You've done the work. You've been consistent with your workouts. But when you look in the mirror, your belly still looks different — there's a dome or a ridge when you sit up, and your core feels disconnected, like it just doesn't respond the way it used to. You've heard the word "diastasis recti" thrown around, but you're not sure if that's what you have, or what it would even mean if it was.

What Is Diastasis Recti — and Can Physical Therapy Actually Fix It?

Diastasis recti is one of the most misunderstood postpartum conditions I work with. It gets blamed for everything from back pain to a belly that won't flatten — and it gets dismissed just as often, with women told to "just do planks" or "wait and see." Neither extreme is helpful. What actually helps is understanding what's going on, and getting a proper assessment so you can start addressing it with a plan that works for your body. Here's what you need to know.

What is diastasis recti?

Diastasis recti (DR) is a separation of the two halves of your rectus abdominis — the muscle most people call the "six-pack" — along the midline of your abdomen. Between those two muscle bellies runs a band of connective tissue called the linea alba. During pregnancy, as your uterus expands, that tissue stretches and the two sides of the rectus abdominis move apart to make room.

After birth, the gap doesn't always close on its own. And while some degree of separation is completely normal in the late stages of pregnancy, when it persists postpartum it can affect how well your core system functions.

What matters most isn't just the width of the gap — it's the tension and function of that midline tissue. A wider gap with good tissue tension can function better than a narrower gap with poor tension. This is why a tape measure or self-test doesn't tell the whole story. A hands-on assessment by a trained physical therapist is the most useful way to understand what's actually happening.

Common signs of diastasis recti include:

• A visible dome, cone, or ridge down the midline of your belly when you do a sit-up or crunch
• A soft, "squishy" gap you can feel when pressing along your midline
• Core weakness that feels different from pre-pregnancy — like your middle just doesn't engage
• Lower back pain or pelvic instability with daily activities
• A postpartum belly that hasn't changed despite consistent exercise
• Feeling disconnected from your core, especially when lifting or carrying

Why does diastasis recti happen after pregnancy?

The short answer: your body is extraordinary at making room for a growing baby, and the linea alba stretches to accommodate. This is normal and expected. The separation itself isn't a problem — it's what happens afterward that matters.

Several factors influence whether and how well the linea alba regains its tension postpartum:

• The size and position of the baby: Larger babies, multiple pregnancies, and babies who sit high and forward tend to create more stretch through the midline.
• How intra-abdominal pressure is managed: If you hold your breath when lifting, push down when bearing down, or return too quickly to high-load exercises after birth, you can keep loading the linea alba before it's had a chance to regain tension.
• Connective tissue makeup: Some women's tissue is naturally more lax, which affects how quickly or fully tension returns.
• Core and pelvic floor coordination: Your deep core system — the diaphragm, pelvic floor, transverse abdominis, and multifidus — all work together. When that coordination is disrupted postpartum, the linea alba doesn't get the support it needs to rebuild function.

The six-week clearance doesn't assess any of this. Most OBs aren't checking linea alba tension or core coordination at that visit — they're checking for healing of tissues and organs. Being cleared to "resume normal activity" doesn't mean your core is ready for crunches, heavy lifting, or running. That's where pelvic floor PT comes in.

What can you do about diastasis recti?

Yes — physical therapy can absolutely help with diastasis recti. The goal isn't to make the gap disappear (though it often does improve). The goal is to restore function: to help your deep core work together effectively so you feel strong, supported, and capable again.

Here's what diastasis recti physical therapy in Sacramento actually looks like:

• Breathing and pressure management: This is almost always the first thing we work on. Learning to use your breath to manage intra-abdominal pressure — rather than directing it down into the linea alba or pelvic floor — creates the foundation for everything else. It sounds simple. It's also transformative.
• Deep core activation: We retrain the transverse abdominis and pelvic floor to work together as a coordinated unit. This isn't "suck in your stomach" — it's a specific neuromuscular pattern that supports the linea alba from the inside out.
• Progressive loading: Once your foundation is solid, we layer in progressive resistance — movements that build real strength without exceeding what the tissue can handle at each stage. The goal is to keep pushing forward, carefully and strategically.
• Movement modification for daily life: How you get out of bed, pick up your baby, carry the carseat, and load groceries matters. We look at all of it and make adjustments that protect the midline while you're rebuilding.
• Return to exercise: Whether you want to get back to running, lifting, yoga, or HIIT, we build a plan to get you there — one that challenges you and respects where your tissue is in its healing process.

One thing I want to be clear about: some exercises that are commonly recommended — like traditional crunches, sit-ups, and double-leg lowers — can increase pressure through the linea alba in ways that work against healing, especially early on. A PT who specializes in this area can assess which movements are safe and effective for your body at this point in recovery. That specificity is what makes the difference.

When should you see a pelvic floor PT for diastasis recti?

If you suspect you have diastasis recti, the most useful thing you can do is get an assessment — not guess at it based on a YouTube video or self-test. That assessment will tell you not just whether you have DR, but how your linea alba is functioning, what's driving any symptoms, and what kind of program will actually help.

You should reach out if:

• You notice coning or doming when you do any core exercise
• You feel like your core has never "come back" since having a baby
• You have persistent low back pain or pelvic instability
• You're leaking, experiencing pelvic pressure, or have other pelvic floor symptoms alongside core weakness (these often go together)
• You want to return to higher-impact exercise and want to do it safely
• You've been told you have DR but haven't been given a clear path forward

Diastasis recti is not a life sentence. It's a condition that responds really well to the right kind of targeted care — and most women I work with see meaningful improvement in how their core feels and functions within a few weeks of starting.