Diastasis Recti Exercise Plan

A diastasis recti exercise plan holds up between appointments only when it is written down, measured, and reviewed on a date both of you agreed. That is what this downloadable template does. It is a two-page clinical action plan.

The form holds patient and record details, a background section, five goals with measures and target dates, and seven actions with named owners. A support checklist and a five-row review record close it out.

The form carries no exercise library and no built-in measurement fields. You choose the movements, the dosage, and the progression criteria from your own assessment, then write them into the goals and actions. The template supplies the structure and the accountability around those choices.

The sequence you write into it is the one most programs follow. Breath work and transverse abdominis activation come first, then loaded stability, then functional movement across roughly six to eight weeks. The rest of this page covers the clinical reasoning behind each stage. It walks through measuring the inter-recti distance, sequencing the movements, avoiding the wrong ones early, and knowing when to refer.

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Key takeaways

Diastasis recti is a separation of the rectus abdominis along the linea alba, most often after pregnancy, though men and non-pregnant patients develop it too.

The downloadable template is a two-page action plan form: background, five goals, seven actions, a support checklist, and a five-row review record.

It contains no exercise library and no measurement fields, so your own exercise selection, dosage, and progression criteria go into the goals and actions.

Safe progression starts with breath work and transverse abdominis activation, then adds loaded stability and functional movement across roughly six to eight weeks.

Practice management software like Pabau stores the completed plan in the patient record, so review dates and reminders sit next to the clinical notes.

What is diastasis recti?

Diastasis recti is a separation of the two halves of the rectus abdominis along the linea alba. The linea alba is the fibrous connective tissue running down the center of the abdomen. The separation happens when pressure inside the abdomen rises beyond what that tissue can withstand.

Pregnancy is the common cause, as the uterus expands and hormones such as relaxin soften connective tissue. After delivery the separation often persists when the deep core is not systematically reactivated. The transverse abdominis and the pelvic floor matter most here.

Patients left without a plan tend to reach for crunches and other high-pressure movements, which slows recovery. Some go on to develop pelvic floor symptoms or ongoing low back pain.

What is inside the template

The download is a generic clinical action plan, titled for diastasis recti and printed across two pages. Knowing its fields before you open it tells you what to prepare in advance.

• Patient and record details: name, date of birth, record or MRN number, who prepared the plan, date completed, date agreed, review date, and next appointment.
• Background: a free-text box for why this plan is needed. This is where your assessment findings go, including the baseline inter-recti distance.
• Goals: five numbered goals, each with a goal statement, how progress is measured, and a target date.
• Actions: seven numbered actions, each with the action itself, who is responsible, a start date, and a review date.
• Support in place: checkboxes for written information, contact details, family or carer involvement with consent, equipment supplied, and a booked follow-up. A free-text box below it covers warning signs and who to contact.
• Review record: five rows, each with a date, progress, changes made, and who reviewed it.
• Signatures: patient signature and date, clinician signature and date.

What the form does not do is prescribe. There is no exercise list, no sets and reps table, no phase chart, and no dedicated field for tracking the inter-recti distance. The split below shows which boxes arrive printed and which ones you fill from your own assessment.

How to measure the inter-recti distance

Measure the inter-recti distance (IRD) with the patient lying supine, using the finger-width method at three sites along the linea alba. The IRD is the width of the separation between the rectus muscles, and it is the baseline you need before prescribing any exercise. Ultrasound or calipers give more precision where you have them.

1. Have the patient lie supine on a firm surface, knees bent, feet flat on the floor.
2. Place index and middle fingers horizontally just above the navel, along the linea alba.
3. With the patient fully relaxed, feel the width of the separation. Normal is 0 to 2 fingers, mild is 2 to 3, and moderate to severe is 3 or more.
4. Ask for a gentle bracing breath, then feel whether tension increases along the linea alba and the separation narrows.
5. Repeat the check at the navel and 2 cm below it to map the whole separation.

Write the baseline measurement into the background box on the plan, along with the site you measured and the method you used. Re-measure every two to three weeks. Each re-measurement then goes into the progress column of the review record, which turns a one-off number into a trend.

If the separation widens, or the patient reports increased pelvic pain, heaviness, or leakage during exercise, refer to a pelvic floor specialist.

Core principles behind every diastasis recti exercise plan

Evidence-based diastasis recti programs share four foundational principles. They are the reasoning behind whatever you write into the goals and actions, and they belong in your patient education handouts as well.

