How to Heal a Diastasis Recti Without Surgery
Can you heal your diastasis? Maybe. But you won’t know until you give it your best effort. I want you to keep in mind, there is NO TIME LIMIT FOR HEALING!!! I’ve seen women 20 years postpartum and we’ve been able to fully rehab their diastasis. You don’t have some arbitrary time window. In reality, once you give the body the right movement patterns that it needs, it will start to respond. At any age and time postpartum!!
Including during pregnancy! (Which is a bit off topic, but I’ve had clients who were
freaking out concerned because their diastasis was opening up rapidly early on in pregnancy, and through the right corrective exercises we were able to get their diastasis to actually decrease.)
Caveat: not everyone can heal their diastasis. (But don’t automatically assume that’s you!!!) Sometimes the damage is too great. BUT that being said, I’ve seen many, many, many women heal who were told by their doctor the only option they had was surgery.
How to check a diastasis
Before we dive into the anatomy of it all, let’s check your diastasis:
Depth - not width - tells us how well your deep abdominals are firing. The only thing width tells us is how well your rectus (the “6 pack” up the front) is working.
Stronger deep abdominals = Less Depth (more important)
Stronger rectus = Less Width (less important)
These women healed their diastasis without surgery
Here are the stories of several women for a bit of encouragement and inspiration — many who were explicitly told by their doctor that they couldn’t heal their diastasis without surgery — and guess what?
Laura was told she’d never heal her diastasis after 5 kids without surgery and she did! She took her 4.5 finger gap down to 1 finger width!
Becky wanted abs for life to handle 3 kids and horses. She closed her gap from 4 fingers to 1 and can safely do the hardest exercises now. She set a goal to avoid surgery and she achieved it!
Stayce made her diastasis worse with common exercise routines postpartum. She dove into learning and kept putting the pieces together for healing!
Cathy has 7 kids and wasn’t sure whether gaining abs after was even a possibility. She’s made incredible progress in her overall abs, body and diastasis by putting in the work!
The last important point to keep in mind before we dive into this article is that working on all the things I mention below will also help you with successful recovery from the surgery if that’s the choice you decide to make. (No judgment here. I just want to see you have the best outcome no matter what path you take!)
Working on the strategies your body uses to move will help prevent doming and bulging at the surgery site. It will help you learn how to contract and brace your core correctly. Not only will this help with your abs but it will help with neck tightness, back pain, pelvic floor strength and hip pain. It has lasting benefits for life!! You literally have nothing to lose by working on it! Especially since surgery doesn’t change the strength of muscles or how they fire. I’ve seen doming and pulling at midlines post-surgery that just make me want to cringe.
- Surgery doesn’t change patterns, it only tightens fascia.
Speaking of results, studies show that back pain is not caused by or related to a diastasis. There is actually more correlation between pelvic floor issues and back pain. So if you’re thinking that getting your diastasis fixed will help your back, it might— but the research shows that it might not. Back pain often has more to do with how we move, breathe and our muscle balance which may be affected more by the strategies we use vs the gap itself.
5 posture improvements to help diastasis
Let’s talk through 5 postural concepts that get to the root of our strategies and thus the root cause for positive abdominal-related change.
#1. Ribcage width for midline support
Being pregnant is tough, and as that baby needs more room our body accommodates by spreading the ribcage. All the change that occurs throughout pregnancy is actually pretty amazing, but without specific steps postpartum some of those changes stick and this can cause lingering issues like diastasis.
Check: An easy way to know whether your ribcage has gone back to normal is your bra fit. Are you back into the same clasp setting as pre-pregnancy or do your bras and sports bras all feel a bit snug?
Ribcage width and obliques
Ribcage width can be fixed! It just depends on the muscles your body is using to move through life. Those who recruit more Internal Obliques tend to have a wider ribcage and those who recruit more External Obliques tend to have a narrower ribcage.
Now, the cool thing about this observation is the issues I’ve seen linked to it.
More Internal Oblique dominance is a finding I tend to see with a diastasis.
More External Oblique dominance is a finding I tend to see with prolapse.
Then in 2017, a study came out that also supported the things I was seeing. Love it when that happens! Women who tended to heal their diastasis faster had more risk of prolapse.
The External Obliques put pressure down on the pelvic floor. So having less dominant External Obliques, and therefore the potential for more opening of the midline, could decrease prolapse risk postpartum. So maybe a bit of a diastasis, especially early postpartum, has a protective effect.
Getting the External Obliques to Kick in To Help Heal a Diastasis
Working On Rib Closure with a Client
Of course, we’re talking in generalizations here. For every 5 women who fit this pattern there will be 2 who don’t, but it’s something good to keep in mind.
