Physiotherapy can reduce the gap of diastasis recti and, more importantly, restore the abdominal wall’s ability to function properly, though full closure to zero gap is not guaranteed and is not the only measure of success. A 2025 network meta-analysis in Scientific Reports, covering 27 randomised trials and over 1,300 postpartum women, found that combined deep and superficial core training produced meaningfully larger reductions in the gap than passive approaches like abdominal binders or taping alone.
This happens because diastasis recti is not simply a hole that needs sewing shut through exercise. It is a thinning and stretching of the connective tissue (the linea alba) running down the midline of your abdomen, caused by the sustained pressure of a growing uterus. Closing that gap requires the deep core system, the transverse abdominis, pelvic floor and diaphragm, to first work together properly again, so that the linea alba is loaded correctly rather than bulged outward every time you sit up, lift or cough.
If it has been more than a few weeks since birth and you can still see or feel a dome or bulge down your midline when you tense your abdomen, that is worth a proper assessment rather than guesswork from an app or a generic postnatal exercise video, because the wrong exercises can widen the gap further. The rest of this article explains what is physically happening in the tissue, gives you a self-check you can do at home, summarises what recent research actually shows about whether exercise works, and covers the specific signs that mean you should see a doctor rather than start with physiotherapy.
What is actually happening in the tissue
Diastasis recti is a stretching and thinning of the linea alba, the connective tissue strip between your left and right rectus abdominis muscles, not a tear or an injury that needs to “heal” in the usual sense.
During pregnancy, hormonal changes soften connective tissue throughout the body while the growing uterus places sustained outward pressure on the abdominal wall. The linea alba responds by thinning and widening to accommodate this, and by late pregnancy, research summarised by Physiopedia puts this separation close to universal in first-time pregnancies. What varies enormously is what happens next. In many women the tissue naturally regains some tension and the muscles draw back together over the following months. In others, particularly with multiple pregnancies, larger babies, or repeated heavy lifting soon after birth, the gap and the tissue’s ability to generate tension across it does not recover on its own. This matters because a wide gap with poor tension transfer, not gap width alone, causes the functional problems people notice: doming when sitting up, a persistent “mummy tummy” appearance unrelated to fat, lower back strain, and sometimes reduced core support contributing to pelvic floor symptoms. Two women can have an identical two-finger gap, and one has full function while the other cannot manage a sit-up without her middle doming outward, because what matters clinically is depth and tension of the tissue as well as its width.
A self-check for diastasis recti at home
Based on the assessment method set out in NHS Lothian’s DRAM clinical guideline, this gives you a starting picture, though a hands-on assessment picks up more than self-palpation can.
- Lie on your back with knees bent, feet flat on the floor.
- Place your fingers just above your belly button, lift your head and shoulders slightly off the floor as if starting a sit-up, and feel for a gap between the two muscle bands.
- Repeat the same check directly at your belly button, and again a few centimetres below it, since the gap and tissue quality often differ at each of these three points along the midline.
- Note two things at each point: how many fingers fit into the gap, and how much resistance you feel pushing down into the tissue (a soft, sinking feel suggests poorly tensioned tissue even if the gap itself is narrow).
| What you notice | What it may suggest |
|---|---|
| Gap of one to two fingers at all three points, with firm resistance under your fingers | Common and often within a functionally normal range; focus on gradual return to activity |
| Gap of three or more fingers, or a visible dome or bulge along the midline when you lift your head | Worth a physiotherapy assessment before returning to running, heavy lifting or high-rep abdominal exercise |
| Gap differs significantly between the three points (for example wide above the navel, narrow below) | Common pattern; assessment should guide which exercises help rather than a generic programme |
| Soft, poorly resisting tissue even with a narrow gap | Function matters as much as width; this needs hands-on assessment, not just measurement |
What the evidence actually says
The evidence on diastasis recti has grown substantially in the last two years, and it now gives a clearer, if nuanced, answer than the “just do your Kegels and it’ll close” advice still common online.
A 2025 systematic review and network meta-analysis in Scientific Reports, pooling 27 randomised controlled trials and 1,340 postpartum women, compared exercise-based programmes against passive approaches such as kinesio taping and abdominal binders. It found that combined deep and superficial abdominal muscle training produced substantially larger reductions in inter-recti distance than either approach used alone, while taping alone and binders showed only modest effect. The authors used a 5 to 10mm threshold as the smallest clinically meaningful change, and the best combined programmes exceeded it several times over.
