Physiotherapy for New Mothers: Addressing Diastasis Recti

Most new mothers get their core recovery wrong – doing crunches and planks that actually widen the abdominal gap instead of closing it. Up to 60 percent of women still have diastasis recti at six weeks postpartum, yet the right physiotherapy exercises can reverse the separation without surgery.

Understanding Diastasis Recti

Diastasis recti abdominis (DRA) is the separation of the two halves of the rectus abdominis muscle, commonly known as the "six-pack" muscle, along the linea alba – the connective tissue that runs down the centre of the abdomen. During pregnancy, the growing uterus stretches this tissue to accommodate the baby, and in many women, the gap does not fully close on its own after delivery.

The condition is remarkably common: research indicates that up to 60% of women have some degree of diastasis recti at six weeks postpartum, and approximately 30% still have a significant separation at twelve months. Despite its prevalence, many Malaysian mothers are unaware of the condition or mistake it for normal post-pregnancy weight that simply will not shift.

How to Check for Diastasis Recti at Home

A simple self-assessment can help identify whether you may have diastasis recti. Lie on your back with knees bent and feet flat on the floor. Place your fingers horizontally across your belly button. Slowly lift your head and shoulders off the floor as if performing a small crunch.

Feel for a gap between the two ridges of muscle on either side of your midline. A separation of more than two finger-widths, or a gap that feels soft and deep, may indicate diastasis recti. While this test provides a useful indication, a physiotherapist can perform a more accurate assessment using palpation and, in some cases, ultrasound imaging.

How Physiotherapy Addresses the Abdominal Gap

Physiotherapy for diastasis recti focuses on retraining the deep core muscles to generate tension across the linea alba and restore functional abdominal support. Key components include:

Transverse abdominis activation: The transverse abdominis is the deepest abdominal muscle, wrapping around the torso like a corset. Learning to engage this muscle correctly is the foundation of diastasis recti rehabilitation. Your physiotherapist will guide you through gentle contractions, often described as drawing the navel towards the spine, coordinated with breathing.

Correct breathing patterns: Diaphragmatic breathing coordinates with core activation. Exhaling during effort and maintaining gentle core tension during daily activities helps protect the healing tissues.

Progressive loading: Once basic activation is mastered, exercises are gradually increased in difficulty to rebuild functional strength for carrying your baby, lifting, and returning to normal activities.

Recommended Exercises for Recovery

Your physiotherapist may prescribe exercises such as:

• Heel slides: Lying on your back, slowly extend one leg along the floor while maintaining core engagement, then return. This builds coordination between breathing and deep core activation.
• Dead bugs: From a supine position with arms extended upward and knees at 90 degrees, slowly lower one arm overhead while extending the opposite leg, maintaining a stable pelvis.
• Modified planks: Starting with wall planks or inclined planks before progressing to full planks, ensuring the abdominal wall does not dome or bulge during the exercise.

Exercises to Avoid During Recovery

Certain movements can worsen diastasis recti and should be avoided until cleared by your physiotherapist:

• Traditional sit-ups and crunches: These create high intra-abdominal pressure that pushes the separated muscles further apart.
• Heavy lifting: Avoid lifting loads beyond your baby's weight in the early postpartum period without proper core bracing technique.
• Exercises that cause abdominal doming: If you see a ridge or bulge along your midline during any exercise, stop and consult your physiotherapist for a modification.

Bengkung Binding: Tradition Meets Evidence

In Malaysian culture, traditional postpartum practices often include bengkung – a long cloth wrapped tightly around the abdomen during the pantang (confinement) period. While bengkung may provide external support and comfort, there is limited scientific evidence that binding alone closes a diastasis recti.

An evidence-based approach combines appropriate binding with targeted exercise rehabilitation. If you choose to use bengkung, ensure it is not wrapped so tightly that it increases downward pressure on your pelvic floor, and pair it with a physiotherapy-guided exercise programme for best results.

Timeline for Improvement and When Surgery May Be Considered

Most women see meaningful improvement within eight to twelve weeks of consistent physiotherapy-guided exercise, though full recovery may take six months or longer depending on the severity of the separation. If a gap greater than three finger-widths persists after six to twelve months of focused rehabilitation, or if the condition causes significant functional impairment such as herniation, surgical repair through abdominoplasty may be discussed with a specialist. This is uncommon, and the vast majority of women respond well to conservative physiotherapy management.

Women's health physiotherapists practising in Malaysia can be found at major private hospitals, focused women's health clinics in Kuala Lumpur, Penang, and Johor Bahru, as well as through home-visit physiotherapy services.

Struggling with Diastasis Recti? A physiotherapist can assess your condition and create a personalised recovery plan. Chat with a physiotherapist near you