You've done everything right. Chiropractic care. Physical therapy. Core work. Maybe massage. Maybe a new mattress. Your back feels better for a while, then returns to exactly where it was. Maybe it's even slowly getting worse.

Here's a question nobody has asked you yet: has anyone ever checked your core for a separation?

Not core strength. Not core stability. A physical separation of the abdominal muscles called diastasis recti — a condition that most providers never screen for and that silently drives back pain in a significant percentage of people who never get a satisfying answer for why their back won't stay better.

What Diastasis Recti Is — And Who Gets It

Diastasis recti (DR) is a separation of the two vertical columns of rectus abdominis muscle along the midline of the abdomen. The connective tissue — the linea alba — that normally holds these muscle columns together becomes stretched, thinned, and weakened, leaving a gap that compromises the integrity of the entire abdominal wall.

Most people associate DR with pregnancy. And pregnancy is the most common cause — the growing uterus puts sustained pressure on the connective tissue that most abdominal walls can't fully withstand. But it's far from the only cause.

DR can develop from: chronic abdominal pressure from excess weight, repeated heavy lifting without proper intra-abdominal pressure management, chronic constipation or straining, intense abdominal training with poor form, hormonal changes that affect connective tissue integrity, and simply the cumulative load of daily movement on connective tissue that was never quite as strong as it needed to be. Men, women who have never been pregnant, and people of any age can have it.

Everyone is technically born with a diastasis — the muscles naturally come closer together around age three as the nervous system develops. But with ongoing pressure on the weakened connective tissue at the belly button, the separation can re-establish itself at any point in life.

How DR Drives Back Pain

Your abdominal muscles and your spine are part of a single pressure management system. When the system is intact, intra-abdominal pressure is generated correctly — providing stability and support for the lumbar spine and pelvis during every movement you make.

When the abdominal wall is separated, this system is compromised. The pressure that should be distributed evenly through a unified core instead leaks through the gap. Your back muscles — the paraspinals, the quadratus lumborum, the erector spinae — are left compensating for a core that can't do its job. Over time, that compensation creates chronic strain, joint compression, sacroiliac dysfunction, and the frustrating pattern of back pain that responds temporarily to treatment and then returns.

It's also worth noting that a weakened abdominal wall affects posture in ways that load the spine asymmetrically — creating the forward pelvic tilt, the increased lumbar lordosis, and the forward-shifted center of gravity that are often mistaken as the cause of back pain when they're actually the downstream consequence of a compromised core.

The Signs Worth Paying Attention To

Back pain that responds to chiropractic or other treatment but doesn't hold
Visible coning, doming, or ridging down the center of your abdomen with any effort
A belly that looks disproportionately rounded or forward despite your overall weight
An outie belly button or a feeling of looseness or instability through the midsection
Bloating after eating that seems out of proportion to what you consumed
Poor posture that you can't maintain consciously without effort
Pelvic floor symptoms — leakage, pressure, prolapse feelings

You can do a basic self-check for diastasis recti at home using the method on the Diastasis Rehab website: diastasisrehab.com/pages/check-belly.

What Doesn't Work — And What Does

The most common mistake people with unidentified DR make is doing more abdominal exercise to try to fix the problem. Crunches, sit-ups, intense Pilates, heavy dead bugs, leg raises — any exercise that creates forward-doming pressure at the midline actively worsens a diastasis by putting more force through the already compromised connective tissue.

This is why gym-goers with DR often find that their back pain worsens with training rather than improving, despite doing "all the right core work." The work is wrong for their specific anatomy.

The Tupler Technique® — a four-step, research and evidence-based program developed by Julie Tupler, RN — is the most well-established non-surgical approach for closing a diastasis. The program focuses on strengthening the connective tissue, repositioning the abdominal muscles, and retraining movement patterns so that daily activities don't continue to worsen the separation. As a Tupler Technique® affiliate, I recommend this program specifically for patients whose back pain has a DR component. Learn more at diastasisrehab.com. (Use code 5DRFREEMAN for discounts on programs and materials.)

Chiropractic care addresses the structural consequences of DR — the spine, the SI joints, the postural compensation patterns — while the Tupler Technique® addresses the core itself. Together they treat the problem and its downstream effects simultaneously rather than cycling through the same temporary relief.

If Your Back Has Been Trying to Tell You Something

Chronic back pain that doesn't fully respond to treatment is not a character flaw, a lack of effort, or something you have to learn to live with. It's often a signal that something structural hasn't been identified yet.

If you've been on the treatment carousel without lasting results, diastasis recti is worth ruling in or out before your next round of care.

Work with Dr. Carla at Breathe Chiropractic:
Book a consultation in Phoenix and let's assess whether DR is part of your back pain picture.
Book Your First Visit

Explore the Tupler Technique® adult program:
diastasisrehab.com/pages/adults-with-a-diastasis-recti Use code 5DRFREEMAN for dicounts on programs and materials.

Dr. Carla Freeman, DC is a Tupler Technique® affiliate at Breathe Chiropractic in Phoenix, AZ.