Diastasis Recti: Removing fear and Understanding the Current Research

What Is Diastasis Recti?

Diastasis recti (DR) or diastasis rectus abdominus is the stretching and thinning of the linea alba, the connective tissue between the left and right sides of the rectus abdominis or “6-pack” abdominal muscles. It’s a normal adaptation during pregnancy with up to 100% of women having a widening of this tissue by the time they are at 40 weeks pregnant. For most women this comes back together on its own but for some it remains wider than pre-pregnancy.

• A gap of 3 cm or more is generally considered clinically significant (Keshwani et al., 2019), though function and tension across the midline may be more important than the gap alone.

Can You Prevent DR?

You can’t fully prevent it—but you can reduce excessive strain:
• Encourage full abdominal wall engagement (TA, obliques, rectus) during pregnancy and postpartum.
• Teach pressure management strategies like exhaling on effort and avoiding breath-holding.
• Avoid fear-based restriction. Movement builds capacity.

Why the First 8 Weeks Matter

The early postpartum period is a key window of healing when the body lays down type I collagen—the kind responsible for long-term tissue strength. The strategies used in this phase can affect the quality and function of the linea alba in the months and years ahead (Keshwani et al., 2019).

What Works Best?

Abdominal Binders

A 2019 pilot RCT by Keshwani and colleagues found that participants who used abdominal binders, either alone or in combination with exercise, had:
• Greater body image satisfaction
• Improved trunk flexion strength
• Better outcomes than those who only did TA exercises or received no intervention (Keshwani et al., 2019)

Binders can be worn for a few hours daily and paired with early functional movement for optimal benefit.
A pelvic health physiotherapist can help assess whether a binder is appropriate, especially in cases of prolapse, abdominal incision healing, or underlying pressure issues.

Whole-Core Movement

• Start with gentle breath work and functional core activation—no need to isolate the TA or “draw in” especially in the first 8 weeks postpartum
  • Work the abs as a team, integrating breath, pressure control, and pelvic floor synergy.
  • Avoid “doming panic”—some doming is okay as long as it’s soft to the touch and there’s no downward force on the pelvic floor.

Everyone’s Goals Matter

While clinical function (strength, tension, control) is an important benchmark, it’s also essential to recognize that how someone feels about their body matters, too. If appearance or body image is a person’s primary concern, that is valid and deserves space in the care plan. A good rehab program supports the whole person, including their physical and emotional goals.

What to Do and When
0–8 weeks postpartum | Support healing tissue, manage pressure | Wear a binder a few hours/day if appropriate, begin breath & pelvic floor coordination, avoid straining.
8–12 weeks postpartum | Rebuild strength, coordinate movement | Add progressive loading, planks, crunches, squats, functional exercises if pressure is managed.
3–6 months | Train for load tolerance and resilience | Prioritize function and personal goals; increase challenge when form is solid.
6+ months | Maintain gains, reassess function | Continue full-body training with progressive overload strategies.

Don’t Go It Alone

A pelvic health physiotherapist trained in diastasis recti can help:
• Assess tension, function, and pelvic pressure strategies
• Guide safe progressions for strength and movement
• Address body image concerns with empathy and evidence-based care
• Rule out contraindications to binders or high-intensity exercise

References

Brockwell, E., & Donnelly, G. (2021, October 19). Bonus session diastasis revolution: Busting the myths [Video]. YouTube. https://www.youtube.com/watch?v=4kpFWXEKZDc

Hallam, T. (2025). Stop getting in the body’s way: The truth about DRA healing [Interview]. In Institute for Birth Healing (Host), 2025 Birth Healing Summit. https://instituteforbirthhealing.com

Keshwani, N., Mathur, S., & McLean, L. (2019). The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: A pilot randomized controlled trial. Physiotherapy Theory and Practice, 37(9), 1018–1033. https://doi.org/10.1080/09593985.2019.1675207

Lo, A. (2023). Diving into diastasis [Handout]. https://www.diastasis.info