Is physical therapy a suitable initial treatment for diastasis recti?

Physical Therapy as Initial Treatment for Diastasis Recti

Yes, physiotherapy should be the first-line treatment for diastasis recti abdominis before considering any surgical intervention. 1

Treatment Algorithm

First-Line: Physiotherapy (Mandatory Initial Step)

• All patients with diastasis recti must undergo a standardized 6-month abdominal core training program before surgery is even considered. 1

• Physiotherapy should focus on core stabilization exercises that have demonstrated effectiveness in reducing inter-rectus distance (23.9-25% reduction), improving trunk flexion strength, and enhancing functional outcomes. 2, 3

• Avoid abdominal strengthening exercises like abdominal curls during pregnancy, as these may worsen the condition and increase the likelihood of requiring postnatal repair. 4

• Continuing aerobic exercise such as walking during pregnancy is associated with decreased odds of developing diastasis recti. 4

Specific Physiotherapy Interventions

Core stabilization exercises combined with abdominal binding show the most robust outcomes: 3

• Significant improvements in inter-rectus distance
• Enhanced trunk flexion strength and endurance (Cohen's d = 0.7)
• Improved balance and reduced disability scores
• Positive effects on body image (Cohen's d = 0.2-0.5)

Exercise therapy alone demonstrates: 5, 3

• Reduction in pain (VAS scores)
• Improved trunk flexor endurance
• Better functional outcomes measured by Oswestry Disability Index

When to Consider Surgery

Surgery should only be considered when ALL of the following criteria are met: 1

1. Patient has completed a full 6-month standardized physiotherapy program with documented functional impairment persisting
2. Inter-rectus distance measures at least 5 cm at its widest point (smaller diastasis may qualify if pronounced abdominal bulging or concomitant ventral hernia exists)
3. At least 2 years have elapsed since last childbirth
4. No future pregnancy is planned

Critical Pitfalls to Avoid

• Do not rush to surgery: Many patients considered "refractory" to conservative therapy have not received an optimal trial of physiotherapy. 6, 1

• Pelvic floor strengthening exercises (Kegel exercises) should be avoided in patients with pelvic floor tenderness, though this applies more to pelvic floor dysfunction than diastasis recti specifically. 4

• Evidence on specific physiotherapy regimens remains limited, but the combination of core stabilization exercises with abdominal binding appears most effective based on available research. 5, 3

• Surgical success rates are high (low recurrence and complication rates), but surgery should remain a last resort after exhausting conservative management. 6