If you work with postpartum clients — or want to — there’s a good chance diastasis recti has come up. Maybe a client mentioned it. Maybe you’ve seen it referenced in a training resource. Maybe you’ve been quietly wondering whether you’re supposed to be checking for it and, if so, how.
The short answer is yes—checking for DR should be a standard part of the postpartum fitness assessment. But when it comes to “postpartum,” we’re really referring to any time period after giving birth — whether it’s been 6 weeks, 16 years, or more. The core undergoes tremendous stress during pregnancy and birth, and many times, without dedicated core recovery work, issues can linger for years. That’s why we recommend including the DR check in your standard new-client assessment for anyone who has given birth.
This post walks you through everything you need to know to perform the DR assessment with confidence — including what to check for, how to perform the test to get the most accurate results, and how to make sense of what you find.
Read on to Learn:
- When to check a client for DR
- What you’re actually assessing during the check
- How to perform the DR check on a client
- How to interpret your findings and determine next steps
- Tips for improving your results
Quick Answer: When checking a client for diastasis recti, you are assessing two things: width (how many fingers fit between the ridges of her rectus abdominis) and depth (how shallow and springy, or soft and deep, the gap feels when you press down on it). To perform the check, have your client lie on her back with her knees bent and both hands behind her head. Place two fingers just below her sternum with your palm facing her head or knees. Cue your client to take a big inhale and, on the exhale, lift her head about one inch off the ground (just to where her abdominal muscles engage). Then slowly walk your fingers down her midline until you reach a few inches below the navel, assessing for width and depth as you go. For the most accurate results, wait until at least 6 weeks postpartum to check.
When to Check a Client for Diastasis Recti
We recommend waiting at least 6 weeks after birth to check for DR. Because diastasis recti is a normal and necessary part of pregnancy, everyone has some degree of it in the immediate aftermath of labor. The tissue will begin healing on its own in the weeks that follow, so checking too soon could give you an inaccurate picture of where your client really stands.
Checking for DR during pregnancy isn’t necessary either, since any client in the later stages of pregnancy should have it because DR is the body’s way of creating space for a growing baby.
What You’re Assessing in a Diastasis Recti Check
Ask most people what they’re checking for when they assess DR, and they’ll say the same thing: how many fingers fit in the gap. While the width of the gap does matter, it’s not the only thing to check for. In fact, there is another measurement that is even more important.
Diastasis recti is a separation of the left and right sides of the rectus abdominis muscle (caused by an extreme stretching of the linea alba tissue that connects the two sides). So, when you’re checking for DR, you want to assess how far apart the “ridges” of the rectus muscle are (the width of the gap) and the integrity of the linea alba (the depth of the gap). Let’s look at each more closely.
1. Width of separation
This is how far apart the left and right “ridges” of the rectus abdominis muscle are. This is referred to as the inter-recti distance (IRD). While there is no standard definition of DR, the most widely accepted definition is an IRD (or gap) of 2.7 cm (approximately 2 finger widths) or greater.
2. Depth of separation
Research suggests that depth of separation is actually a more telling indicator of DR severity than width. In other words, how the tissue feels when you press down into the gap can tell you more about where your client stands than how wide the gap is. A gap that feels shallow, taut, and springy indicates that the linea alba still has good integrity. A gap that feels soft, squishy, and deep suggests a more compromised linea alba that will likely take longer to heal.
When factoring in your width and depth assessments, depth weighs more heavily in determining the speed of the healing process than width. For example, a shallow, springy 3-finger gap will often heal faster than a soft, deep 2-finger gap.
How to Perform the DR Check on Your Client
Before you begin, take a moment to give your client a brief overview of what DR is and reassure her that all birthing bodies experience it to some degree. Many clients come in with fears that they may never recover or that they might need surgery. A little context about this perfectly natural pregnancy adaptation goes a long way in helping her feel calm and ready for the assessment. When you are ready to begin, follow the steps below:
- Ask permission: Always ask your client’s permission before performing this check. Many people are not comfortable being touched in the abdominal area, and that’s completely valid. If your client would prefer not to have you perform the assessment, you can teach her to do a DR self-check instead.
