Part 2: Diastasis Recti Treament, Pelvic Floor PT in Kirkland
Part two of a three part series on diastasis recti from a pelvic floor physical therapist.
In Part 1, we covered what diastasis recti is and how to check for it at home. Now for the questions I get asked most, usually with a worried look: Will this just go away? Do I need surgery? And is there anything I can actually do?
The short version: most people improve a great deal, the body does meaningful repair on its own in the early months, and there's solid research showing that the right kind of exercise helps — while the wrong kind can set you back. Let's unpack that.
Does it heal on its own?
Partly, yes. The first six weeks or so after birth involve a lot of spontaneous healing as hormones shift, swelling settles, and the connective tissue begins to recover its tension. Remember those numbers from Part 1 — separation present in about 60% of women at six weeks but only around 30% at one year. That drop reflects a genuine natural recovery curve.
But "some healing happens on its own" is not the same as "doing nothing is the best plan." For a meaningful share of women, the gap and more importantly the core dysfunction persists past a year if nothing is done to retrain the system. Think of it like a sprained ankle: it'll heal somewhat no matter what, but whether you regain full strength, balance, and confidence depends a lot on rehab.
Why "closing the gap" is the wrong goal
Here's a mindset shift that helps almost everyone I work with. The internet is obsessed with the width of the gap, as if success means smashing the two muscles back together. But research has shown something important: the distance between the muscles correlates surprisingly poorly with symptoms and function. Some women with a wider gap feel strong and have no complaints; some with a narrow gap struggle with instability and pain.
What actually matters is whether the linea alba can generate tension, whether that midline tissue becomes a taut trampoline that transfers force across your core, rather than a slack hammock. A functional, load-bearing core with a slightly wider gap beats a "closed" gap that can't do its job. So the goal isn't a number. The goal is a core that works.
What the evidence actually says about treatment
This is where I get to share genuinely encouraging research. A 2025 systematic review and network meta-analysis published in Scientific Reports pulled together 27 randomized controlled trials covering more than 1,300 postpartum women — the most comprehensive comparison of treatments we have. A few takeaways stand out:
Comprehensive exercise wins. Programs that train both the deep core muscles (like the transverse abdominis and pelvic floor) and the more superficial abdominal muscles consistently produced the biggest reductions in separation — far more than passive or single-muscle approaches. The headline finding was that combined deep-and-superficial training, especially when paired with coordinated breathing techniques, outperformed everything else.
Passive fixes alone are weak. Kinesio taping on its own showed low effectiveness, and abdominal binders/belts landed in the low-to-moderate range. These tools can have a place — a binder can offer comfort and support in the early days, particularly after a C-section — but they're not a standalone cure. They support; they don't rehabilitate.
Breathing matters more than people expect. The studies that added breathing-based techniques to exercise tended to do better. That's because your diaphragm, deep abdominals, and pelvic floor work as one coordinated pressure system. Learning to manage that pressure is often the missing piece.
One honest caveat the researchers themselves stressed: the quality of evidence varies, and there's a real difference between "this exercise improved a measurement in a study" and "any random core workout will help." Generic exercise done with poor pressure management can actually make doming and separation worse. Which brings us to the exercises to be careful with.
Exercises to approach with caution (for now)
These aren't banned forever, they're things to set aside until your core can handle the load without doming:
Traditional crunches and sit-ups — they pull the rectus abdominis forward and tend to bulge the midline outward.
Full planks and push-ups (early on) — a lot of midline load before you've rebuilt deep core control.
Big twisting or rotational movements done without control.
Anything that makes your belly dome or "tent" — that visible ridge is your sign the load is too much right now.
The telltale sign to watch for is that doming. If a movement makes the midline push outward into a ridge, it's asking more of your connective tissue than it can currently give. Back off, and rebuild from underneath.
So where does that leave you?
Most women recover meaningful core function with a thoughtful, progressive program and rarely need surgery, which is generally reserved for severe cases that haven't responded to a year or more of conservative care. The path that works isn't punishing or extreme. It's learning to coordinate your breath and deep core, then gradually layering in strength as your tissue regains its tension.
In Part 3, I'll get specific about how pelvic floor physical therapy approaches this, what an evaluation looks like, the kinds of exercises we start with, and a FAQ answering the exact questions people type into Google at 2 a.m.
This series is educational and isn't a substitute for an individual assessment. The research summarized here describes group averages, your body deserves a plan built for you, which is exactly what a pelvic floor physical therapist provides.