BackgroundInter-recti distance (IRD) measurement using musculoskeletal USI has been used in physiotherapy research, in particular, to investigate pregnancy-related diastasis recti abdominis (DRA) and to seek its effective treatment methods. Severe and untreated diastasis may result in the formation of umbilical or epigastric hernias.ObjectiveThis study aimed to systematically map physiotherapy-related research articles that included descriptions of IRD measurement procedures using USI to present their similarities and differences, and formulate recommendations on the procedure.DesignA scoping review was conducted according to PRISMA-ScR guidelines, including 49 of 511 publications from three major databases. Publications were selected and screened by two independent reviewers whose decisions were consulted with a third reviewer. The main synthesized data items were: the examinees’ body position, breathing phase, measurement sites, and DRA screening methods. The final conclusions and recommendations were the result of a consensus between seven reviewers from four research centers.ResultsStudies used 1–5 measurement sites that were differently determined. IRD was measured at the umbilicus (n= 3), at its superior (n= 16) and/or inferior border (n= 9), and at different levels: between 2 and 12 cm above the umbilicus, or a third of the distance and halfway between the umbilicus and xiphoid (n= 37); between 2 and 4.5 cm below the umbilicus or halfway between the umbilicus and pubis (n= 27). Different approaches were used to screen subjects for DRA.ConclusionsThe discrepancies between the measurement procedures prevent between-study comparisons. The DRA screening method should be standardized. IRD measurement protocol standardization has been proposed.Critical relevance statementThis scoping review indicates that the inter-recti distance measurement procedures using ultrasound imaging differ between studies, preventing between-study comparisons. Based on the results synthesis, the measurement protocol standardization has been proposed.Key pointsThe inter-recti distance measurement procedures using USI differ between studies.Proposed standardization concerns body position, breathing phase, measurements number per location.Determination of measurement locations considering individual linea alba length is suggested.Recommended locations: umbilical top, ½ of umbilical top-xiphoid, ¼ of umbilical top-xiphoid/pubis distances.Diastasis recti abdominis diagnostic criteria are needed for proposed measurement locations.Graphical AbstractSupplementary InformationThe online version contains supplementary material available at 10.1186/s13244-023-01443-4.