Reclaim Your Core: Your Postpartum Diastasis Guide

Redefining Your Core Journey

Your body is resilient and adaptable, and coming to physical therapy shows you’re ready to develop your functional strength. In the postpartum period, seeing a “gap” can be alarming. Let’s work beyond “fixing a gap” to restoring a core that supports every aspect of your movement. 

Understanding Diastasis Recti: A Natural Adaptation

Diastasis Recti Abdominis (DRA) is often misunderstood as a "tear" or a "failure" of the abdominal muscles. In reality, it is a stretching and thinning of the linea alba, the band of connective tissue that joins the two sides of your abdominal muscles. Recent clinical perspectives emphasize that this is a healthy, necessary adaptation. In fact, DRA occurs in 100% of women by late pregnancy. It is a universal physiological response driven by hormones and mechanical pressure as your baby grows. 

The Spontaneous Healing Timeline

While natural tissue remodeling occurs over 6 to 12 months, targeted physical therapy provides the strategic loading to support functional strength long after spontaneous recovery plateaus. Physical therapy can support your recovery by teaching you strategies to optimize the load placed on these recovering tissues to help them heal faster and improve your functional strength to handle the demands of your daily life. 

The Paradigm Shift: Function Over the "Gap"

For decades, the focus of recovery was solely on the width of the "inter-recti distance." However, more recent research has changed our perspective: a gap of 1 to 2 finger widths (approximately 2.0 cm) is considered clinically normal. From a physical therapy standpoint, the width of the gap is far less important than midline tension and load transfer. We want our muscles to be able to create enough tension to support your trunk and manage internal pressure. This may involve exercises to address your transverse abdominis, rectus abdominis, obliques, and pelvic floor. 

But what about the “doming”? 

Clients often come to me with concerns about the appearance of their abdomen, particularly the midline dome, lower belly pooch, or pesky cesarean shelf. Fortunately, by shifting our focus on improving midline tension, load transfer, posture, and abdominal strength, we are often able to see significant changes in appearance as well. 

Practical Strategies for Core Rehabilitation

Based on your presentation in your initial physical therapy evaluation, and during subsequent visits, your treatment plan may include breathwork, core bracing strategies, postural re-education, core strengthening, and hip strengthening. Depending on your goals, we may be working on running, jumping, or heavier lifting to get you back to your desired activities. 

Monitoring Your Progress: What to Look For

My primary approach with recovering the core is how YOU feel during an activity. If you’re having pain or feel an uncomfortable amount of pulling/pressure at the abdominal midline or around surgical incisions, it is appropriate to reduce the intensity. Some folks want to monitor the diastasis and doming more closely with video during an exercise or by placing a hand on their abdomen. You can watch and feel for doming/bulging or a deep sinking/valley along the midline. These are signs that we consider biofeedback, not damage. They help us determine that the load may be too high for your tissues to manage OR we just need to change strategies on how to approach that load. If you see doming, I encourage you to approach it with curiosity - try decreasing the intensity, checking your breath (don't hold it!), or adjusting your position. No change? Don’t stress! Let’s just chat about it in your next session. 

Myth busting:

"You must never do a curl-up/sit up again." 

Research by Gluppe et al. (2023) shows that progressive abdominal exercises, including curl-ups, are safe and can improve muscle thickness and core function. 

"A gap always causes back pain or leaking." 

Studies show no direct difference in pain or leaking between those with and without DRA. However, while the gap itself isn't the cause, the overall management of internal pressure is key to preventing these issues.2,3

"Waist trainers will fix the gap." 

While postpartum binders or splints can provide comfortable support, gentle compression, and helpful proprioceptive feedback in the early weeks, they do not replace an active exercise program. Binders should be used with caution, as excessive compression can increase intraabdominal pressure and put a downward strain on the pelvic floor