• Breath-core connection: every exercise starts with a 360-degree breath. Inhalation expands the rib cage and abdomen, and exhalation engages the transverse abdominis and pelvic floor. Teach patients that the breath cues the deep core to fire.
• Transverse abdominis activation first: the deepest abdominal layer has to wake up before load is added. Supine leg lifts, dead bugs, and gentle wall presses do that work. Hold back rectus-dominant movements until activation is automatic.
• Pelvic floor integration: the pelvic floor and transverse abdominis work as a team. As the transverse abdominis tightens the pelvic floor lifts, and both release on the exhale. Poor coordination between them slows healing and sustains leakage or pelvic pain.
• Intra-abdominal pressure management: high-impact activity, heavy lifting, and straining spike intra-abdominal pressure. Early phases keep it low by avoiding unsupported dynamic movement. Progression means building tolerance to load and impact gradually.

Safe exercises for diastasis recti

Clinician-led programs tend to draw from four families of movement. Pick from them according to what your assessment found, then name the specific exercises in the plan.

• Breathing and activation: 360-degree breathing, transverse abdominis isolation, pelvic floor elevator, supported wall press.
• Supine core stability: pelvic tilts, heel slides, dead bugs, single-leg lifts, bridge variations, single-leg bridge.
• Supported dynamic work: bird-dogs on hands and knees, quadruped rocking, side-lying leg lifts, standing glute activation.
• Functional movement: step-ups, lunges with core bracing, low-impact cardio such as walking, cycling, or swimming, and upright posture work.

Set the dosage yourself. A workable habit is one action line per exercise family. Each line names the movement, the sets and reps, who is responsible, and the date you will review it. Seven action lines is usually enough for two phases of work, so start a fresh plan rather than crowding the boxes.

Exercises to avoid in the early phases

These movements generate high intra-abdominal pressure or strain the linea alba directly. Hold them back until the separation closes and load tolerance improves. That is typically week six to eight at the earliest, and always subject to assessment.

• Crunches, sit-ups, V-ups, and full-body planks, front or side
• Heavy compound lifts such as deadlifts, back squats, and barbell rows without core brace coaching
• High-impact work including running, jumping, box jumps, and CrossFit-style movements
• Unsupported forward bends or twisting movements
• Breath-holding during exertion
• Any exercise that causes bulging along the linea alba or triggers pelvic pain or heaviness

The warning-signs box on the plan is the right place for this list. Write the two or three movements your patient is most likely to attempt, plus who to contact if symptoms appear.

Transverse abdominis and pelvic floor: the foundation of recovery

The transverse abdominis and the pelvic floor are inseparable in diastasis recti rehabilitation. The transverse abdominis wraps the trunk like a corset, and its contraction draws the two halves of the rectus abdominis together. The pelvic floor stops pressure from dropping downward, which would otherwise worsen leakage or pelvic pain.

Early work isolates transverse abdominis activation. The patient lies supine with knees bent and inhales normally. On the exhale they draw the lower belly gently inward, hold for five seconds, then release. Three sets of ten repetitions, with rest between them, teach the nervous system to reach the deepest layer first.

Pelvic floor awareness comes next. As the transverse abdominis draws in, the pelvic floor lifts, and both release as the exhale deepens. Scoring the pelvic floor symptoms at baseline gives the review record something to compare against. The Pelvic Floor Distress Inventory covers the urinary, colorectal, and prolapse domains in a single questionnaire.

A phased progression you can write into the plan

The template imposes no phase structure of its own. The three-phase framework below is the clinical scaffolding most programs use, and it gives you something concrete to put in the goals section.

Progression depends on symptom resolution, IRD closure, and functional capacity rather than calendar days. A patient who struggles with breath coordination may stay in phase 1 for an extra week. Use one goal line per phase target. The progression criterion goes in the “how progress is measured” column, and the phase end date becomes the target date.

How to track progress and when to advance a phase

The five-row review record is the tracking section. Each row takes a date, a progress note, the changes you made, and who reviewed it. Recording the IRD, symptom changes, and exercise tolerance in the progress column at every visit gives you a readable trend across the program.

These milestones signal readiness to advance:

• IRD closes by at least one finger width every two weeks
• No linea alba bulging during supine leg lifts or dead bugs
• Pelvic floor function improves, with fewer leaks, less heaviness, and better endurance in holds
• The patient tolerates increased load without a symptom flare
• Functional capacity improves, such as walking further or climbing stairs without strain

Stalled progress points the other way. An unchanged IRD, ongoing pelvic pain, or exercise intolerance calls for re-assessment or specialist referral.

