Diastasis Recti and the Return to Lifting
Separating myth from evidence — why inter-recti distance alone is the wrong metric
The Most Misunderstood Postpartum Diagnosis
Of all the conditions that affect the postpartum athlete, few are more laden with conflicting advice, clinical misinformation, and unnecessary restriction than diastasis recti abdominis. Women are told not to do crunches — ever. They are told their core is permanently compromised. They are told a gap of any size is dangerous. Almost none of this is supported by current evidence, and much of it actively delays a return to the activities these women love.
This article sets the record straight. Diastasis recti abdominis is a real clinical condition that warrants assessment and rehabilitation — but it is a functional problem, not simply a structural one, and inter-recti distance alone is not the right measure of rehabilitation success or athletic readiness.
What DRA Actually Is
Diastasis recti abdominis refers to the separation of the rectus abdominis muscles at the linea alba — the fibrous midline structure connecting the left and right abdominal walls. During pregnancy, the linea alba stretches to accommodate the growing uterus. This is normal and expected. What varies is the degree of stretch, its persistence postpartum, and its functional consequence.
The key insight from the current evidence base is this: inter-recti distance alone is a poor predictor of function. What matters is linea alba tension — the ability of the midline to transmit force effectively between the abdominal walls during loaded movement. A woman can have a measurable gap with excellent tension and full force-transfer capacity. Another can have a narrower gap with poor tension and significant functional impairment. The number is not the diagnosis.
“The gap is not the goal. Linea alba tension — the ability to transfer load across the midline — is what determines when an athlete is ready to lift heavy again.”
The "No Crunches Ever" Myth
The advice to avoid curl-up exercises indefinitely is not evidence-based. The 2025 network meta-analysis published in Scientific Reports, which examined 27 randomized controlled trials and over 1,300 participants, found that curl-up exercises improved abdominal strength without worsening inter-recti distance. The fear of crunch-type movement in postpartum women is not supported by the literature — and perpetuating it unnecessarily restricts athletic development.
What the evidence does support is a staged approach: begin with deep core re-education (transversus abdominis, pelvic floor, diaphragm co-contraction), progress to functional loaded patterns, and introduce higher-load exercises as linea alba tension improves and symptoms remain absent. The exercise is not the problem. Premature loading without adequate motor control is.
WHAT THE 2025 RESEARCH SHOWS
Network meta-analysis (27 RCTs, 1,340 participants) found deep core and TrA-focused training produced clinically meaningful IRD reductions (Scientific Reports 2025)
Curl-up exercises improved abdominal strength without worsening inter-recti distance — debunking the "no crunches ever" rule
Pilates, core stability training, and suspension training all showed meaningful benefit across multiple outcomes
Beamish et al. (BJSM 2024) confirmed exercise interventions reduce DRA severity postpartum
What Clinical Assessment Should Include
A functional DRA assessment for the returning athlete should include measurement of inter-recti distance at the umbilicus, above, and below using real-time ultrasound or clinical palpation; observation of linea alba tension during active loading (abdominal curl, single-leg squat, loaded carry); symptom report during and after activity; and evaluation of intra-abdominal pressure management — particularly doming or coning of the midline under load.
Doming or coning of the linea alba during loaded movement is a more clinically meaningful finding than gap width. It indicates that force is not being effectively transferred through the midline, and that load should be modified until motor control improves.
Returning to Lifting: A Practical Framework
Return to heavy lifting in the DRA population follows the same criterion-based logic as return to impact sports. Before loading, the athlete should demonstrate: no symptom provocation with low-load core exercises, ability to maintain IAP during moderate-load movement, absence of midline doming, and adequate pelvic floor co-contraction. Progressing from bodyweight to loaded patterns to compound lifts (deadlifts, squats, overhead press) should be gradual and symptom-monitored.
Most postpartum women with DRA can return to full athletic lifting given proper rehabilitation. The timeline varies — some achieve it by 12 weeks, others by 6 months — but the destination is the same. PT's role is to build the pathway and monitor the journey.
References: Nature Scientific Reports. Network meta-analysis of postpartum DRA interventions. 2025.
Beamish NF, et al. Impact of postpartum exercise on pelvic floor disorders and diastasis recti abdominis. Br J Sports Med. 2024.
Lee D, Hodges PW. Behavior of the linea alba during a curl-up task in diastasis rectus abdominis. J Orthop Sports Phys Ther. 2016;46(7):580–589.
Mota P, et al. Diastasis recti abdominis in adult women and its association with pregnancy, gravidity, body mass index, and inter-rectus distance. J Orthop Sports Phys Ther. 2015;45(7):601–608.
Gluppe SL, et al. Effect of a postpartum training program on the prevalence of diastasis recti abdominis in postpartum primiparous women. J Physiother. 2023.