A 2024 clinical review in the Journal of Pelvic, Obstetric and Gynaecological Physiotherapy, published by POGP, took a more cautious position on the evidence base itself. It found no professional consensus on what gap size should count as a diagnosable diastasis, and noted that measuring inter-recti distance alone gives incomplete clinical information without also assessing the depth and tension quality of the tissue. The authors were direct that several widely used clinical recommendations, including some breathing-based techniques promoted online, currently lack the trial evidence to fully support them.
Read together, physiotherapy-guided, progressive core training has real trial support for narrowing the gap and improving function, while claims of guaranteed full closure go further than current evidence justifies.
When to see a GP rather than start with exercise
Most diastasis recti is not an emergency, but a few presentations need medical assessment first. See your GP that week, sooner if severe, if you notice:
- A bulge in the midline that does not reduce when you lie flat and relax, particularly if it is painful, firm or changes colour, which can suggest a hernia rather than straightforward diastasis
- Severe abdominal pain, especially with nausea, vomiting or a rigid abdomen
- A wound that is not healing normally after a caesarean section, including increasing redness, discharge or fever
- New loss of bladder or bowel control alongside your abdominal symptoms, which needs assessment rather than being assumed to be “normal after birth”
A hernia and a diastasis can feel similar to the touch, and only a clinical assessment reliably tells them apart.
How assessment and treatment work at PhysioReform
Assessment identifies the specific gap pattern and tissue quality at each point along the midline, then builds a progressive plan rather than issuing a generic sheet of postnatal exercises.
A postnatal assessment at PhysioReform includes measuring the inter-recti distance at rest and during controlled movement at three points along the linea alba, checking pelvic floor coordination alongside it since the two systems work as one unit, and screening for signs suggestive of hernia before treatment begins. From there, treatment follows the principle the evidence supports: activate the deep system, transverse abdominis, pelvic floor and diaphragm, together first, before progressing to demanding abdominal work, rather than starting with crunches or generic ab classes that can increase doming. Fara Sonday, who leads postnatal care at the Central London clinic, is POGP and Pelvic Floor Society registered with more than 20 years across pelvic health and MSK physiotherapy, and reviews return-to-running and return-to-gym timelines within this same assessment, since diastasis, pelvic floor function and lower back load are rarely separate problems in practice.
Common questions
How long after birth should I wait before checking for diastasis recti?
You can self-check from a few weeks postnatal, but the gap is expected to be present in almost all women in the early weeks and often narrows naturally over the following months. A physiotherapy assessment is most useful from around six to eight weeks, or sooner if you have a visible bulge, pain, or plan to return to running or heavy lifting.
Will crunches or sit-ups make diastasis recti worse?
They can, particularly early on or if the gap is wide, because they load the linea alba directly and can increase doming. Deep core activation before progressing to more demanding abdominal work is the approach current evidence supports, which is why an assessed, staged programme performs better than generic ab exercises.
Does diastasis recti close on its own without treatment?
For many women it improves substantially in the first months as tissue tension and muscle coordination recover naturally. For others, particularly after multiple pregnancies or without guided rehabilitation, the gap and its associated function do not fully recover without a structured exercise programme.
Is diastasis recti the same as a hernia?
No, though they can be mistaken for each other. Diastasis recti is a widening of connective tissue without a defect that organs can push through, while a hernia involves a true gap that abdominal contents can protrude into. A bulge that does not soften when you lie down and relax needs medical assessment to rule out a hernia.
Can diastasis recti affect back pain and pelvic floor symptoms?
Often, yes. The deep core, pelvic floor and diaphragm function as one coordinated system, so reduced tension transfer through the abdominal wall can reduce the support available to the lower back and pelvis, which is why assessment usually covers all three areas together rather than the abdominal gap in isolation.
Do abdominal binders fix diastasis recti?
Not on their own. Current trial evidence shows binders and taping produce only modest reductions in the gap compared with active, progressive core training, so they are better used as short-term comfort support rather than a primary treatment.
About the author
Fara Sonday is a specialist pelvic health, oncology and MSK physiotherapist with more than 20 years’ clinical experience, HCPC and CSP registered, and a member of the Pelvic Obstetric and Gynaecological Physiotherapy (POGP) network and the Pelvic Floor Society. She leads pre and postnatal physiotherapy, including diastasis recti and return-to-exercise assessment, at PhysioReform, just off Tottenham Court Road between Tottenham Court Road and Goodge Street stations. Learn more about pre and postnatal physiotherapy at PhysioReform.
Book an assessment
If you have a visible gap, doming, or ongoing core weakness after birth, a postnatal physiotherapy assessment can tell you exactly what is happening in your tissue and build a plan around it. Book an appointment at PhysioReform in Central London.