By Dr. Brooke Meinema, DPT, FAFS

First things first, what is a diastasis recti?

A diastasis recti is a separation between the rectus muscles in the abdomen. While it is most associated with the pregnant/postpartum population, anyone can develop a diastasis. One study found 33% of women still had a diastasis recti 12 months after delivery, and 52% of urogynecological menopausal patients demonstrated a diastasis recti. This shows a diastasis recti isn’t necessarily determined by your age (women far removed from their last pregnancy were also very likely to demonstrate a diastasis, not just the new moms!).

Keep in mind: Having a diastasis does NOT mean the muscles or tissues are torn! That may happen under extreme circumstances, but it is not common.

Why isn’t my diastasis improving?

1. Poor pressure management

Rule number 1 of dealing with diastasis recti: do NOT hold your breath during activity! (This rule applies to any activity you do regardless of if you have a diastasis recti or not.)

This is one of the first things I have people with diastasis work on. Breathing coordination is an integral part of core muscle firing and preventing increased abdominal pressure which can lead to further stress on the abdominal wall. When someone holds their breath during a heavy activity, the pressure needs to go somewhere, and the belly is an easy outlet leading to weakness and separation.

What you can do.

Exhale on exertion. When doing a heavy task (think the overhead press, sit-ups, or other activity), exhale during the hard parts to allow the diaphragm to take the strain instead of the fascia/diastasis.

2. Wide infrasternal (rib cage) angles

The infrasternal angle (ISA) is the angle along the bottom of the ribcage (see the picture). Ideally, this angle would be about 90*. If the ISA iswide, this can put excess tension along the top of a diastasis preventing it from coming together and potentially making things worse. This can happen due to pregnancy (the rib cage widens to make room for the baby), poor breathing mechanics, or postural issues.

What you can do.

Start by assessing your posture. If you stand with your rib cage flared forward and back arched back, work on “stacking” your rib cage to prevent that rib flare (see picture). Similarly, working on breathing mechanics encouraging the ribcage to come down and in when you exhale is a great, gentle place to start. You may also find certain muscles, often the external oblique muscles, may be weak or uncoordinated. A physical therapist can help you assess these issues and talk you through exercises that would best help your specific case.  

3. Cesarean sections

Having a cesarean section has been shown to increase the likelihood of having a diastasis. This is because of fascial disruption and further weakening of core musculature. That being said, just because you have a C-section does not mean you will have a diastasis.

What you can do.

Working on improving scar healing and core control and stability can go a long way in helping reduce the diastasis.

4. Compensatory/poor muscle use

There are 2 different parts to measuring a diastasis: the width of the separation and the depth. Addressing the depth vs width requires a different approach for each. Let’s talk about the depth first since this is typically the first thing you would want to work on.

Depth:

People who have a deep diastasis often have weakness in their deep core muscles (underactive transverse abdominis, underactive external obliques/overactive internal obliques)

A depth of 1 knuckle is considered “normal,” but even more important than just the depth is the actual end feel when testing. If the tissue seems to have a nice bounce to it (kind of like a trampoline), that’s great! If the end feel seems “boggy” like your fingers could just sink right in without being pushed back out, this is not as great. The boggy feeling is a sign that the deep core muscles aren’t firing correctly, which means you have likely been compensating for this weakness by kicking in other muscle groups.

What you can do.

A great first step is to work on deep core stabilization.

Width:

The width can be bit easier to correct. A “normal” width would be 2 knuckles wide when measuring.

What you can do.

If the end feel for the depth is a nice bouncy ending, but the width is more than 2 knuckles wide, working on improving strength through the rectus abdominis muscles (these are your 6 pack muscles) is going to be your go to! Keep in mind, you still need to breathe because holding your breath can make things worse!

5. Genetics

Unfortunately, some of us have genetics that allows for reduced strength of connective tissue leading to an increased risk of developing diastasis recti. Some conditions, such as Ehlers-Danlos or hypermobility spectrum disorders, make it so the tissues have less of the “bounce back” qualities of typical fascia leading to a greater likelihood of having laxity.

What you can do.

Work with your doctor to address these issues. Improving overall stability and control of surrounding muscles and joints can reduce symptoms in this case.

6. Tight pelvic floor

Similar to pressure management problems, having increased tension in your pelvic floor can make it difficult to heal a diastasis recti. If the pelvic floor is too tight, the pressure from an inhalation needs to find a place to go, and the weakened tissue of a diastasis can be an easy target. Every inhalation requires the pelvic floor to stretch and move down to allow for the pressure change, but if the pelvic floor muscles are so tight they cannot expand, the pressure will push further into the abdominal wall.

What you can do.

Work on your breathing and reducing hip and pelvic tension. Talk with your pelvic floor physical therapist about ways to release tension in your pelvic floor.

With all of this being said: there are many ways to manage a diastasis. If you have tried one thing and not seen changes, it doesn’t mean you are stuck and can never improve. Seeing a physical therapist to work with your specific case and set up a plan with you can be a great next step! Call us at 616.847.1280 to set up your complimentary assessment.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370915/#:~:text=However%2C%20at%2012%20months%20postpartum,even%20persist%20past%20childbearing%20years

https://pubmed.ncbi.nlm.nih.gov/16868659/