Can physiotherapy actually help diastasis recti, or is that “gap” in your stomach something you just have to live with after having a baby? For most people, the honest answer is yes, physiotherapy can help, and for many, a fair amount of what’s happening with that gap is more normal than the internet makes it sound.
If you’ve had a baby and noticed a soft bulge running down the middle of your stomach when you sit up, cough, or pick up your toddler, you’re not imagining it and you’re not alone. Diastasis recti, sometimes called abdominal separation or “ab separation,” affects the vast majority of pregnancies to some degree. What varies a lot is how much it bothers someone, how long it sticks around, and what actually helps it settle down.
This guide walks through what diastasis recti is, how a physiotherapist assesses and treats it, what the research actually supports (and doesn’t), and when it’s worth booking an assessment rather than waiting it out. It’s written for anyone navigating postpartum recovery in Toronto and beyond, whether you’re six weeks out from delivery or dealing with a separation that never quite closed years later.
What Is Diastasis Recti?
Diastasis recti abdominis (DRA) refers to a widening of the linea alba, the strip of connective tissue that runs down the midline of your abdomen and joins the left and right sides of the rectus abdominis muscle, the muscle most people mean when they say “abs” or “six pack.” As that connective tissue stretches and thins, the two muscle bellies move further apart, and the tissue between them becomes less able to transfer tension efficiently.
It isn’t a tear and it isn’t a hernia. The muscles and the connective tissue between them stay intact; the tissue is simply wider and, in some cases, less taut than before pregnancy. That distinction matters, because a true hernia (where tissue or organs push through a defect in the abdominal wall) is a different problem that sometimes needs a surgical opinion, while diastasis recti is a soft-tissue and muscle-function issue that physiotherapy is well suited to address.
Why It Happens During Pregnancy
As your uterus grows, it pushes outward on the abdominal wall, and rising levels of relaxin and other pregnancy hormones make connective tissue more pliable so your body can stretch to accommodate a growing baby. This is a normal, expected adaptation, not a sign that anything has gone wrong. Research reviewing abdominal wall changes across pregnancy has found that some degree of inter-recti widening is present in essentially all pregnancies by the third trimester.
How Common Is It After Birth?
The separation that builds up during pregnancy typically starts to close on its own in the weeks after delivery, but it doesn’t always fully resolve. Studies tracking postpartum recovery have found the prevalence of a clinically significant gap drops from very high rates immediately after birth to somewhere around half of new mothers by four to six weeks postpartum, continuing to decline to roughly a third to two-fifths of women by six months. For a meaningful number of people, some degree of separation persists well beyond that, especially without any targeted rehabilitation.
- Softness or looseness along the midline. Usually a normal postpartum change: Common in the early weeks as tissue gradually tightens. Worth having a physiotherapist look at: Persists well past 8-12 weeks with no improvement.
- Mild bulge with a cough or sneeze. Usually a normal postpartum change: Can happen in early recovery. Worth having a physiotherapist look at: Present with light daily activities like standing from a chair.
- Occasional low back ache after a long day. Usually a normal postpartum change: Very common in new parents from lifting and altered sleep positions. Worth having a physiotherapist look at: Persistent low back or pelvic girdle pain that isn’t easing.
- Feeling “not put back together” core-wise. Usually a normal postpartum change: Reported by most postpartum people to some degree. Worth having a physiotherapist look at: Combined with leaking urine, heaviness in the pelvis, or a visible dome that doesn’t soften.
Signs and Symptoms of Diastasis Recti
Diastasis recti isn’t always painful, and plenty of people with a noticeable gap have no symptoms at all beyond the visual change. Others notice a cluster of related issues that make daily movement harder.
The Visible Signs
The most recognizable sign is a ridge or dome running down the centre of the abdomen that becomes more obvious during a sit-up motion, a crunch, or even just coming up from lying flat. Some people also notice their belly button looks different, or that there’s a soft, give-y feeling when they press along the midline rather than a firm, springy resistance.
