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Checking a Client for Diastasis Recti

While assessing postpartum clients for Diastasis Recti is standard practice, the check itself is anything but clear and simple. There are many variables that can influence the results, and even the most widely accepted definition of DR can be misleading when trying to get a true assessment of an individual’s core integrity or the degree of recovery work needed. This can certainly be frustrating for those looking to the DR check to provide precise measurements and clear guidance on how to proceed.

In this article, we’ll show you how to perform the assessment in a more accurate way to give you a clearer picture of the degree of recovery work needed. We will also discuss the variables that can influence your results so that you can improve your testing accuracy and more confidently proceed forward with recovery work.

Before Reading On, Get the Basics

This article assumes you have a basic understanding of what Diastasis Recti (DR) is and the factors that cause it. Not yet familiar with this? Start here with Diastasis Recti: A Guide for Fit Pros.

When to Perform the DR Assessment

Recall that during pregnancy, virtually ALL women get DR by some point in the third trimester. Therefore, it is not really necessary to assess for DR during pregnancy because — especially in the later stages — she should have it. Moreover, many pregnant women are just not comfortable with you poking at their bellies. That said, if you see that a client is experiencing DR symptoms earlier in pregnancy, such as coning in her belly during movement, then you can perform this assessment provided your client is comfortable with it.

In the postpartum period, we recommend waiting at least 6 weeks to check for DR. This is because every woman will have some degree of DR in the immediate aftermath of labor that may start to heal over the next few weeks on its own. So, waiting these 6 weeks will give you a little more accurate picture of the recovery work needed.

What to Check For

Recall that DR 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). Therefore, the first thing we are checking for is how far apart the left and right sides 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 well-accepted definition is an IRD (or gap) of 2.7 cm or greater (the equivalent of approximately 2 finger-widths or more). In other words, when you are checking to feel the distance between the left and right “ridges” of the rectus abdominis muscle, if you can fit two or more fingers in between those ridges, then this would be considered DR. Pretty simple right? Unfortunately, this definition that takes into account width-only does not provide an accurate enough picture of the true severity of a client’s DR.

Newer research is revealing that depth of separation can actually be a more telling indicator of DR severity. In other words, when you press down on the gap, how “taut” (or not) does it feel? If the gap feels shallow, taut, and springy, this is a good sign. It indicates good integrity of the linea alba tissue. However, if the gap feels “soft and squishy” enabling you to sink your fingers down into the gap, this is a sign of a more compromised linea alba tissue, which will take longer to heal. Unlike the width measurement, there is no objective criteria for the depth measurement to assess severity. It’s really up to your own perception. The more testing you do, the better sense you will get for this.

When factoring in your width and depth assessments, the depth weighs more heavily on the speed of the healing process. As an example, a gap that is 3 fingers wide, but quite shallow, will likely take less time to heal than a gap that is 2 fingers wide, but deep.

How to Perform the DR Assessment

Watch the video below to get a basic overview of how to perform the client assessment. Then, review the recapped step-by-step process below. One important point to note. This video begins when the client is already on her back. When you perform the check, it is essential that your client transitions onto her back safely by performing a Bed Roll. In other words, she should roll to her side first to get onto her back, then roll to her side when the assessment is complete in order to avoid any crunch-like movements.

In summary, here are the key points to follow:

  1. Ask permission: Always ask your client permission to perform this check, as many women are not comfortable with their bellies being poked and prodded. If your client is not comfortable with you touching her, show her how to perform a DR Self-Check
  2. Put her at ease: If she is feeling anxious or nervous, this can impact the tension you assess in her linea alba tissue. Try to create a comfortable, supportive environment. One of the ways to do this is to explain that a degree of DR is actually a normal and natural part of pregnancy, and not a failure on their part for having it.  Another way to ease tension is to be calm about your assessment findings, whatever they may be.
  3. Have her lie down safely: Have your client safely transition onto her back by rolling to her side first. Then, have her place her knees up with her feet flat on the floor, and both hands behind her head.
  4. Perform the assessment at rest first: This can be tricky, especially if the client has excess abdominal fat. The purpose of doing this is to assess the difference in the tension of the gap from at-rest to when she lifts her head, so it’s good to have this baseline assessment of tension if possible.
  5. Ask your client to perform the head lift: Have inhale first, then on the exhale lift her head no more than one inch. Remember to let her come back down and rest from time to time during your check.
  6. Assess for width: Place your fingers at the client’s sternum facing her head or her legs so you an assess the width of her separation. Begin walking your fingers downward feeling for the left and right ridges of her rectus abdominis muscle. Check all the way down to a few inches below her navel. Typically, the widest gap is around the navel, but not always. If the gap is 2.7 cm (about 2 finger-widths) or greater, this is considered DR.
  7. Assess for Depth: As you are walking your fingers downward, also check for the tension, or depth, of the gap. Does it feel quite shallow and taut, very soft and squishy, or somewhere in between? The deeper the gap, the more severe the DR. Also, refer back to that at-rest check. If the gap feels more taut now than it did at rest, that is a good sign. It shows your client is able to generate good tension in her linea alba. However, if you feel barely any difference at all, that means the tissue is more compromised, and therefore the healing will take longer.
  8. Safely get up: Don’t forget to have your client roll to her side to get up when you are done!

Improving Your Testing Accuracy

While the DR test is an imperfect one that may yield slightly different results at different times, follow the tips below to improve your testing accuracy:

  • Avoid test if she’s feeling bloated: Don’t check a client if she has eaten within the hour or if she notes feeling bloated. Bloating pushes the abdominal contents forward, which widens the gap.
  • Exhale on the head lift: The way your client breathes during the assessment impacts the results. Because we are trying to measure the best tension that her linea alba can generate, it is important that the client inhales before lifting her head, then exhales as she lifts her head. To be most accurate, she begins her exhale a split second before she lifts her head (then continues exhaling as she lifts).
  • Lift no more than one inch: This is important. Many women will lift their heads up high to try to see a clear view of their stomach. However, as noted in the video, lifting the head too high will cause the gap to close a bit, which can make you think she does not have a gap when she really does.
  • Apply consistent pressure: Note the pressure you apply when you test. Try to apply this same pressure each time you check because how hard you press down also impacts your results.
  • When in doubt, assume DR: Sometimes it may be difficult to assess your client’s DR, especially in cases where there is excess abdominal fat. In these instances, you can often assume DR, especially if you have noticed any coning in her belly, or if she is 6 months or less postpartum. Even if the client does not have DR, going through DR recovery work will help her core grow stronger.

How to take action on your results

If you have taken our Pre/Postnatal Performance Training Specialist Course, you can work with clients who have gap sizes up to 3 finger-widths and moderate depth using the Core Recovery Protocol taught in the course. If your client has a more severe gap, it is generally best for them to seek additional support from a women’s health or pelvic floor physical therapist.

How to Gauge Success

When working with a client in the DR healing process, how do you know when she is fully healed? Many women come in determined to “close their gap,” but first, we now know that the width is not the most important thing anyway, and second, this may not be realistic. Many women have a natural separation (remember DR is a gap of over 2 finger-widths). You likely do not know what her pre-pregnancy IRD was. Perhaps she always had a bit of a separation, so complete gap closure may not be realistic.

The most important indicators to look for are that she can maintain good core control during movement, she does not show any symptoms of “coning” in her belly, and she is not experiencing pain. If you can say “check” to all these things, but she still has a slight gap, that may be completely fine.