Diastasis Recti (Abdominal Separation).
What is diastasis recti?
Diastasis recti is a separation of the abdominal muscles, specifically the rectus abdominis muscles, along the linea alba — the connective tissue that runs down the centre of the abdomen. This separation occurs due to the stretching and weakening of the abdominal muscles, often during pregnancy or as a result of repetitive strain.
The linea alba is a band of connective tissue running from the sternum to the pubic symphysis that connects the two halves of the rectus abdominis. During pregnancy, the expanding uterus progressively stretches both the rectus abdominis muscles and the linea alba. Some degree of this stretching occurs in virtually all pregnancies — studies show that by the third trimester, nearly all pregnant women have a clinically measurable inter-recti distance. The clinical question is not simply whether separation exists but whether it is producing functional impairment.
Diastasis recti is not exclusively a postpartum condition. It can also develop in men and non-pregnant women from repetitive heavy lifting, abdominal obesity, or chronic straining, though pregnancy is by far the most common cause.
How is diastasis recti assessed?
Physiotherapy assessment of diastasis recti goes beyond simply measuring the gap width between the two rectus abdominis muscles. While inter-recti distance — measured by palpation or ultrasound — is part of the assessment, the most clinically relevant finding is whether the linea alba has adequate tension to provide load transfer across the midline during functional movements.
A wide gap with good linea alba tension may produce no functional impairment, while a narrower gap with poor tension may significantly compromise abdominal wall function. The functional tests — active straight leg raise, loaded trunk curl-up, ability to generate intra-abdominal pressure without coning or doming through the midline — provide more useful rehabilitation information than gap width alone.
Diastasis recti is typically diagnosed through a physical examination by a physiotherapist or doctor, who will assess the gap between the rectus abdominis muscles and check for any bulging or herniation. Real time ultrasound provides objective measurement of the inter-recti distance and assessment of linea alba integrity during functional tasks — it is the most precise tool available for diastasis recti assessment and for monitoring rehabilitation progress.
What are the symptoms?
Many women with diastasis recti have no symptoms beyond the visible midline "dome" or bulge during abdominal exercises. When symptoms are present they typically include lower back pain, pelvic girdle pain, a sense of abdominal weakness, difficulty with heavy lifting, and in some cases pelvic floor dysfunction. The relationship between diastasis recti and lower back pain and pelvic girdle pain is well established — the abdominal wall is an important component of the lumbopelvic stability system, and compromise of its integrity can contribute to these conditions.
In severe cases and very rarely, patients may have an abdominal wall hernia resulting in a visible bulge. If this is the case you should see a physiotherapist or doctor as they will likely not resolve on their own.
What about exercise — what should I avoid?
The traditional advice to avoid all abdominal exercises until diastasis recti resolves has been substantially revised by the current evidence. The functional approach focuses not on avoiding exercises based on gap width, but on avoiding exercises that produce visible doming or coning through the midline — which indicates the linea alba is unable to manage the load — regardless of the specific exercise type.
Traditional crunches and sit-ups are often poorly tolerated in the early rehabilitation period and may produce the visible coning pattern — but this is a loading issue, not a categorical contraindication. As abdominal wall function improves through rehabilitation, most exercises can be progressively reintroduced. The goal is building toward full functional capacity, not permanent avoidance.
How can physiotherapy help?
Physiotherapy can be extremely helpful in managing diastasis recti. Treatment will typically focus on strengthening the deep core muscles — specifically the transversus abdominis, pelvic floor and multifidus — which provide the dynamic stabilisation and intra-abdominal pressure regulation that compensates for the reduced passive linea alba tension.
The rehabilitation progression moves systematically from deep core activation in unloaded positions through to progressively loaded functional movements. Breathing strategies — particularly learning to manage intra-abdominal pressure during exertion — are a critical early skill that underpins all subsequent rehabilitation. Load progression is guided by the functional tests described above — advancing when doming is absent and linea alba tension is adequate at the current load level.
Real time ultrasound provides biofeedback on transversus abdominis activation and linea alba behaviour during exercises, making this retraining precise and objective. Clinical Pilates is particularly well suited to diastasis recti rehabilitation — the emphasis on deep core activation, breathing and movement quality directly addresses the functional rehabilitation goals. Our Mums and Bubs postnatal Pilates course is designed with diastasis recti in mind and is an excellent post-physiotherapy maintenance program.