Symptoms Beyond the Belly
Because the deep abdominal wall works together with the pelvic floor, the diaphragm, and the deep muscles of the low back as one coordinated system, a change in one part can show up as symptoms somewhere else entirely. People with a significant diastasis sometimes report:
- Low back or pelvic girdle pain: Reduced tension through the linea alba can shift load onto the low back and pelvis during lifting or standing
- Urinary leakage or a feeling of heaviness: The abdominal wall and pelvic floor coordinate pressure together; a change in one often affects the other
- Difficulty lifting a car seat, stroller, or toddler: Reduced ability to generate trunk tension under load
- A sense of feeling unstable through the trunk: Decreased functional abdominal strength and coordination
Related Article: Does OHIP Cover Pelvic Floor Physiotherapy?
Diastasis Recti vs a Hernia
A true abdominal or umbilical hernia involves a gap in the muscle or connective tissue wide and deep enough that tissue, and occasionally a loop of bowel, can push through it. Hernias more often cause a firmer, more defined bulge that may be painful, especially with straining, and they don’t reliably respond to exercise alone. If a bulge feels hard, is very tender, changes colour, or won’t reduce (soften) when you relax, that’s a reason to see a physician promptly rather than starting a home exercise program, since this can indicate a hernia or another issue that needs medical evaluation first.
Risk Factors for a Diastasis That Lingers
Almost everyone develops some abdominal widening during pregnancy. What differs is who is more likely to still have a functionally significant gap months or years later. Research has pointed to several contributing factors, though none of them guarantee a persistent diastasis, and having several of these doesn’t mean physiotherapy won’t help.
- Multiple pregnancies: Repeated stretching of the linea alba over successive pregnancies
- Carrying twins or multiples: Greater and more sustained abdominal wall stretch
- Higher birth weight: Increased mechanical demand on the abdominal wall late in pregnancy
- Advanced maternal age: Connective tissue may respond and remodel more slowly
- Lower activity levels before or during pregnancy: Less baseline core strength and coordination to draw on postpartum
- C-section delivery: Scar tissue and altered abdominal wall mechanics can factor into recovery, alongside the surgical healing process itself
Related Article: Understanding the Role of Pelvic Floor Physiotherapy in Postpartum Recovery
How a Physiotherapist Assesses Diastasis Recti
How do physiotherapists check for diastasis recti? A physiotherapist assesses the width of the gap between the abdominal muscles using finger-width palpation or callipers along the midline, usually at rest and again while you gently lift your head or perform a mini curl. They also check the depth and tension of the tissue, since that tells them more than the distance alone.
What Happens During an Assessment
An assessment usually starts with a conversation about your pregnancy and delivery history, current symptoms, and functional goals, whether that’s returning to running, lifting your kids without discomfort, or simply feeling more confident in your body. From there, your physiotherapist will typically check the inter-rectus distance at a few points along the midline, both at rest and under light abdominal tension, since the width can change depending on how the muscles are engaged.
Emerging research suggests the depth of the gap and how much tension the tissue can generate, sometimes described as “doming” or “coning” when pressure pushes the midline outward, may matter as much as the raw width measurement. A thorough assessment also looks at breathing patterns, posture, pelvic floor coordination, and how you move during everyday tasks like getting out of bed or picking something up off the floor, since diastasis recti rarely exists in isolation from the rest of the core system.
Related Article: What to Expect During Your First Physiotherapy Session
- How wide and how deep is my separation?: Helps set realistic expectations and track progress over time
- Is my pelvic floor coordinating well with my core?: The two systems influence each other directly
- Which activities should I modify for now, and which are fine?: Avoids unnecessary restriction while protecting healing tissue
- What does a realistic timeline look like for me specifically?: Recovery speed varies with the size of the gap and other factors
- Do I need any additional referral, such as to a physician or pelvic health specialist?: Some symptoms warrant a broader care team
Related Article: Top 10 Questions for Your Physio
How Physiotherapy Treats Diastasis Recti
There’s widespread clinical agreement, supported by a growing body of research including a clinical review on diastasis recti rehabilitation published through the National Institutes of Health, that physiotherapy should be the first line of treatment for diastasis recti before surgery is even considered. Rather than one exercise or trick, effective treatment tends to combine several strands working together.
