It’s Not About Closing the Gap
Almost every pregnancy produces some separation of the abdominal muscles. It is one way the body adapts to make room for a growing baby. What matters most is not whether the gap closes completely, but how well your core functions and whether you can comfortably do the things you want to do.
At Peak Pelvic Health Physical Therapy in Apex, we help patients navigate diastasis recti and postpartum recovery from across West Cary, Cary, Holly Springs and the wider Triangle.
What Diastasis Recti Actually Is
Diastasis recti is a separation between the two muscle bellies of the rectus abdominis, the muscle most people think of as the “six pack” muscles.
It is worth being precise about what separates: the muscles themselves are not tearing. Instead, the linea alba, the connective tissue running between the two sides of the rectus abdominis, lengthens and changes in tension as the abdomen expands. It is a normal and necessary adaptation rather than an injury, and it is very common during pregnancy and in early postpartum.
The degree of separation and how the surrounding tissues recover vary from person to person.
Does The Gap Have To Close?
No. The research shows that a diastasis does not necessarily need to close completely, or return to a pre-pregnancy state, for your core to function well.
A diastasis that stays separated does not inherently mean something is wrong. The size of the gap alone does not tell us how well your core is working. Some people have a noticeable separation without pain or functional limitations. Others experience difficulty with core control, back or pelvic pain, or challenges returning to exercise.
That is why closing the gap is not our primary goal in physical therapy. Sometimes the separation becomes smaller as strength, coordination, and tissue tension improve. That can be a positive change, but it is not the only measure of progress. If the gap remains while your core becomes stronger and better able to manage pressure, therapy can still be successful.
Our goal is to help you move confidently, manage abdominal pressure, and return to the activities you enjoy, while setting you up for long term success and considering future injury prevention.
Dr. Kristen Long, PT, DPT, PWCS
When Is It Worth Looking At?
The size of the gap isn’t the only thing worth looking at. These are some of the reasons people seek help for diastasis recti:
- ✓ Back, pelvic, or hip pain
- ✓ A core that feels weak, or that you cannot connect to
- ✓ Difficulty progressing with core exercises or returning to previous activities
- ✓ A visible gap along the midline of the abdomen
- ✓ Doming or coning, a bulge through the middle, during certain movements
You may notice doming during sit-ups, planks, getting up out of bed, or with other activities that challenge your core. Doming does not automatically mean you are damaging your abdominal muscles. That said, it can provide useful information about how your body is managing pressure and whether an exercise needs to be modified.
How We Assess It
We do measure the separation itself, by finger width, and severity is often described that way. That measurement on its own does not tell us everything we need to know.
What matters just as much, if not more, is how well the core functions. Can you engage your deep core muscles? What happens at the gap when you are activating your core? Does that separation draw together? Can you coordinate your breathing and manage pressure during movement? Are those deep muscles listening and doing what you tell them to do, or have they not quite clocked back in since pregnancy or delivery?
So we look at the core functionally rather than just numerically. We also assess hip strength, movement patterns, and other factors that may be contributing to your symptoms or limiting your progress. Depending on your presentation, we may assess the pelvic floor as well, particularly if you also experience bladder or bowel symptoms, pelvic pressure, or other signs of pelvic floor dysfunction. An internal pelvic floor examination is not necessary for everyone.
Our approach looks at the whole picture rather than relying on a single measurement.
New to Pelvic Floor Therapy?
We'll walk you through what to expect: what a first visit involves, what to bring, what it costs, and how a course of care usually progresses.
What to Expect ➝What Treatment Involves
Treatment is individualized to your symptoms, current abilities, and goals. We start where you are and build from there.
- 1
Reconnecting with your core
Early treatment may focus on learning to engage your deep abdominal muscles and coordinate that activation with your breathing. Pregnancy and delivery can change how your core feels and functions, and it can take practice to regain confidence and control.
- 2
Learning to manage pressure
We work on coordinating your abdominal muscles and breathing so you can manage pressure during everyday activities and exercise. If you notice doming or coning during an exercise, we use it as information. Depending on what we observe, we may adjust your technique, modify the exercise, change the intensity, or provide additional support. The goal is to find a level of challenge your body can manage and progress from there.
- 3
Building strength and coordination
As your control improves, we progress your exercises to challenge the core in different positions and under increasing loads. We want your abdominal muscles to work together effectively, not just during isolated exercises, but during the activities that matter to you.
- 4
Returning to the movements you enjoy
Whether your goal is lifting your toddler, running, strength training, or returning to your favorite fitness class, treatment should help prepare your body for those demands. We gradually build toward more challenging movements based on your symptoms, strength, and control.
What About Rotation?
You may have read that you should avoid rotational exercises if you have diastasis recti. The trouble is that we rotate constantly in daily life. We turn to reach for things, carry children on one hip, lift objects, and participate in sports and exercise.
Rather than avoiding rotation indefinitely, we focus on helping your core manage rotational forces effectively.
The same principle applies to sit-ups, planks, and other challenging exercises: having a diastasis does not automatically mean these movements are off-limits. We consider your symptoms, technique, current capacity, and response to loading, then help you build toward your goals.
The aim is not to create a list of movements you can never do again. It is to help you develop the strength and control to do more of what you enjoy.
Dr. Kristen Long, PT, DPT, PWCS
Questions People Ask Us
Will my diastasis ever close?
It may become smaller over time, with or without physical therapy. The extent of recovery varies from person to person and is impacted by many factors. Sometimes it does not, and that is not necessarily a concern if it is not causing dysfunction. Our focus is on improving core function, strength, coordination, and your ability to participate in the activities you enjoy. A persistent gap does not automatically mean something is wrong or that treatment has failed.
Do I need a referral?
No. North Carolina is a direct access state, so you can generally begin care without a physician referral.
Is it too late if I gave birth years ago?
Not at all. Your core can still benefit from targeted strengthening and coordination work long after pregnancy. Treatment focuses on how your body functions now, your current symptoms, and the goals you want to achieve, regardless of how long ago you gave birth.
Do I need physical therapy if I have a gap but no symptoms?
Not necessarily. A diastasis without pain or functional limitations does not automatically require treatment. If you are unsure how your core is functioning or want guidance on returning to exercise, an assessment can help you understand your options.
You do not have to chase a perfectly closed gap to have a strong, functional core. At Peak Pelvic Health Physical Therapy, we help you understand what your body needs, build strength and coordination, and return to the activities that matter to you.
If you have questions about diastasis recti or want individualized guidance for your postpartum recovery, we’d be happy to help.
References
The research behind the specific claims on this page.
- Berg-Poppe, Hauer, Jones, Munger and Wethor. Use of Exercise in the Management of Postpartum Diastasis Recti: A Systematic Review. Journal of Women’s Health Physical Therapy, 46(1), 35-47, 2022. Fourteen studies, nine of them randomised controlled trials. Supports abdominal and pelvic floor exercise for reducing the gap and improving quality of life. https://doi.org/10.1097/JWH.0000000000000231
Worth Getting Assessed
Book a free 15-minute call and we can tell you whether this is worth looking at properly.
Schedule an AppointmentDiastasis rarely turns up on its own. These often travel with it: Pregnancy & Postpartum Recovery, Urinary Leakage & Bladder Issues and Chronic Pelvic Pain.