An Expert Technique for Healing Diastasis Recti to Improve Core Function

Promote better core function and get great results with this technique to help with healing diastasis recti

Treatment techniques to aid in healing diastasis recti are essential for working with postpartum clients. Studies vary, but 24% – 39% of women experience diastasis recti six to twelve months after having a baby. Learning techniques specific to healing diastasis recti will help your postpartum clients improve core function quicker and heal faster if their abdominal tissues are able.

Keep scrolling:

• to see what happens to the abdominal muscles in pregnancy

• tips to help support your pregnant clients

• a video with instructions for the Oblique Release that is specifically designed to help with healing diastasis recti in your postpartum clients.

What is Diastasis Recti?

Let’s start with the basics, the rectus abdominis consists of two muscle bellies called recti muscles, which run from the end of the sternum to the pubic bone. They are held together by connective tissue called the linea alba. When there is prolonged excessive pressure on the anterior abdominal wall, it can cause separation of the recti muscles resulting in diastasis recti. “Diastasis recti is the partial or complete separation of the rectus abdominis, or ‘six-pack’ muscles, which meet at the midline of your stomach” (Healthline, Diastasis Recti: What Is It, and How Is It Treated?).

But did you know that during pregnancy, elevated estrogen levels trigger a shift from rigid type I collagen to more elastic type III collagen in the linea alba? This transition reduces tissue stiffness, enabling abdominal expansion to accommodate fetal growth. Postpartum, the linea alba’s collagen composition does not immediately revert to its pre-pregnancy state, contributing to persistent tissue laxity.

We have roughly 8 weeks postpartum until the collagen reverts back to the stiff type I collagen, so we’ll want to take advantage of this time period to best support the healing of this tissue.

Soft tissue work and exercise can help clients with diastasis recti heal more quickly and fully after childbirth. I’d like to share with you one of those techniques that is super helpful.

Pregnancy’s Impact on the Abdominal Muscles

The transverse abdominis muscles are the stabilizers of our core. During pregnancy, the transverse abdominis muscles stretch as the uterus grows. This constant state of expansion can cause the muscles to weaken unless they are actively contracted and relaxed during pregnancy, allowing them to remain strong. Most pregnancy and postpartum strengthening programs only focus on keeping this muscle strong. As you’ll see here, we want to shift this focus to include the other muscles of the abdomen.

The oblique muscles are traditionally the movers of the core and are responsible for enabling trunk rotation in the body. These muscles attach to the linea alba and recti muscles. During the postpartum period, the oblique muscles are often found to be tight and restricted.

The rectus abdominis is responsible for trunk flexion and is the muscle group impacted by diastasis recti. The connective tissue holding these two muscle bellies in the midline is the linea alba. As mentioned above, the stiff collagen fibers are replaced by more flexible collagen during pregnancy. This creates more laxity in the linea alba tissue for the uterus to grow which causes doming out of these tissues with some exercises and motions.

Is Doming Bad?

During pregnancy, the linea alba frequently domes outward with trunk motions. There has been a fear of doming too much, which can cause more separation of the recti muscles. There is no evidence of this in the research.

Because of this fear of doming making DRA worse, the focus has been on strengthening the transverse abdominis in pregnancy and avoiding any crunches or oblique exercises that cause doming.

New research is showing us our focus has been wrong.

Maintaining a strong abdominal wall throughout pregnancy is crucial. The abdominal muscles all attach to the recti muscles and the linea alba. A current theory held by professionals is that the linea alba is the only structure translating forces from one side of the abdominal wall to the other. However, newer theories are exploring how a strong rectus abdominus muscle is what the abdominal musculature is anchoring off of for strength. If we ignore the recti and oblique muscles and only focus on the transverse abdominus muscle, we are setting up our pregnant clients for challenges in their postpartum recovery.

One client I worked with after her third pregnancy had lost so much trunk flexion strength from rolling to her side to avoid doming that she couldn’t even sit up from lying down. That’s a wake-up call.

In our efforts to help clients avoid the development of diastasis recti, we are minimizing their function and strength in the abdominal wall, which may lead to other issues, such as pelvic girdle pain. One of the most significant factors in a research paper done by Starzec-Proserpio et at in 2022 for subjects that were dealing with pelvic girdle pain early postpartum was that they had a higher interrecti distance on curl up than those without pain. Achieving a proper approximation of the recti muscles after birth is crucial for minimizing pain and diastasis recti healing.

Can We Avoid Developing Diastasis Recti?