Deep Core and Breathing Retraining
Much of early-stage rehab focuses on the transverse abdominis, the deep muscle that wraps around the trunk like a natural corset, along with diaphragmatic breathing. Learning to coordinate a gentle inward draw of the lower abdomen with a relaxed exhale helps manage intra-abdominal pressure and starts to restore tension across the linea alba, rather than pushing outward against it.
Pelvic Floor Coordination
Because the pelvic floor and deep abdominal wall are part of the same pressure-management system, physiotherapists trained in pelvic health often assess how well the two are working together. Research has found that a large proportion of people with a significant diastasis also have difficulty generating an effective pelvic floor contraction, which is one reason pelvic floor physiotherapy and diastasis recti rehab overlap so heavily in practice.
Related Article: Top 3 Signs You Need Pelvic Floor Physiotherapy
Progressive Loading and Functional Strength
Once the basics of breath and deep core activation feel more natural, treatment usually progresses toward loading the abdominal wall in a graded way, think controlled curl-type movements, side-lying work, and eventually functional patterns like carrying, lifting, and rotating, all introduced at a pace the tissue can tolerate. A randomized controlled trial on postpartum curl-up exercises found that a structured 12-week abdominal strengthening program improved strength without widening the separation, which runs counter to the idea that any abdominal exercise is automatically harmful.
Posture and Everyday Body Mechanics
Small adjustments to how you stand, sit, breathe, and lift throughout the day influence how much pressure is placed on the healing tissue. A physiotherapist can help you translate good mechanics into the moments that matter most, like lifting a car seat or getting up from the floor with a toddler.
Related Article: How Physiotherapy Helps Manage Chronic Lower Back Pain
- Individualized physiotherapy. Main focus: Assessment-driven, progressive core and pelvic floor rehab. What the evidence supports: Associated with reduced inter-rectus distance and improved function in multiple studies.
- General postpartum fitness class. Main focus: Broad conditioning, not diastasis-specific. What the evidence supports: Can support overall recovery but may not address tension, breathing, or pelvic floor coordination directly.
- No structured rehabilitation. Main focus: Waiting for natural resolution. What the evidence supports: Many cases improve somewhat on their own, but a meaningful proportion of significant separations persist without intervention.
- Surgery alone, without prior rehab. Main focus: Mechanical closure of the gap. What the evidence supports: Guidelines generally recommend it only after conservative treatment has been tried and specific criteria are met.
Exercises Commonly Used in Diastasis Recti Rehab
It’s worth saying clearly: there’s no single exercise proven to “fix” diastasis recti on its own, and no universal list of exercises that’s right for everyone. What follows is general education on the types of movement physiotherapists commonly use, not a substitute for an individualized program built around your own assessment findings.
Examples of Movements Often Introduced Early
- Diaphragmatic breathing with a gentle transverse abdominis draw-in
- Pelvic tilts and heel slides in a supported supine position
- Modified side-lying core activation
- Bird-dog and gentle four-point kneeling stability work
- Supported standing posture and gentle bracing during daily tasks
Movements to Approach Thoughtfully
Traditional crunches, full planks, and heavy straining exercises used to be broadly labelled “off limits” with diastasis recti, but the research here is more nuanced than that blanket advice suggests. A 2023 randomized controlled trial published in the Journal of Physiotherapy found that a structured curl-up program did not worsen inter-rectus distance in postpartum women and improved abdominal strength. That doesn’t mean everyone should jump into crunches; it means the right approach depends on how well you can control intra-abdominal pressure and avoid visible doming during the movement, which is exactly the kind of thing a physiotherapist can assess and coach you through in person.
Related Article: The ’10-Minute Reset’ Routine for Desk Workers
How Long Does Recovery Take?
How long does it take to heal diastasis recti with physiotherapy? Timelines vary widely depending on the size of the gap, tissue quality, consistency with a home program, and other factors, but many people see meaningful improvement within a few months of starting targeted rehab, while more significant separations can take a year or longer of consistent work.