Bottom line to simplify: How does your bra strap fit? A little snug? Ok, then, that’s something I’d address before heading into surgery for your diastasis!
Diastasis belts and braces
Why work this hard when you could simply throw on a brace and fix it, right? Ha!!! I have some ocean front property in Arizona that I’d like to sell you while we’re at it. Bracing can be useful when you’re very, very, very early on postpartum, like the first few weeks, to give a bit of support. After those first few weeks it’s better to get the muscles involved to make a natural brace. Now, if someone’s symptoms are severe, I might want to use KT tape to give their midline a little extra support. That’s more of a nudge in the right direction instead of a brace that could potentially put too much pressure down on the pelvic floor and cause pelvic floor issues. Plus, most of the people I see who use a brace go back to their starting point within a few days of removing it. Unless you want to use it like the old Chinese foot binding, where you do it for so long you permanently malform the body, let’s get your muscles working to support you!
#2. Diaphragm Alignment and Strength for Diastasis Healing
The ribcage helps to control how the diaphragm functions. If the ribcage is too wide, then the diaphragm is put in a disadvantageous position to work. It flattens out decreasing its ability to contract.
The diaphragm, our breathing muscle, plays an incredibly important role in how our core looks and responds. If the diaphragm is in a more flattened position due to the wider ribcage, it can’t get that great contraction on an inhale. Without that, we’re much more likely to use a shallow breathing pattern and need to recruit our abs to get a good exhale instead of simply getting good passive movement from the diaphragm.
You might be thinking, well isn’t more work from our abs to breathe a good thing?
Not at all! This overworking for breathing leaves the abdominals tight, and not tight in a good way! Tight in a way that creates excessive stress on your midline and perpetuates your diastasis.
The connection between diastasis and deep inner core muscles
Almost all the women I see with a diastasis either have a deep inner core that’s too tight, causing distention and that bread loaf appearance in the front, or they have a deep inner core that is kind of “offline” and doesn’t want to engage.
When our deep inner core is responding with our system as a whole, you get a lot of give on your inhale into your sides and back. This is an eccentric lengthening of the muscle. This eccentric movement takes the stress off the midline and off the diastasis.
Bottom line too simply: The abs should move out in all directions on your inhale as your diaphragm moves down. The women I see with a diastasis tend to either be in a shallow breathing pattern or a belly breathing pattern. Both are bad and can prevent healing. Good news is that it's something tangible to work on!!
Here’s an interview talking about why lateral breathing is so important for diastasis prevention during pregnancy as well.
#3. Spinal Alignment for Diastasis Healing
Without expansion of the back part of the diaphragm, it often creates a curve or high hinge point in the spine at the segment where the diaphragm attaches. This high hinge point (not an official name, just a term that made sense to me) is something I almost always see with a poochy belly.
Many women often blame their belly pooch on a diastasis, but this isn’t necessarily the cause.
You can have flat abs with a diastasis. A diastasis doesn’t necessarily cause a poochy belly, but the things that are causing the poochy belly might be what’s preventing your diastasis from healing. And now I’m going to ask how tight your psoas (hip flexors) and quadratus lumborum (back muscles) are, because they can stop your diaphragm from expanding to the back as it should.
Bottom line to simplify:
Take a selfie in the bathroom mirror and let’s analyze! Does your lumbar curve (curve toward your belly) sit down in your low back or is the curve toward your belly higher? If it’s higher, this can be contributing to your diastasis. I almost always see this correlating with more of a gap or squishiness right above the belly button region.
#4. Lower Abs and Pelvic Tilt for Diastasis Healing
Part of this higher lumbar curve or high hinge point is related to lower abdominal strength and compensation happening in the pelvis. When your lower abs are weak (this weakness is NOT caused by your diastasis) your pelvis will either spill forward (an anterior pelvic tilt- APT) or you’ll tuck it under (a posterior pelvic tilt- PPT).
Both postures can perpetuate a diastasis. Along with lower abs, the glutes and hamstrings play a large role in positioning the pelvis. This is usually one of the final phases of healing that I check on when working with women with a diastasis. (Laura mentioned it in her MomFit story as the final piece of the puzzle for her.)
Strong glutes help with diastasis
If everything is “working” like it should and we have a great breathing system, abdominal strength, spinal alignment and a diaphragm that expands in the back (diastasis surgery will not magically get your back muscles to let go of tightness), then my next stop is to look at their glutes. A flat bottom is something we want to fix. Strong glutes go a long way toward healing!
Bottom line to simplify: Take a look at that bathroom selfie again. Without overarching your back to stick out your bottom, take a look at your glutes. (Seriously, do not become an Instagram model where you’re cranking on your spine so hard to make it look like you have glutes that it makes us all cringe! Spinal cranking to stick it out is fake glutes, and that much arching will cause back tightness. I’ve also seen people go from no diastasis to a diastasis because someone told them to stick out their bottom. Sigh!)