We all want to know what we can do to avoid having DRA, but the reality is that it may just come down to the genetics of what is in our tissues. People who are hypermobile tend to have a larger quantity of the stretchy type III collagen in their tissues. This allows their tissues to separate significantly during pregnancy and then recoil better afterward. One study suggests that some people who develop persistent diastasis recti have lower levels of collagen type III. Their tissues cannot recoil. Biotta et al 2018. Unfortunately, this is not something that can be determined in advance.

Instead of telling our pregnant clients what to avoid doing during pregnancy, let’s keep the focus on keeping the entire abdominal wall strong. Instead of just having your clients do transverse abdominus strengthening, adding crunches and twists will help keep the recti muscles strong too.

Immediate Postpartum Focus For DRA Healing

Immediately after birth, the drop in estrogen causes the stiff collagen fibers to return to the linea alba and the stretchy collagen to go away. The stiff collagen lies down between the recti muscles. Our focus for the immediate postpartum period is to approximate the recti muscles so the stiff collagen lays down in as narrow a space as possible. We have approximately 8 weeks to help achieve the narrowest IRD possible. How do we do that?

Treatment Technique to Help with Healing Diastasis Recti

Soft tissue work and exercise focusing on approximating the recti muscles can help with healing diastasis recti. During pregnancy, the oblique muscles get tight as they can’t stretch out with the baby in the belly. Helping to lengthen the oblique muscles and release the fascia surrounding the recti muscles so they can approximate should be our focus as soon as possible after birth. These two techniques are done in all of my postpartum clients dealing with abdominal separation.

My goal with my clients is to ideally teach them this oblique release during pregnancy and have them start doing it after the uterus has involuted. If I didn’t see them in pregnancy, I like to get my postpartum clients in around 3-4 weeks after birth. This way we still have time to figure out which exercise helps to approximate their recti muscles together the most. I then see how many repetitions it takes until the muscles stop approximating. This is their exercise goal. I teach them how to monitor the activity of the rectus muscles so they know when they can increase the repetitions. Immediate focus on strengthening the recti muscles post birth will help with the approximation of the tissues and the laying down of the stiff type I collagen in a shortened range.

The following is a video of the oblique release. Both the rectus and oblique releases are available in the Holistic Treatment of the Postpartum Body course for bodyworkers interested in learning more to support their postpartum clients.

Video: Oblique Release to Aid in Healing Diastasis Recti

Oblique Release to Aid with Healing Diastasis Recti

1. The goal of this technique for healing diastasis recti is to release tightness in the lateral fascia and the oblique muscles, allowing the recti muscles to move into the midline.
2. When performing the oblique muscle release, have your client lie in a supine position with their lower rib cage in contact with the table. If the lower rib cage is not in contact with the table, place a pillow or blanket under your client’s head and shoulders until the ribs come into contact with the table.  
3. Have your client anchor down one side of their lower ribcage with their hand, and then, with their knees bent and feet flat on the table, have your client rotate their knees away from the anchored ribs. In other words, have them slowly drop their knees to the opposite side of the anchored ribs. NOTE: Ensure the ribs remain in contact with the table during knee rotation. Only have your client go as far as they can without their ribs coming up away from the table.  
4. Have your client reach around their waist with their other hand. You will use three strokes (along the lower rib cage, in the middle, and along the iliac crest) to gently encourage the lateral abdominal wall tissues toward the midline and up to the umbilicus. 

Additional Tips for Healing Diastasis Recti

1. Focus on recti approximation in the first 8 weeks after birth. After this period, add in additional core strengthening exercises.
2. Splinting may be needed when there is excessive separation and constant strain on the abdominal wall, and can be helpful during those first 8 weeks. Having some compression of the tissues to help keep the tissues approximated will help with the healing tissues.

Taking Your Practice to the Next Level

The oblique release is one of two treatments that provides immediate results to help with the healing of diastasis recti. Releasing the recti fascia is another important treatment technique that will enable the core muscles to return back to the midline for your postpartum clients. Release work on the abdominal muscles enables the core to fully function and as a result strengthen and aid in healing diastasis recti.

These treatment techniques along with many others, including treatments to address multiple birth patterns and restore the pelvic floor, are available in the Holistic Treatment of the Postpartum Body course. Take your practice to the next level by becoming the go-to practitioner for pregnant and postpartum clients.

About the Author: Lynn Schulte is a Pelvic Health Therapist and the founder of the Institute for Birth Healing, a pelvic health continuing education organization that specializes in prenatal and postpartum care. For more information, go to https://instituteforbirthhealing.com