- Early postpartum. General focus: Gentle breathing, pelvic floor awareness, activity pacing. Rough timeframe (varies by individual): Weeks 0-6, often before or alongside a first assessment.
- Foundational rehab. General focus: Deep core activation, pelvic floor coordination, posture. Rough timeframe (varies by individual): Roughly weeks 6-12.
- Progressive strengthening. General focus: Graded loading, functional movement, return to exercise. Rough timeframe (varies by individual): Roughly months 3-6.
- Ongoing tissue remodelling. General focus: Continued adaptation of connective tissue, which heals more slowly than muscle. Rough timeframe (varies by individual): Can continue for up to 12-24 months in some cases.
These stages are a general guide, not a guarantee. Your physiotherapist can give you a clearer sense of what to expect once they’ve assessed your specific separation and history.
Related Article: How Long Does It Take to See Results From Pelvic Floor Physiotherapy?
Do You Need Surgery?
Most people with diastasis recti never need surgery. Clinical guidance generally reserves surgical repair, often called abdominoplasty when combined with cosmetic contouring, for situations where there’s a genuine functional impairment, a coexisting hernia, or a separation that hasn’t responded meaningfully to a sustained, well-structured rehabilitation program, typically after at least twelve to eighteen months of conservative care. Surgery is a decision made with a physician or surgeon, ideally alongside input from the physiotherapist who has been tracking your progress, and it isn’t something to pursue as a first option based on appearance alone.
Diastasis Recti Beyond Pregnancy
While this article focuses on the postpartum experience, diastasis recti isn’t exclusive to people who have been pregnant. It can occur in men and in people who haven’t given birth, often related to significant weight fluctuation, heavy lifting with poor pressure management, or connective tissue factors. The assessment and rehabilitation principles are largely similar: an individualized look at core coordination, breathing, and progressive loading rather than a single fix.
When to Seek Medical Attention
Most diastasis recti symptoms are safely managed with physiotherapy, but a few signs warrant a conversation with your family doctor or a visit to urgent care before continuing with exercise:
- A bulge that is firm, very tender, or doesn’t soften when you relax, which can suggest a hernia
- Sudden, severe abdominal pain
- Signs of infection around a C-section incision, such as increasing redness, warmth, or discharge
- New or worsening bowel or bladder symptoms alongside abdominal changes
If none of those apply, but you’re noticing persistent separation, back pain, or a core that just doesn’t feel like it’s “come back,” that’s a reasonable and common reason to book a physiotherapy assessment.
Frequently Asked Questions
What is diastasis recti?
Diastasis recti is a widening of the connective tissue between the left and right sides of the rectus abdominis muscle, most often occurring during pregnancy as the abdominal wall stretches to accommodate a growing baby.
Is diastasis recti the same as a hernia?
No. The tissue stays intact with diastasis recti, while a hernia involves an actual gap that tissue can push through; hernias usually need a physician’s evaluation rather than exercise alone.
How common is diastasis recti after pregnancy?
Some degree of abdominal separation is present in almost all pregnancies by the third trimester, and studies suggest roughly a third to half of postpartum women still have a measurable gap by four to six months after delivery.
How do I know if I have diastasis recti?
Common signs include a visible ridge or bulge along the midline of the stomach when sitting up or straining, a soft feeling when pressing along the midline, and sometimes low back pain or a sense of core instability, though a physiotherapist’s hands-on assessment is the most reliable way to confirm it.
Can physiotherapy fix diastasis recti?
Physiotherapy can meaningfully reduce the separation and improve core strength and function for many people, though results vary by individual, and it’s considered the recommended first line of treatment before surgery is discussed.
How long does it take to heal diastasis recti with physiotherapy?
It depends on the size of the separation and consistency with treatment; many people notice improvement within a few months, while connective tissue changes can continue for a year or more in some cases.
Will diastasis recti go away on its own?
For many people, some natural improvement happens in the first six weeks after delivery, but a significant separation often benefits from targeted rehabilitation rather than time alone.
What exercises help diastasis recti?
