Rectus diastasis, often called diastasis recti or abdominal separation, describes a widening of the connective tissue line down the centre of your abdomen (the linea alba) so that the left and right “six-pack” muscles (the rectus abdominis) sit further apart than usual. This is especially common during and after pregnancy, because the abdominal wall needs to stretch to make space for a growing baby. Importantly, it is usually not a “tear” of muscle. It is more like the central tissue has been stretched and thinned, which can change how your abdominal wall manages pressure.
For many people, abdominal separation improves naturally in the early postpartum period. For others, the gap and the midline bulge can persist, especially with tasks that increase abdominal pressure (getting out of bed, lifting, coughing, carrying a baby seat, or returning to exercise too quickly). Some people also notice a sense of core weakness, reduced trunk support, or lower back discomfort, particularly later in the day.
It is also worth knowing that the size of the gap is not the whole story. Two people can have the same measured separation but very different symptoms. What often matters most is the function of the linea alba, including how well it can tense, transfer load, and manage pressure without doming. This is why assessment by a Women’s Health Physiotherapist can be so useful: physiotherapy for diastasis recti focuses on restoring control, strength, and confidence in everyday movement, not just “closing the gap”.
Physiotherapy for rectus diastasis typically includes education about pressure management, retraining breath and deep abdominal activation, improving pelvic floor and hip strength, and gradually progressing back to lifting, running, gym training, or sport. If you have pelvic floor symptoms (leaking, heaviness, prolapse sensations) or ongoing back pain, a physiotherapist can address these alongside your diastasis recti rehab, because these systems work together.
Key Facts
Risk Factors
- Pregnancy (especially late pregnancy), due to stretching of the linea alba and abdominal wall.
- Multiple pregnancies or closely spaced pregnancies.
- Twin or multiple pregnancy, or carrying a larger baby (increased abdominal load).
- Higher weight gain or higher BMI, which can increase abdominal pressure.
- Returning to high-pressure abdominal exercise too early postpartum or using techniques that cause doming.
- Constipation and straining in pregnancy or postpartum.
Symptoms
- A visible midline bulge or “doming” (sometimes called coning) when you sit up, roll in bed, lift, or strain.
- A noticeable gap along the midline of the abdomen, often felt around the belly button (and sometimes above and below).
- A feeling of abdominal weakness or reduced control during lifting, carrying, or exercise.
- Lower back discomfort or fatigue, especially after long days on your feet or when carrying children.
- Poor posture or rib flare that feels hard to control (often linked with reduced trunk pressure management).
- In some people, pelvic floor symptoms such as leaking or heaviness can occur alongside abdominal separation (not always caused by diastasis, but commonly associated).
Aggravating Factors
- Getting out of bed or rising from the floor without rolling (often triggers doming early postpartum).
- Heavy lifting or carrying (prams up stairs, baby capsules, laundry baskets) especially while holding breath.
- High-pressure core exercises too early (full sit-ups, crunches, aggressive planks, double leg lowers) if they cause doming.
- Constipation and straining, which repeatedly increases abdominal pressure.
- Coughing bouts without support strategies (for example during respiratory illnesses).
Causes
Rectus diastasis is most commonly linked to pregnancy-related stretching of the abdominal wall. As the uterus expands, the linea alba lengthens and thins to accommodate the growing baby. Hormonal changes that soften connective tissue also contribute, which is why abdominal separation is often described as a normal protective adaptation during pregnancy rather than a “failure” of your body.
Several factors can influence how noticeable or persistent abdominal separation becomes:
- Repeated or closely spaced pregnancies can lead to greater cumulative stretching of the abdominal wall.
- Higher abdominal load, such as carrying twins, a larger baby, or higher gestational weight gain, can increase pressure on the midline tissues.
- Genetics and connective tissue quality influence how much tissues stretch and how they recover.
- Postpartum pressure and movement habits matter. Early return to high-pressure abdominal exercises, frequent breath-holding with lifting, and repeated straining with constipation can all keep the linea alba under stress.
- Co-existing factors such as reduced hip strength, rib flare mechanics, pelvic floor dysfunction, or poor load management can contribute to ongoing symptoms, even if the gap itself is not “severe”.
Physiotherapy for diastasis recti focuses on modifiable drivers, particularly pressure management, deep abdominal control, and graded strengthening. The aim is to help your abdominal wall become strong and functional for real life tasks like lifting, carrying, returning to sport, and feeling confident in your body again.
How Is It Diagnosed?
Rectus diastasis is diagnosed with a combination of history and physical assessment. A physiotherapist will ask about your pregnancy and postpartum timeline, your functional symptoms (doming, weakness, back pain, pelvic floor symptoms), and what tasks trigger symptoms.
Assessment commonly includes checking the midline above, at, and below the belly button at rest and during a gentle abdominal contraction. Your physiotherapist may assess:
- the width of the inter-recti distance (gap)
- the depth and tension of the linea alba (how well the tissue firms up)
- whether you have doming with tasks
- how you breathe and manage pressure (rib flare, breath-holding patterns)
- hip and trunk strength, posture, and movement strategies for lifting and rolling
Some clinics will use ultrasound to measure the inter-recti distance more precisely, but hands-on assessment can still be useful, especially when paired with functional tests. An Australian hospital fact sheet also describes a simple self-check (feeling for a gap during a small curl-up), but an assessment by a Women’s Health Physiotherapist is recommended if you are unsure or symptomatic.
