Fear Mongering the D-Word

The things I have been hearing lately: 

From my friends and patients: “I stopped doing Pilates when I got pregnant because it gives you diastasis recti.”

At my pelvic floor workshops: “My abs are separated, can you fix this?”

On Social media from a pelvic floor influencer:  “5 exercises to prevent diastasis recti during pregnancy.”

All of these statements are either inaccurate, oversimplified, or rooted in fear. Unfortunately, the way we talk about diastasis recti can make pregnant and postpartum women afraid to move, exercise, or use their core. So, before we start avoiding exercises or worrying about whether our abs are “separating,” let’s talk about what diastasis recti actually is, why it happens during pregnancy, and what the research tells us about exercise. 

In the middle of everyone’s abdomen, there is a dynamic connective tissue called the linea alba. This connective tissue runs from the sternum to the pubic bone and connects the left side and right side abdominals. It is designed to transmit forces between muscles on either side of the abdomen and accommodate changes in the abdominal pressure and volume. Everyone’s linea alba, male or female, varies in width and structure. There is no research-based set width that everyone needs to have. In fact, there is still no universal consensus on exactly what measurement should be used to define clinically significant diastasis recti.

During pregnancy, as the uterus grows, starting at 20 weeks and beyond, the linea alba begins to expand and stretch across a woman’s abdomen. This is when women can start to see some coning or doming with movements in the gym, core exercises, or movements at home like getting out of bed. According to a recent study 99% of women will see an increase in their linea alba length that denotes diastasis recti. That does NOT mean that 99% of women have a pathological condition that needs to be “fixed.” It means that an increase in the space between the rectus muscles is an extremely common physiological adaptation to pregnancy. And postpartum, 70% of people’s linea alba’s return to their natural positions. 

But having an increased inter-recti distance does not automatically mean that someone will have pain, dysfunction, or a poor postpartum recovery. This distinction is important: a measurement is not the same thing as a symptom.

Some women with a persistent or more significant diastasis may experience abdominal wall weakness, difficulty generating or transferring force, changes in abdominal function, or difficulty returning to certain activities. Some may also experience pain or other pelvic floor or lumbopelvic symptoms. THIS is why we can become scared of diastasis recti, but fear not! There are things that we can do to help! 

What things make it worse: Not much! We often hear that certain exercises will “make your diastasis worse” or that you should avoid planks, crunches, Pilates, lifting, or other abdominal exercises during pregnancy. But the research doesn’t support the idea that simply using your abdominal muscles during pregnancy causes or worsens diastasis recti.

In a 2024 randomized controlled trial, pregnant women participated in a 12-week program of abdominal and pelvic floor muscle exercises. The researchers found that the exercise program had a negligible effect on inter-recti distance compared with the control group. In other words, exercising the abdominal and pelvic floor muscles did not meaningfully increase diastasis recti. So no, doing Pilates, lifting weights, performing core exercises, or using your abdominal muscles during pregnancy does not appear to “cause” diastasis recti.

If someone notices coning or doming during a particular movement, that doesn’t necessarily mean they are damaging their linea alba. Instead, it can be useful information about how that person is managing pressure and load during that particular movement. As physical therapists, we can use that information to modify positioning, breathing, load, range of motion, or exercise selection if the movement is uncomfortable, difficult, or not meeting the person’s goals.

What things make it better: Not much! In the same study noted above, if core exercises don’t make it worse, they also don’t prevent it from happening. The goal of exercising during pregnancy shouldn’t necessarily be to keep your linea alba at its pre-pregnancy width. That also doesn’t mean core training is pointless. Your core is much more than the distance between your rectus muscles. It is a system that includes the diaphragm, abdominal muscles, pelvic floor, back muscles, and the rest of your body working together to manage pressure and produce and transfer force. If we work on proper core bracing through pregnancy, we can decrease visible coning/doming, improve ability to push baby out during delivery and improve core and pelvic floor recovery outcomes postpartum.

As a pelvic floor physical therapist, one of my goals is to change the language and fear surrounding diastasis recti.

First, your abs are not “seperating.”  The fascia in the middle of your body is just stretching. 

Second, coning and doming are not automatically bad. Seeing a ridge or bulge along the midline of your abdomen does not mean that you are damaging your core or making your diastasis worse. However this could be a sign that our core isn’t working as efficiently as it could, so we may need to address the movement or activity that is causing the coning.

Third, EVERYONE that is pregnant will have diastatis. So instead of telling pregnant women that they need to “prevent diastasis,” we should be teaching them how to adapt to the normal changes their bodies are going through. Your body is supposed to change during pregnancy. Your abdominal wall is supposed to expand. Your linea alba is supposed to adapt.

Your ability to move, lift, exercise, breathe, and feel confident in your body is far more important than trying to maintain one specific measurement throughout pregnancy. Postpartum, instead of asking, “How do I close my gap?” we should also be asking, “How do I rebuild strength? How do I restore abdominal function? How do I return to the activities I love? And how do I make my body feel capable again?”

Your ability to move, lift, exercise, breathe, and feel confident in your body is far more important than trying to maintain one specific measurement throughout pregnancy! LOVE YOU, BYEEE.