Physiotherapists commonly use diaphragmatic breathing, transverse abdominis activation, pelvic tilts, and progressive core loading, tailored to the individual rather than a single “best” exercise.
What exercises should I avoid with diastasis recti?
Rather than a fixed avoid list, physiotherapists usually coach you on how to control intra-abdominal pressure and avoid visible doming during a movement, which lets many people continue modified versions of exercises they enjoy.
Can I still do crunches or planks with diastasis recti?
Some structured research has shown supervised curl-up programs don’t necessarily worsen the separation, but the right answer depends on your individual tissue tension and technique, which is best assessed in person.
Does diastasis recti cause back pain?
It can. Reduced tension through the abdominal wall may shift more load onto the low back and pelvis, though back pain after childbirth can also have other contributing causes worth assessing.
Is diastasis recti connected to pelvic floor dysfunction?
Yes, the two systems work together to manage pressure in the trunk, and many people with a notable diastasis also have reduced pelvic floor coordination.
Do I need surgery for diastasis recti?
Most people don’t. Surgery is typically considered only after a sustained rehabilitation program hasn’t achieved the needed functional improvement, or when there’s a coexisting hernia.
Can men or people who haven’t been pregnant get diastasis recti?
Yes, it can occur with significant weight changes, heavy lifting with poor pressure control, or connective tissue factors unrelated to pregnancy.
Does diastasis recti get worse with age or with more pregnancies?
It can become more persistent with multiple pregnancies and may be influenced by connective tissue changes that come with aging, though it’s never too late to benefit from an assessment.
When should I see a physiotherapist for diastasis recti?
If a visible gap or bulge persists past eight to twelve weeks postpartum, or if you notice back pain, pelvic heaviness, or difficulty with everyday lifting, it’s a good time to book an assessment.
How is diastasis recti assessed by a physiotherapist?
Assessment typically involves checking the width and depth of the gap along the midline at rest and during light abdominal engagement, along with a broader look at breathing, posture, and pelvic floor coordination.
Can walking help diastasis recti?
Walking is generally a safe, low-impact way to stay active postpartum and supports overall recovery, though it isn’t a targeted treatment for the separation itself.
Will a belly wrap or binder fix diastasis recti?
A binder may offer comfort and support, particularly for larger separations, but it isn’t a substitute for the muscle retraining and progressive strengthening that address the underlying issue.
Getting Support at Body Dynamics
Body Dynamics is a multidisciplinary physiotherapy clinic on Eglinton Avenue West in North York, offering pelvic floor physiotherapy, manual therapy, and individualized rehabilitation for postpartum recovery among the many services provided at the clinic. If you’re noticing a persistent gap, back discomfort, or a core that doesn’t feel like it’s fully recovered since pregnancy, a physiotherapist can assess your specific situation and build a plan around your goals, whether that’s returning to running, lifting your kids comfortably, or simply feeling steadier in your body again.
General information in this article is educational and isn’t a substitute for an individual assessment. A physiotherapist can confirm whether what you’re noticing is consistent with diastasis recti, rule out other causes of your symptoms, and discuss your history, prior deliveries, current activity level, and goals before recommending a specific plan. You’re also welcome to ask about candidacy for pelvic floor physiotherapy, realistic expectations for your situation, and how a home program would fit around your schedule.
To take the next step, you can contact Body Dynamics to ask about booking an assessment, or learn more about the clinic’s pelvic floor physiotherapy services and how they connect with broader physiotherapy care.
Related Article: Benefits of Pelvic Floor Physiotherapy in Pregnancy
Related Article: How to Prepare for Your First Pelvic Floor Physiotherapy Appointment
Related Article: Pelvic Floor Physiotherapy in Toronto: Who Needs It and Why
Related Article: The Top 3 Goals of Manual Therapy
Related Article: Massage Therapy for Recovery: A Physiotherapist’s Guide
Related Article: Signs to Know You Need Physiotherapy
Related Article: How Much Does Physiotherapy Cost?
Related Article: Is Physiotherapy Covered by OHIP?
Related Article: Diagnosing Lower Back Pain and Finding Treatment
