The New Client with Diastasis Recti and a Deadlift Habit
A 34-year-old client, 14 weeks postpartum after a cesarean, comes to your mat class. She reports a 2.5-finger-width gap at the navel that she checks by curling up, and she says her OB cleared her for exercise 'as tolerated.' She is eager to return to heavy lifting and asks whether she can do full roll-ups and planks because 'core work is what fixes it.' During a supine assessment you notice her abdomen domes into a ridge along the midline when she lifts her head, and she reports a pulling sensation at the scar. She has no pain, no bleeding, and no pelvic-floor leaking, and she has been walking 30 minutes daily without symptoms.
1. How do you respond to her request to begin full roll-ups and planks in the first two weeks, and what is your clinical reasoning?
Read the worked answer
Decline the full roll-up and standard plank as starting points, but frame it as sequencing rather than prohibition. The doming ridge and midline pulling are signs of poor load transfer through the linea alba and excessive intra-abdominal pressure relative to current tissue tolerance. A full roll-up demands high spinal flexion plus a large pressure spike; a front plank demands high anti-extension tension. Neither is inherently forbidden forever, but both exceed the demonstrated capacity right now.
Reasoning chain: (1) she is early postpartum with a healing cesarean and connective-tissue laxity; (2) the assessment shows a visible pressure-management failure (doming), which is a load-tolerance signal, not a cosmetic one; (3) therefore start with breath-and-position work (supine 90-90 breathing, side-lying, quadruped), then graded flexion with a hand or towel supporting the midline, and only progress to loaded anti-extension when she can maintain a flat, non-doming midline through a set. Reassess the gap and symptoms weekly. Document the decision and the rationale, and tell her the plan is to earn the roll-up, not avoid it.
2. She asks whether the 2.5-finger gap will 'close' if she does enough core work. What is an accurate, non-alarmist answer?
Read the worked answer
Explain that finger-width measurement is a crude, position-dependent screen and that the goal is functional tension and control of the midline, not a number. Many people without symptoms have a palpable gap; the evidence does not support promising that a specific exercise closes it. What you can influence is how well she manages pressure during daily tasks and exercise, which is what the doming assessment actually reflects.
Set expectations: progress is judged by less doming, less pulling at the scar, and tolerance of harder positions over weeks, not by a tape measure. Avoid fear-based language and avoid guaranteeing closure. Redirect her toward the behaviors she controls: exhale on effort, avoid breath-holding, and build load gradually.
3. She wants to know when she can return to heavy lifting. What criteria and communication do you use?
Read the worked answer
Give criteria rather than a date, and be explicit that heavy lifting is outside your scope to clear alone; coordinate with her OB or a pelvic-health physical therapist. Reasonable criteria: no doming or coning during bodyweight anti-extension and rotation; no scar pulling during loaded hinge patterns; ability to brace with an exhale under moderate load; no leaking or heaviness. Then progress load in small increments with a hinge-first bias.
Communication: state what you will monitor, what would make you pause the progression (pain, doming that persists, heaviness, leaking), and that a pelvic-health PT referral is the standard of care for returning to maximal loading. Document the referral and her understanding.