By Dr. Brooke Meinema
Diastasis recti is one of those conditions that can feel confusing and frustrating, especially when you feel like you’re “doing everything right” but not seeing change.
The good news: in most cases, lack of improvement is not because the condition is unfixable. It usually comes down to how pressure is managed, how the core is being used, and what is (or isn’t) being coordinated in the system.
Let’s break it down.
What is a diastasis recti?
A diastasis recti is a separation between the two sides of the rectus abdominis muscles (your “six-pack” muscles) along the midline of the abdomen. This happens through the linea alba, a connective tissue structure that is designed to stretch and adapt, not tear under normal conditions.
Note: A diastasis is not typically a tear or rupture of muscle.
It is more accurately described as a change in tension and load transfer through connective tissue.
How common is it?
Diastasis recti is not exclusive to postpartum individuals.
Research has shown:
Approximately 33% of women still have a diastasis 12 months postpartum
Up to 50%+ of urogynecologic or postmenopausal patients may demonstrate some degree of separation
This tells us something important: Diastasis is not only about pregnancy but is also about load, pressure, tissue quality, and system coordination over time.
Why your diastasis may not be improving
1. Poor pressure management (most common factor)
Your core is a pressure system, not just a muscle group. When pressure is not managed well, it often finds the path of least resistance through the abdominal wall.
The biggest contributor: Breath-holding during effort
When you hold your breath during lifting, exertion, or even daily tasks:
Intra-abdominal pressure increases
The abdominal wall is forced to absorb that load
The linea alba may continue to bulge or strain
What to do instead: Exhale on exertion
Exhale when lifting, standing, pushing, or transitioning positions
Let the diaphragm and rib cage help manage pressure rather than locking everything down
Think: “exhale through the effort” rather than bracing and holding.
2. Rib cage positioning (infrasternal angle + rib flare)
The rib cage and pelvis are meant to stack, kind of like building blocks.
When the rib cage flares upward or forward:
The abdominal wall is placed in a stretched position
The linea alba is under constant tension
Deep core activation becomes less efficient
This is often seen with: pregnancy adaptation, chronic postural patterns, and breathing mechanics that rely on upper chest expansion.
What helps:
· “Stacking” the rib cage over the pelvis
· Gentle rib cage down-and-back positioning on exhale
· Breathing into the sides and back of the ribs instead of only the chest
The goal is not rigidity; it’s alignment and pressure balance.
3. Cesarean delivery considerations
A cesarean section does not automatically cause a diastasis, but it can contribute to:
Fascial disruption through abdominal layers
Altered neuromuscular control of the core
Protective guarding patterns in the trunk
C-section recovery is not just about the incision; it is also about restoring load transfer through the abdominal wall and deep core system.
Scar mobility, breath coordination, and gradual core reintegration are key.
4. Muscle coordination issues (not just “strength”)
Diastasis is not only about “closing the gap.” Two people can have the same visible separation but very different function underneath.
We now often look at:
Depth (control + tone)
Healthy response: gentle spring or “rebound” under pressure
Concerning response: soft, sinking, “boggy” tissue with poor recoil
This often reflects:
Underactive transverse abdominis
Poor coordination of deep obliques
Reliance on superficial muscles for stability
Width (visible separation)
Some separation is normal functionally
More relevant than width is how the tissue behaves under load
Key shift in modern rehab thinking: Function matters more than measurement alone.
5. Tight pelvic floor (yes, this can be part of it)
This can sometimes surprise people. A pelvic floor that is too tight can actually make a diastasis harder to improve.
Why?
The diaphragm and pelvic floor work as a pressure team
If the pelvic floor cannot descend on inhale, pressure gets redirected upward
The abdominal wall often becomes the “escape route”
What this can look like:
Rib flare + belly doming
Difficulty engaging deep core muscles
Persistent abdominal pressure or bracing patterns
Sometimes the first step is not strengthening but is instead downtraining and restoring mobility.
6. Connective tissue and genetics
Some individuals have naturally more elastic connective tissue, including those with hypermobility spectrum disorders or Ehlers-Danlos syndrome (EDS).
In these cases:
Tissue “rebound” is reduced
Stability demands increase
Progress may require more emphasis on motor control and joint stability rather than compression-based strategies
This does not prevent improvement; it just changes the approach.
7. Excessive bracing or poor strategy
A common misconception is that more tightening equals more healing.
In reality, constant abdominal gripping can increase pressure downward/outward, and over-recruitment of superficial muscles can limit deep core function. A better strategy would be: working on coordinated breathing, gradual load progression, and controlled tension (not maximal tension).
The big picture
If your diastasis is not improving, it usually is not because you are doing “too little.”
More often it is because:
Pressure is not well managed
Breathing mechanics are not coordinated
The rib cage and pelvis are not stacking efficiently
The pelvic floor and diaphragm are not working as a system
The encouraging part: Diastasis is not a permanent condition; it is a load management and coordination problem, and that means it is adaptable. Even long-standing cases can improve with the right approach.
When to seek help
Working with a pelvic floor or orthopedic physical therapist can be especially helpful if you are experiencing:
Persistent abdominal doming
Low back or pelvic pain
Urinary symptoms alongside diastasis
No improvement despite exercise
A tailored plan is often what makes the difference between frustration and progress.
