscles, which can lend support to the affected area of your stomach.
• Education: In an effort to reduce the strain placed on your abdominal muscles, it is important to avoid certain activities that put more stress on the area where muscular separation has occurred. Your PT will teach you the most common movements to avoid and will help you find compensatory strategies that work for you.
• Bracing: In addition to exercises that target the core muscles, certain braces can help support your abdomen and decrease the amount of separation that has occurred. Your PT can help you find a garment that allows you to carry out your daily activities while providing stability in the area where diastasis recti has occurred.
• Neuromuscular electrical stimulation (NMES): NMES is a device that uses an electrical current to stimulate your abdominal muscles to activate. This treatment is frequently utilized by physical therapists to treat diastasis recti in combination with core strengthening exercises. Research has shown that the use of NMES along with exercise leads to smaller abdominal separation width and increased stomach strength when compared with treating the condition with exercise alone.

Ways to Prevent Diastasis Recti

Most, if not all, women will experience some degree of diastasis recti as they progress through their pregnancy. In these cases, it may be impossible to completely prevent the condition from occurring. That said, starting a regular core strengthening program early in your pregnancy may help facilitate the resolution of the condition and alleviate some of the symptoms after labor.

In other situations, certain steps can be taken to reduce the chances that diastasis recti occurs, like:

• Maintaining a healthy body weight
• Avoiding the strain that obesity can place on the wall of the stomach
• Regularly focusing on exercises that keep your stomach, hip, pelvic, and low back muscles strong

Frequently Asked Questions

How long will it take to heal diastasis recti with physical therapy?

While individual situations will vary, a review of the evidence supporting the use of PT to treat diastasis recti showed some improvement was noted in as little as six weeks. Other studies, however, reported it took three to six months before significant progress occurred.

What should you wear for physical therapy with diastasis recti?

As part of their evaluation, your physical therapist will typically examine your bare abdominal area to assess the diastasis recti. As a result, your stomach should be easily accessible when going to PT. In addition, it is important to wear loose-fitting, comfortable clothes that make it easy to exercise during your sessions.

Will your stomach get softer when going to physical therapy for diastasis recti?

After the birth of a baby or significant weight loss, it can take a long time for the skin in your stomach to regain its elasticity and firmness. In fact, in many people, this area will always appear softer or less firm after it is stretched by pregnancy or excess weight. While physical therapy can help strengthen the core muscles in your stomach, it is typically not effective in resolving this completely normal side effect of pregnancy or obesity.

A Word From Verywell

Diastasis recti can be an uncomfortable and unpleasant condition to deal with. Not only does it cause a visible deformity in your stomach, but it can also lead to pain during your daily activities. The important thing to remember is that this issue is both extremely common and very treatable! If you are experiencing separation in your stomach muscles, be sure to speak to your doctor or physical therapist about which treatments are right for you.