Our physiotherapists Bethany Kippen and Emma Cameron both have experience in women's health physiotherapy and diastasis recti rehabilitation and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Diastasis recti is a separation of the abdominal muscles, specifically the rectus abdominis muscles, along the linea alba — the connective tissue that runs down the centre of the abdomen. This separation occurs due to the stretching and weakening of the abdominal muscles, often during pregnancy or as a result of repetitive strain.
The linea alba is a band of connective tissue running from the sternum to the pubic symphysis that connects the two halves of the rectus abdominis. During pregnancy, the expanding uterus progressively stretches both the rectus abdominis muscles and the linea alba. Some degree of this stretching occurs in virtually all pregnancies — studies show that by the third trimester, nearly all pregnant women have a clinically measurable inter-recti distance. The clinical question is not simply whether separation exists but whether it is producing functional impairment.
Diastasis recti is not exclusively a postpartum condition. It can also develop in men and non-pregnant women from repetitive heavy lifting, abdominal obesity, or chronic straining, though pregnancy is by far the most common cause.
How is diastasis recti assessed?
Physiotherapy assessment of diastasis recti goes beyond simply measuring the gap width between the two rectus abdominis muscles. While inter-recti distance — measured by palpation or ultrasound — is part of the assessment, the most clinically relevant finding is whether the linea alba has adequate tension to provide load transfer across the midline during functional movements.
A wide gap with good linea alba tension may produce no functional impairment, while a narrower gap with poor tension may significantly compromise abdominal wall function. The functional tests — active straight leg raise, loaded trunk curl-up, ability to generate intra-abdominal pressure without coning or doming through the midline — provide more useful rehabilitation information than gap width alone.
Diastasis recti is typically diagnosed through a physical examination by a physiotherapist or doctor, who will assess the gap between the rectus abdominis muscles and check for any bulging or herniation. Real time ultrasound provides objective measurement of the inter-recti distance and assessment of linea alba integrity during functional tasks — it is the most precise tool available for diastasis recti assessment and for monitoring rehabilitation progress.
What are the symptoms?
Many women with diastasis recti have no symptoms beyond the visible midline "dome" or bulge during abdominal exercises. When symptoms are present they typically include lower back pain, pelvic girdle pain, a sense of abdominal weakness, difficulty with heavy lifting, and in some cases pelvic floor dysfunction. The relationship between diastasis recti and lower back pain and pelvic girdle pain is well established — the abdominal wall is an important component of the lumbopelvic stability system, and compromise of its integrity can contribute to these conditions.
In severe cases and very rarely, patients may have an abdominal wall hernia resulting in a visible bulge. If this is the case you should see a physiotherapist or doctor as they will likely not resolve on their own.
What about exercise — what should I avoid?
The traditional advice to avoid all abdominal exercises until diastasis recti resolves has been substantially revised by the current evidence. The functional approach focuses not on avoiding exercises based on gap width, but on avoiding exercises that produce visible doming or coning through the midline — which indicates the linea alba is unable to manage the load — regardless of the specific exercise type.
Traditional crunches and sit-ups are often poorly tolerated in the early rehabilitation period and may produce the visible coning pattern — but this is a loading issue, not a categorical contraindication. As abdominal wall function improves through rehabilitation, most exercises can be progressively reintroduced. The goal is building toward full functional capacity, not permanent avoidance.
How can physiotherapy help?
Physiotherapy can be extremely helpful in managing diastasis recti. Treatment will typically focus on strengthening the deep core muscles — specifically the transversus abdominis, pelvic floor and multifidus — which provide the dynamic stabilisation and intra-abdominal pressure regulation that compensates for the reduced passive linea alba tension.
The rehabilitation progression moves systematically from deep core activation in unloaded positions through to progressively loaded functional movements. Breathing strategies — particularly learning to manage intra-abdominal pressure during exertion — are a critical early skill that underpins all subsequent rehabilitation. Load progression is guided by the functional tests described above — advancing when doming is absent and linea alba tension is adequate at the current load level.
Real time ultrasound provides biofeedback on transversus abdominis activation and linea alba behaviour during exercises, making this retraining precise and objective. Clinical Pilates is particularly well suited to diastasis recti rehabilitation — the emphasis on deep core activation, breathing and movement quality directly addresses the functional rehabilitation goals. Our Mums and Bubs postnatal Pilates course is designed with diastasis recti in mind and is an excellent post-physiotherapy maintenance program.
Our physiotherapists Bethany Kippen and Emma Cameron both have experience in women's health physiotherapy and diastasis recti rehabilitation and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
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