Does your bottom look flat or does it stick out with nice round muscle without having to arch your back? We want nice round muscle. Glutes could be part of your missing link.
Posture overview on using lower abs to come tall:
Quick posture standing tip:
#5. Pelvic Floor Tightness for Diastasis Healing
A diastasis plays off the ability of the abs to fire as they should. The abs work in response to our habitual breathing pattern and our base of strength.
Pelvic floor tightness can decrease the ability of our diaphragm to go down. Remember how important diaphragm movement is for healing?
I also see pelvic floor tightness associated with lack of glute strength and core stability. It’s the thing in the middle that acts to stabilize and support the spine and pelvis. Now I’m not talking about crazy tightness, but just enough to decrease a good breathing pattern and decrease movement of the pelvic floor. Since the lower deep abdominals work with the pelvic floor, they become a chicken and egg situation for tightness.
Pelvic floor tightness = lower transverse abdominal tightness and vice versa. They play off of each other.
Bottom line to simplify: Take a big inhale down. Did you feel your pelvic floor give a little with your inhale? If not, you might have some pelvic floor tightness and that might be part of your puzzle for improving your diastasis.
Once you feel like your alignment is good and breathing is going well, making sure you keep the right amount of intensity in your exercises is important. Too much stress on your linea alba will delay healing and possibly make your diastasis worse. Too little stress and the fascia won’t know it needs to remodel. Why heal if the area never gets stressed?!
So, knowing when to modify is important. Here’s a quick video looking at planks and when to increase the intensity to help your diastasis continue to improve.
Picking the right modification or exercise intensity:
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Improving a diastasis is not always straightforward
The cause of a diastasis can extend far beyond the things I’ve mentioned above. That’s what makes the human body so amazing!!
I’ve healed a client’s diastasis by strengthening their arches or fixing forward head posture. Areas that couldn’t be further away from the midline of the body.
Improving a diastasis is not always straightforward. Oh, I wish I could say, “Here, do these 3 exercises and you’ll be fixed.” Ha! The human body usually doesn’t work that way, which is why we have to dive in and do lots of troubleshooting together.
Hopefully, your brain is reeling right now with possibility!
Here’s your challenge— if you want to see improvement, you have to start taking action today!! (Different action if what you’ve been doing isn’t working.)
- Find someone amazing to work with. Like a good Physical Therapist in your area or check out the Graduate Map of Corrective Exercise Specialists. Getting the right help can make all the difference!!
- Start learning online!
There are so many options for learning, the key is to not give up and don’t be afraid to get another opinion. No one has all the answers, and by seeking additional resources you can put the pieces together to help your unique body.
Are you getting frustrated because you think it’s healed and then pop, you do something hard and it goes right back to where you started? Well, that means you haven’t really healed yet. You haven’t changed the strategies your body is using well enough yet to get the results to hold. It also probably means you need to do things differently. If this keeps happening, I’d get a different opinion from someone really good at troubleshooting! With real progress, you won’t get those backslides and things will start to hold. You will also not have to keep “doing your rehab exercises” for the rest of your life. We are changing the way your body moves. We are changing your automatic patterns and habits. Once you do this, everything just becomes part of the positive changes made by rehab instead of having to keep doing all the little exercises. 🙂
Helpful Diastasis Videos
Helpful Rotation Exercise
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- Sancho MF, Pascoal AG. Abdominal exercises affect inter-rectus distance in postpartum women: a two-dimensional ultrasound study. Physiotherapy. 2015 Sep;101(3):286-91.
- Diane Lee, Paul W. Hodges. Behavior of the Linea Alba During a Curl-up Task in Diastasis Rectus Abdominis: An Observational Study. Journal of Orthopaedic & Sports Physical Therapy, 2016 Volume:46 Issue:7 Pages:580–589.
- Bø K, Hilde G. Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: Prospective cohort study. Neurourol Urodyn. 2017 Mar;36(3):716-721.
- Patrícia Gonçalves Fernandes, Augusto Gil Brites Andrade. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual Therapy. Volume 20, Issue 1, February 2015. 200-205.
- Coldron Y, Stokes MJ. Postpartum characteristics of rectus abdominis on ultrasound imaging. Man Ther. 2008 May;13(2):112-21.
- TAKAKI S, KANEOKA K, OKUBO Y, et al. Analysis of muscle activity during active pelvic tilting in sagittal plane. Physical Therapy Research. 2016;19(1):50-57.
- Sancho MF, Pascoal AG. Abdominal exercises affect inter-rectus distance in postpartum women: a two-dimensional ultrasound study. Physiotherapy. 2015 Sep;101(3):286-91.