Many people assume the gap, the bulge, or the feeling that their core never came back after pregnancy is just something they have to live with. It's not. Physical therapy is the first-line treatment for diastasis recti — and the right approach addresses the functional consequences, not just the appearance.
Diastasis recti is a separation of the rectus abdominis muscles — the two vertical columns of muscle that run down the center of your abdomen — along the connective tissue called the linea alba. It happens most commonly during pregnancy, when the growing uterus stretches that tissue over time. It can also occur in people who have never been pregnant, particularly with repeated heavy loading and poor pressure management.
The separation itself isn't the whole problem. What matters functionally is whether the connective tissue has the tension and load-transfer capacity to do its job. A wide gap with good tension can be less problematic than a narrower gap with poor tension. That distinction is exactly why self-diagnosing and self-treating based on finger-width measurements often misses the point.
Physical therapy doesn't just close the gap. It restores the function of the whole system — how your core manages pressure, transfers load, and supports movement.
The visible "pooch" or doming along the midline is what most people notice first. That concern is real. But the more important story is what's happening underneath: your core's ability to stabilize your spine, manage intra-abdominal pressure, and support your pelvic floor is compromised.
Diastasis recti shows up in more ways than most people expect. If several of these sound familiar, that's enough reason to get an assessment.
Core and trunk symptoms: a visible ridge or doming down the center of your abdomen when you sit up, a feeling of weakness or instability through your midsection, difficulty with movements that require trunk control.
Pain and pressure symptoms: low back pain that doesn't resolve with standard treatment, pelvic girdle pain, a sense of heaviness or pressure in the pelvis.
Pelvic floor symptoms: leaking with coughing, sneezing, or exercise; urgency; symptoms of prolapse; pain with intercourse. These often coexist with diastasis recti because both involve impaired pressure management.
Activity limitations: symptoms that worsen with lifting, running, or returning to exercise postpartum. If you've been told to "just take it easy" without a clear plan for getting back to activity, that's a gap PT can fill.
A lot of patients arrive with a mix: tight in some areas, weak in others. That's why blanket prescriptions (“do a hundred Kegels a day”) so often don't help. The right approach starts with finding out what's actually going on.
Assessment first. Before any exercise prescription, we assess the separation, the tissue tension, how you manage intra-abdominal pressure, your breathing mechanics, and how your pelvic floor is functioning. This is what makes the treatment specific to you — not a generic core program.
Pressure management and breathing. A significant part of diastasis recti rehabilitation is learning how to coordinate breath and intra-abdominal pressure during everyday movement and exercise. This is foundational. Without it, even well-intentioned exercise can continue stressing the tissue.
Progressive loading. The connective tissue needs load to remodel and regain tension — but the loading has to be appropriate and sequenced correctly. We build from controlled, low-load movements toward the activities you actually want to return to, whether that's lifting your kids, getting back to the gym, or running.
Pelvic floor treatment when indicated. Because diastasis recti and pelvic floor dysfunction so frequently coexist, we assess and treat both in the same session. You don't need to see two different providers. One clinician, the whole picture.
Progressive return to activity. Whatever you want to be doing, whether that's running, lifting, intimacy, or your job, the plan builds toward you doing it without symptoms.
This is where a lot of people get stuck. The instinct to "strengthen your core" with crunches and sit-ups after noticing a gap or weakness is understandable. It's also one of the most common ways diastasis recti gets worse.
Traditional crunch-based exercises create a spike in intra-abdominal pressure and load the linea alba in a way that can increase separation and reduce tissue tension, especially early in recovery. Heavy lifting with breath-holding does the same thing. So does returning too quickly to high-intensity exercise without first restoring pressure management mechanics.
The exercises that help diastasis recti are specific to your presentation and staged carefully. What's appropriate at eight weeks postpartum looks different from what's appropriate at eight months. And what's appropriate for someone with a hypotonic pelvic floor looks different from someone with a hypertonic one. This is why assessment-guided progression matters — and why a generic YouTube core program often doesn't move the needle or, worse, sets things back.
If you've been doing crunches, planks, or heavy lifts and your symptoms haven't improved — or have gotten worse — that's important information. It doesn't mean you're broken. It means the approach needs to change.
Can diastasis recti heal on its own? Sometimes, particularly in the early postpartum period, the separation reduces on its own. But "healing" in the sense of restoring functional tissue tension and core stability rarely happens without targeted rehabilitation. Many people are months or years postpartum and still experiencing symptoms they've been told to accept. It's not too late to start. PT can make a meaningful difference well beyond the early postpartum window.
What exercises should I avoid with diastasis recti? As a general rule: crunches, sit-ups, double-leg lowering, heavy lifting with breath-holding, and intense abdominal exercises that cause visible doming or coning along your midline. That said, the specific list depends on your assessment. Some people tolerate movements that others shouldn't attempt yet. The goal isn't permanent avoidance — it's appropriate sequencing so you can eventually return to everything you want to do.
How do I know if I have diastasis recti? Some people can feel a gap or notice doming when they attempt to sit up from lying down. But self-assessment has real limits — you can feel a gap and have good tissue tension, or feel no obvious gap and still have poor load transfer. The only way to know what you're actually working with, and what it means for your symptoms and activity, is a hands-on assessment. That's where we start.
No. The conversation around pelvic floor health has historically centered on women's health, but pelvic floor dysfunction affects people of all genders. Men experience pelvic pain, post-prostatectomy incontinence, chronic prostatitis-type symptoms, and other pelvic floor conditions. Centered treats all patients.
Two possibilities. One: you have a hypertonic pelvic floor, and Kegels are making things worse. Two: your pelvic floor is weak in the way Kegels can help, but you're doing them in a way that isn't translating to function (timing, breathing, posture, force production). An assessment sorts out which one is happening for you.
Centered Physical Therapy & Wellness