Investigations & Imaging
- Clinical assessment
- Assesses gap width, linea alba tension, doming, breathing and pressure management, plus functional movement patterns.https://www.thewomens.org.au/images/uploads/fact-sheets/Abdominal-muscle-seperation-270719.pdf
- Ultrasound
- Can measure inter-recti distance at specific points and may help track change over time, particularly in research or complex cases.https://link.springer.com/content/pdf/10.1007/s10029-021-02468-8.pdf
- Medical review
- Recommended if there is suspected hernia (a focal, persistent bulge with pain), significant abdominal wall pain, or red flags.
Grading / Classification
- Mild
- Smaller gap with good ability to tense the midline. Often minimal symptoms, but doming may still appear with poor pressure management. Some clinicians consider this in the 1 to 2 cm range, noting that definitions vary.
- Moderate
- More noticeable widening, often with reduced midline tension or doming during tasks. May need targeted diastasis recti physiotherapy exercises and pressure management to improve function. Some clinicians consider this around 2 to 4 cm, noting that definitions vary.
- Severe
- Large separation and/or poor midline tension with significant doming and functional symptoms (back pain, reduced lifting tolerance, confidence issues). May need longer rehab and, in select cases with hernia or severe functional impairment, surgical opinion. Some clinicians consider this >4 cm, noting that definitions vary.
Physiotherapy Management
Physiotherapy for rectus diastasis (diastasis recti physiotherapy) aims to improve how your abdominal wall functions under real-life loads such as lifting, carrying, getting up from the floor, and returning to gym or sport. While many people focus on “closing the gap”, physiotherapy focuses on what matters most for symptoms: midline tension, pressure control, and load tolerance.
A Women’s Health Physiotherapist will typically assess your inter-recti distance (above, at, and below the belly button), the quality of linea alba tension, and whether you dome with common movements. From there, your plan is built around:
- breath and pressure management (so your abdominal wall is not repeatedly pushed outward)
- deep abdominal and pelvic floor coordination
- progressive strengthening for trunk, hips, and glutes
- return-to-exercise progressions that avoid symptom flare and doming
- movement retraining for lifting, carrying, rolling, and exercise technique
This approach is particularly important if you are returning to higher-load training like weights, Pilates, running, CrossFit-style sessions, or physically demanding work.
Exercise
Diastasis recti physiotherapy exercises are chosen based on your stage postpartum, symptoms, and whether your abdominal wall can generate tension without doming. Early on, many people benefit from simple drills that reconnect breath with deep abdominal activation and pelvic floor coordination. The aim is to rebuild an “automatic” strategy where the abdominal wall supports you before pressure spikes.
As you progress, exercises become more functional and strength-based. A typical diastasis recti rehab progression might include:
- Early stage (control and comfort):
Breath work, gentle deep abdominal activation, supported movements for rolling and getting up, and low-load strength for hips and glutes. - Mid stage (strength and endurance):
Progressive core strength (still pressure-managed), more challenging hip and posterior chain work, and graded carries and lifting patterns that match your daily life. - Late stage (return to performance):
Heavier lifting patterns, impact prep (if returning to running), and sport or gym-specific conditioning, while monitoring for doming and next-day symptoms.
Your physiotherapist will also teach you how to recognise and avoid “red flag technique” signals during exercise, such as visible coning, breath-holding, or pelvic floor heaviness. The right exercise is the one that strengthens you while keeping the abdominal wall working with you, not bulging against you.
Activity Modification
Activity modification in rectus diastasis is about reducing repeated pressure spikes while your tissues recover and your control improves. This is not about avoiding movement. It is about choosing smarter loads and better technique so you can keep living your life and still heal.
Common early changes include:
- rolling to get out of bed rather than sitting straight up
- avoiding repeated heavy lifting that causes doming (and changing how you lift instead)
- reducing high-pressure abdominal exercises (crunches and full sit-ups) if they cause bulging
- managing constipation to reduce straining
Your physiotherapist will help you return to the activities you care about, including gym, running, and sport, using graded progressions and technique coaching so the abdominal wall adapts rather than flares.
Manual Therapy
Manual therapy is not the main treatment for diastasis recti, but it may be used by some physiotherapists to address contributing factors such as rib and thoracic stiffness, hip mobility issues, or muscle tension that is affecting breathing and pressure control. Manual therapy can also support comfort during the early postpartum period when your body feels generally tight or fatigued.
When used, manual techniques should support an active plan that includes education and progressive strengthening. The long-term improvement in abdominal separation symptoms comes from better function, not from hands-on work alone.
Postural Retraining
Postural retraining for rectus diastasis usually focuses on your ribcage and pelvis relationship, because this influences abdominal pressure. Some people develop a rib flare posture postpartum, especially when carrying a baby, feeding, or standing for long periods. This can make it harder for the deep abdominal wall to engage effectively, increasing doming with tasks.
