A check for diastasis recti must always be performed before initiating abdominal exercise. Only the corrective exercises (head lift or head lift with pelvic tilt) should be used until the separation is corrected to 2 cm (two fingerwidths) or less.

Head lift
Patient position and procedure. Hook-lying with her hands crossed over midline at the level of the diastasis for support. Have the woman exhale and lift only her head off the floor or until the point just before a bulge appears. At the same time, her hands should gently approximate the rectus muscles toward midline Then have the woman lower her head slowly and relax. This exercise emphasizes the rectus abdominis muscle and minimizes the obliques. Some women may not be able to successfully reach over their abdomen. In this case, the use of a sheet wrapped around the trunk at the level of the separation can be used to provide support and approximation.

Head Lift with Pelvic Tilt
Patient position and procedure. Hook-lying. The arms are crossed over the diastasis for support as above. Have the patient slowly lift her head off the floor while approximating the rectus muscles and performing a posterior pelvic tilt, then slowly lower her head and relax. All abdominal contractions should be performed with an exhalation so that intra-abdominal pressure is minimized.

Abdominal Muscle Exercises
As pregnancy progresses, the abdominals will undergo extreme overstretching. Therefore, exercise must be adapted to meet the needs of each individual, and periodic re-assessment must be done (approximately every 4 weeks during pregnancy). The following exercises progress from least to most strenuous.

Pelvic Tilt Exercise
Patient position and procedure. Quadruped (on hands and knees). Instruct the patient to perform a posterior pelvic tilt. While the patient keeps her back straight, have her isometrically tighten (imagine drawing in) the lower abdominals and hold, then release and perform an anterior tilt through very small range.
• For additional exercise, while holding the abdominals in and the back straight, have the woman laterally flex the trunk to the right (side-bend to the right), looking at the right hip, then reverse to the left.

• Have the woman practice pelvic tilt exercises in a variety of positions, including side-lying and standing.

Leg Sliding

Patient position and procedure. Hook-lying with pelvis in a posterior tilt. Instruct the woman to hold the pelvic tilt as she slides one foot along the floor until the leg is straight or to the point at which she is unable to maintain the pelvic tilt. Have her slowly slide the leg back to the starting position, then repeat with the other leg. Breathing should be coordinated with the exercise so that abdominal contractions occur with exhalation.

Trunk Curls
• Curl-downs and curl-ups are classic abdominal exercises for rectus abdominis strengthening and can be used if tolerated and no diastasis recti is present. Have a pregnant patient protect the linea alba with crossed hands while performing trunk curls.

• Diagonal curls are carried out to strengthen the oblique muscles. Have the woman lift one shoulder toward the outside of the opposite knee as she curls up and down and protects the linea alba with crossed hands.

Modified Bicycle
Patient position and procedure. The woman is supine with one lower extremity flexed and the other partially extended. The lower abdominals stabilize the pelvis as the lower extremities flex and extend in an alternating pattern as if cycling. The further the lower extremities extend, the greater the resistance. In order to not strain the back, the woman must keep it flat against the floor by controlling the arc of the cycling pattern.

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