Best Position for Observing Diastasis Recti
The optimal position to observe diastasis recti is lying supine on the exam table with the head and shoulders lifted (performing a partial sit-up or crunch maneuver), as this activates the rectus abdominis muscles and makes the separation maximally visible and palpable.
Examination Technique
The standard examination position involves:
- Patient positioned supine with knees flexed to relax the abdominal wall initially 1, 2
- Head and shoulders then lifted (partial sit-up maneuver) to contract the rectus abdominis muscles and reveal the diastasis 2
- Palpation performed during the contraction phase when the muscle edges are most distinct 2
This dynamic maneuver is essential because the separation becomes apparent only when the rectus muscles are activated. At rest, the diastasis may not be clinically evident 2.
Measurement Locations
When examining for diastasis recti, assess at multiple standardized points:
- Above the umbilicus (most common location, typically 3-12 cm above) 1, 2
- At the umbilical level 1
- Below the umbilicus (less common but should be checked) 1
The above-navel pattern is most prevalent, occurring in 48 of 82 patients (59%) in one ultrasound study, with mean separation of 40 mm 1. Even when diastasis extends the full length, it is typically wider above the umbilicus 1.
Clinical Examination Accuracy
Clinical examination (palpation during partial sit-up) correlates well with ultrasound imaging, particularly at measurements 12 cm above the umbilicus where correlation is strong (r > 0.75) 3. The Kappa test showed 65% of clinical diagnoses were confirmed by ultrasonography 3. This validates the clinical examination technique as reliable when imaging is unavailable 3.
Why Other Positions Are Inadequate
- Lying flat and quiet: The diastasis is not visible or palpable without muscle contraction 2
- Left lateral position: Not a standard position for abdominal wall examination and would not allow proper visualization
- Supine with knees bent alone: This is the starting position but requires the additional step of head/shoulder lift to activate the muscles 1, 2
Important Caveats
The measurement technique has demonstrated significant interrater variability when using finger-width measurements 2. For consistency, use standardized measurement points and consider ultrasound confirmation when precise measurements are needed for surgical planning 4.