- Transition to supine safely: To reduce pressure on the core, have your client roll to her side first, then onto her back. Once on her back, instruct her to lie with her knees bent, feet flat on the floor, and both hands behind her head.
- Perform the at-rest check first: Place your two fingers just below the sternum, with your palm facing your client’s head or knees. Slowly walk your fingers down the midline to about 2 inches below the navel, noting what the linea alba tissue feels like at rest. Does it feel springy when you press on it, or soft and deep with little resistance? This gives you a baseline to compare against the next step.
- Perform the head lift check: Ask your client to take a big inhale and, on the exhale, lift her head only about one inch off the ground. Begin walking your fingers slowly down the midline, just as you did in the at-rest check, with your client continuing to exhale. If she runs out of breath, have her rest, then repeat the exhale and head lift to continue until you reach a few inches below the navel. As you walk your fingers down, assess for both width and depth. This means you’re checking for how many fingers you can fit in between the left and right ridges of the rectus abdominis. The widest point is typically at the navel, but not always. You are also checking how the tissue feels when you press down. Is it shallow, taut, and springy? Or soft, squishy, and deep? Apply firm pressure to glean the most accurate information.
- Compare to the at-rest check: Now, it’s time to compare your findings from steps 3 and 4. Did the tissue feel different during the head lift than it did at rest? If the gap felt tighter or shallower with the head lift, that’s a good sign. It means your client can generate tension in the linea alba. If you felt little to no difference, this may indicate more compromised tissue.
- Help your client return to a seated position safely. Have her roll to her side before sitting up to reduce pressure on her core.
To watch the entire assessment in action, click on the video demonstration below.
How to Interpret Your Findings
With your measurements in hand, here is how to make sense of what you found.
If the gap is 2 finger widths or more, your client meets the technical definition of DR. However, as we covered above, width alone doesn’t tell the full story. A 2-finger gap that is soft and deep is actually a more severe case than a 3-finger gap that is shallow and springy. And if your client’s gap is less than 2 fingers but feels quite deep, it is still reasonable to treat this as DR and approach recovery work accordingly.
When in doubt, assume DR. In cases where excess abdominal fat makes the assessment difficult to perform accurately, simply assume DR and begin core recovery work. Core recovery exercises are beneficial at any stage, so starting them is always a sound decision.
Tips to Improve Your Testing Accuracy
The DR test is an imperfect one, with several variables that can affect your results. The steps above will go a long way toward improving your accuracy, but keep these additional tips in mind as well:
- Skip the test if your client is bloated or has eaten within the last hour. Bloating pushes the abdominal contents forward, which can artificially widen the gap and skew your results.
- Cue your client to exhale when lifting her head, not after. The timing of your client’s breath during the assessment affects the tension the linea alba can generate. For the most accurate results, your client should begin exhaling a split second before the head lift, completing the exhale as she lifts. Exhaling after the head is already up will affect your results.
- Ensure head lift is only about an inch: Many clients will naturally want to lift their heads high, similar to a crunch — especially as they may want to see what you are doing. However, lifting the head too high causes the gap to close slightly, making it appear smaller than it actually is. Cue your client to lift only to the point where she feels her abdominal muscles engage. This is typically about an inch off the ground.
- Apply consistent pressure each time you check. How firmly you press down affects what you feel. Try to use the same pressure across every check, so your results are comparable over time.
Learn How to Heal Diastasis Recti
Performing the DR check is an important first step in understanding your client’s starting point. With this information in hand, you’re ready to begin the recovery work. If you’re interested in learning how to do this work, explore the ProNatal Fitness Pre & Postnatal Fitness Specialist Certification. You’ll learn a step-by-step core recovery protocol that you can take all your postpartum clients through to heal DR, recover from a Cesarean birth, and rebuild a strong, functional core from the inside out.
Sources:
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Lee, D., & Hodges, P. W. (2016). Behavior of the Linea Alba During a Curl-up Task in Diastasis Rectus Abdominis: An Observational Study. The Journal of orthopaedic and sports physical therapy, 46(7), 580–589.
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Spitznagle, T. M., Leong, F. C., & Van Dillen, L. R. (2007). Prevalence of diastasis recti abdominis in a urogynecological patient population. International Urogynecology Journal, 18(3), 321-328.