How to use the template in your practice

The plan is designed to be completed with the patient rather than handed over finished. Working through it in the appointment is what makes the goals stick.

• Add your practice name and logo to the header before you print a batch.
• Write the assessment into the background box: baseline IRD and measurement site, pelvic floor screening findings, symptoms, and the patient’s own functional goal.
• Turn that functional goal into goal 1, with a measure attached. “Return to a 30-minute run without leakage” beats “get stronger”.
• Use the actions for this block of work only, naming the exercises, the dosage, and who is responsible for each one.
• Tick the support checklist honestly. An unticked “follow-up booked” box at the end of the appointment is your prompt to book it.
• Set the review date and the next appointment in the header, then book the appointment before the patient leaves.
• Fill one review row per visit so the plan carries its own history instead of living across loose notes.

Storing the completed plan in structured patient records and linking progress notes to it creates an audit trail of assessment, prescription, and outcome. That trail is what you rely on when a case is reviewed or a patient transfers to another practitioner.

Postpartum rehabilitation rarely arrives as a caseload of its own. Practices that also carry obstetric and fertility work keep this plan in the same chart as the pregnancy record. Women’s health teams usually run both inside fertility clinic software rather than a separate rehab folder.

When to refer to a physical therapist or pelvic floor specialist

A written action plan suits clinician-guided self-management in straightforward cases. Refer to a pelvic floor physical therapist in any of these situations.

• Leakage worsens or starts during exercise: this suggests pelvic floor over-activity or incoordination, and calls for manual assessment and biofeedback training.
• Pelvic pain, heaviness, or dragging persists past three weeks of activation work: it may indicate pelvic floor dysfunction, prolapse, or visceral restriction.
• IRD widens or fails to progress over four weeks: imaging may be needed to assess linea alba integrity or to check for an occult hernia.
• Severe bulging or doming with any movement: pressure management and motor control are still poor, so supervised retraining is warranted.
• History of cesarean delivery or other abdominal surgery: scar tissue and nerve involvement may call for scar mobilization before load progresses.
• Concurrent back pain, hip instability, or postural dysfunction: an integrated assessment addresses the underlying biomechanics.

Set the referral threshold before you start, and write it into the warning-signs box so the patient knows what to report. Practices managing the wider recovery episode often pair this form with a postpartum care plan template. That one covers the non-exercise side of the same period.

How Pabau keeps the plan, the reviews, and the reminders together

A paper action plan holds up until the review date arrives. The original goes home with the patient, a copy sits in the file, and the follow-up depends on someone remembering to book it. A missed review then surfaces months later, when the patient returns with the same separation.

Pabau holds the same plan as a digital form inside the patient record. You complete the goals and actions during the appointment, the patient signs on screen, and the finished form files itself against their chart. Sharing it through our patient portal means the patient always has the current version rather than a photocopy from three weeks ago.

The review dates then do some work for you. Automated reminders prompt the patient before each review, and each completed review sits in the same record as the assessment that started the plan. So when you reopen the chart, the trend in IRD and symptoms is already assembled.

Keep every exercise plan and review in one record

Pabau stores completed action plans in the patient record, schedules the review appointments, and reminds patients between visits. Your goals, actions, and progress notes stay in one place instead of across paper forms.

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Conclusion

This template earns its place through the agreement it forces. Five goals with measures and target dates turn “do your core work” into something you can review in three weeks. Seven actions with named owners make clear who does what between visits.

The clinical judgment stays yours. Choose the movements, set the dosage, define the progression criteria, and decide the referral threshold before the first session. Then write those decisions into the form so the patient and the next clinician can both read them.

Download the plan, adapt the header to your practice, and use it from the first assessment onward. Book a demo to see how Pabau stores completed plans, schedules the reviews, and keeps patient progress in one record.

Continue your research

Need a validated pelvic floor symptom score? Pelvic Floor Distress Inventory template covers the urinary, colorectal, and prolapse domains in one questionnaire you can repeat at every review.

Managing the wider postpartum episode? Postpartum care plan template covers assessment, screening, warning signs, and discharge planning around the exercise work.

Advising on nutrition alongside the exercises? Postpartum diet plan template sets out a seven-day structure for recovery and breastfeeding needs.

Building a pelvic health service from scratch? How to start a pelvic health practice covers what it takes to launch a pelvic health service step by step.

Frequently asked questions