Your physiotherapist will coach positions and cues that help you feel supported without forcing a rigid posture. This commonly includes breathing patterns that expand the ribs and back, then reconnect the deep abdominals and pelvic floor in a coordinated way. The goal is a posture you can actually maintain while parenting and moving, not a perfect pose you cannot sustain.
Bracing & Taping
Bracing and taping can be useful short term in diastasis recti rehab, particularly in the early postpartum window when the abdominal wall feels unsupported or you have significant doming with daily tasks. Some people feel immediate relief in their back and better comfort when feeding, walking, or carrying.
Australian hospital guidance includes wearing an abdominal support (such as Tubigrip or firm compressive underwear) as one option alongside deep abdominal strengthening and technique changes. A Women’s Health Physiotherapist can help you choose the right type, ensure it is not overly restrictive, and show you how to use it without relying on it long term.
Kinesiology taping may be used by some physiotherapists to improve comfort and body awareness, and to support better movement strategies. If taping or support makes you feel more confident during daily loads, it can be a helpful bridge while strength and control improve.
Shockwave
Therapeutic ultrasound is not a routine treatment for rectus diastasis itself. Ultrasound imaging may be used in some clinics as an assessment tool to measure the inter-recti distance and assess how the abdominal wall behaves during activation, but it is not required for most people.
Heat & Ice
Heat and ice are not primary treatments for abdominal separation. They may be used for general comfort (for example, muscle soreness in the back or hips), but they do not directly change the linea alba or close a diastasis.
Education
Education is one of the most valuable parts of physiotherapy for diastasis recti. You will learn how to reduce unnecessary pressure on the midline during daily life, including how to lift, carry, cough, and get up from the floor without repeated doming. You will also learn what to do if you see coning during exercise, and how to modify movements so you can keep training safely.
Education also covers realistic expectations. Many people still have a small gap even when they are fully functional and symptom-free. The aim is a strong, supportive abdominal wall that works well for your life, not a specific number on a measurement.
Other
Other management may include referral coordination if there are significant pelvic floor symptoms, suspected hernia, or persistent pain. Your physiotherapist may also liaise with your GP, obstetrician, or women’s health team if further assessment is needed. For people returning to high-level sport or heavy lifting jobs, a physiotherapist can provide return-to-training testing and progressive programming that matches your goals.
Other Treatments
Other treatments can include guided return to general exercise (walking, low-impact cardio), management of constipation to reduce straining, and in some cases short-term use of abdominal supports. If pelvic floor dysfunction is present, pelvic floor physiotherapy is often an important part of the overall plan, because pelvic floor and deep abdominal function are closely linked.
Some people seek online programs or generic “gap closing” routines. These can help, but they can also be the wrong fit if you have significant doming, pain, or pelvic floor symptoms. A tailored plan with a Women’s Health Physiotherapist is often the most efficient way to progress safely.
Prognosis & Return to Activity
For many women, abdominal separation improves substantially in the early postpartum period. Research summarised in a review reported that diastasis recti is common early postpartum, with one study showing 60% prevalence at 6 weeks postpartum and 32.6% at 12 months postpartum (using that study’s definition). Another study summarised in the same review reported 52.4% prevalence at 6 to 8 weeks postpartum using ultrasound criteria.
What this means in plain terms is that rectus diastasis is very common early on and often improves over time, but a meaningful proportion of women still have some separation at 12 months. Having a persistent gap does not automatically mean you will have symptoms, but if you do have doming, weakness, back pain, or pelvic floor symptoms, diastasis recti physiotherapy can help improve function and confidence.
Prognosis is generally very good with appropriate rehab, especially when the focus is on pressure management and progressive strengthening rather than rushing back into high-pressure abdominal training.
Complications
- Persistent doming and reduced trunk support with lifting and carrying, particularly if pressure management is not addressed.
- Ongoing lower back pain or fatigue related to reduced abdominal wall support, especially during high parenting load periods.
- Associated pelvic floor symptoms (leaking, heaviness) in some people, particularly with early return to high-impact exercise.
- In a smaller number of cases, an associated hernia may require medical assessment and potentially surgical management.
Preventing Recurrence
- Practise pressure-smart lifting: exhale during effort, avoid breath-holding, and keep loads close when lifting and carrying to reduce repeated doming.
- Avoid returning too quickly to high-pressure core work. Progress planks, crunch-type tasks, and heavy lifting gradually, ensuring the abdominal wall stays controlled without bulging.
- Stay on top of constipation to reduce straining, which repeatedly loads the linea alba and pelvic floor.
- Maintain your deep core, pelvic floor, and hip strength even after symptoms improve, especially if you return to running, heavy lifting, or high-volume parenting tasks.
When to See a Physio
- If you have doming or bulging that does not improve, especially when lifting or getting up from the floor.
- If you have back pain, pelvic pain, or pelvic floor symptoms alongside abdominal separation.
- If you are returning to gym, Pilates, or running and want a safe plan (especially after caesarean birth or complicated delivery).
- If you suspect a hernia (a focal bulge with pain, or a bulge that does not change with posture) or you are worried about what you are seeing or feeling.