121. Diastasis; Social media is more damaging than crunches with Gráinne Donnelly

In this episode, I discuss with fellow physiotherapist and researcher, Gráinne Donnelly, the effect that social media has on diastasis rectus abdominis:

• The recent study published that evaluated Instagram content related to DRA, exercise, and sports, and explored its perceived impact on the behaviours of women with DRA.
• The majority of diastasis related content on Instagram is not evidence based
• Fear based vs empowering based information 

Gráinne Donnelly is an Advanced Physiotherapy Practitioner in pelvic health with over 15 years of experience spread across the public health, private practice and clinical research. She is on the Board of Trustees for the Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) professional network and charitable body where she is the Editor for the Journal of Pelvic, Obstetric and Gynaecological Physiotherapy. She is currently completing her PhD at Cardiff Metropolitan University and her recently edited book “Sports Medicine and the Pelvic Floor: Science to Practice” was released by Elsevier in November 2025 and will be officially published in April 2026.

HOW TO CONTACT GRÁINNE

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Website

LINKS MENTIONED

#diastasisrecti: a mixed-methods analysis of Instagram posts and their influence on women's exercise and sports participation

https://pubmed.ncbi.nlm.nih.gov/40618057/

Lead researcher: @silviagiagio.physio

THANK YOU TO THIS EPISODE SPONSOR

SRC Health:  Use the link below for a discount at checkout!

https://srchealth.com/?ref=PELVICFLOORPROJECT

Thanks for joining me!
Here is where you can find out how to work with me:  www.pelvicfloorprojectspace.com/

mel@pelvicfloorprojectspace.com

Transcript

SPEAKER_00 0:00

Welcome to episode 121. Diastasis rectus abdominis. Don't worry, you're not wrong if you say diastasis. Oh, the fear it causes. Don't do crunches. Avoid planking. Be careful of rotating. You could make it worse. Wait until you heal before you do any exercise. Something is wrong if you see doming or coning. You guys, this fearful advice you're hearing is not founded in research. It's just founded in caution. And social media is not helping. Social media creates tremendous diastasis fear, and if you ask me, it is more harmful than crunches or planks. Joining me again on the show today is Grania Donnelly, a fellow physiotherapist and member of a research team who analyzed Instagram posts and their influence on women's exercise and sport participation. Are you surprised to hear that they found the majority of the posts that they viewed on Instagram were sharing non-evidence-based information and led with fear avoidance and caution rather than what we know to be true, which is more like there are no bad exercises. You need to start somewhere where you feel good, and most importantly, you need to keep progressing. And then you think about how the algorithm works. Once one post comes across your feed, it influences the others that you see. And so if you end up on the non-evidence-based posts, the bad information multiplies for you. Look what we're up against in this space. As a supplement to this episode, I highly suggest you listen to episodes four and eighty-four of this podcast that will help you understand what diastasis actually is, and most importantly, take the fear out of it. I'd love to hear from you after you listen to this episode. Does it change anything for you? Listeners, before we get rolling, can I ask you a favor? Would you consider downloading the episodes when you listen on this podcast? The only way podcast uptake is measured is through downloads. Listens without downloading is not captured. And this helps me in so many ways. Thank you. And now I'll be right back with Grania Donnelly. Listeners, have you ever heard of the benefits of using a high quality compression garment during pregnancy, after birth, or to address feelings of vulnerability, maybe in your tummy, or heaviness in your undercarriage? Did you know the evidence tells us that using these garments can decrease pain, ease apprehension, and increase the ability to move with comfort in your day if you have these unwanted symptoms? I'm grateful to have SRC Health as a podcast sponsor, and I want to take some time to tell you about their high-quality products. Using a revolutionary fabric created by medical professionals, SRC has designed a line of compression shorts and leggings that are made to support your back, tummy, and pelvis in pregnancy or help you feel less pain and more confident with movements as you recover after pelvic surgery or birth. Their products have also helped many for symptoms like incontinence, diastasis, and prolapse. I also have to add that their customer service is like no other because they stand behind their products. To check out their full line, use the QR code provided in the show notes, which will automatically provide you with 10% off site-wide. Doesn't your mind and body deserve the support? All right, Grania. I always look forward to having you on this podcast. There's certain people that are just so easy to talk to. And um I it's six o'clock in the morning for me, so I feel like my voice is a little sexier than normal. Um, but I we're coming on today to talk a little bit about a subject I like to talk about, but diastasis and how it is like it's a it's kind of a jungle out there. There's a lot of misinformation, there's a lot of fear, and there's certain topics, you know, when you work in the clinic that have a little bit more energy behind them, if you will, or a little bit more fear. I feel like prolapse is another one, but this is this is a big one in the pregnant and postpartum world. And so you've got a lot of cool things going on, and you you I think it's neat how you take some of these topics and you've now learned how to like how do we research this or how do we put a little bit more evidence behind what we're thinking? And so we're gonna talk today about some some research you looked at the effects of social media on on diastasis. And so before we get going, will you tell people a little bit more about yourself and all the cool things you do, Grania?

SPEAKER_01 4:36

Thank you so much, Melissa. I'm so happy to be on the podcast again, and all the work you do is so inspiring. So thank you. Um I'm Grania Donnelly, I'm a pelvic health physiotherapist from Northern Ireland, which is really confusing because of part of the UK, but on the island of Ireland. So it's yeah. Um I still do clinical practice, but I'm also embarking on a doctoral research journey. So the more I've started to try and be part of the picture, exploring some of these topics, the more I've got the bug for research and and be in that vehicle that can hopefully take research and bring it directly into clinical practice because the dissemination of it's important too. Um, and my topics of interest, so for my PhD, I'm doing postpartum return to running and specifically compression garments, but other topic areas of interest that I'm also on collaborative projects with include diastasis or diastesis. And that's something that I think you're right, it's such a topical area at the minute. And I'm actually just off a meeting this morning. For anyone who's in the diastis world, they will be aware of Dr. Nina Theodorsen, who recently did her PhD on diastasis and hopefully empowered us that we it's safe to do a lot of exercises with it. But we were just talking about the the issues with where we currently are in our understanding of diastesis and how um there's a lot of confusion out there.

SPEAKER_00 6:04

Yeah. That's what I think. Um, like when someone comes into the clinic and they're clearly there because they want to address a symptom related to you or they have questions around. I find so much of the first um appointment is so much education, which is obviously why I love this podcast, is because I'm looking to like cut down the amount of time I have to talk to this person and so that we can get straight to exercise or get get straight to hands-on work or whatever. And so I love these episodes, just like let's maybe digest some of this before you come in or as a supplement to your appointment. But I think, yeah, so we're gonna talk a little bit about like the influence because social media is huge for when we're looking something up or when we want to understand something that's very common that we turn to that. But I find it it sure creates so much confusion and people have a hard time just exercising. So I'm thinking maybe what would be helpful is if we start with talking about for people a little bit like what exactly, and you can hear that diastasis is like certain words where theater, theater, like we say it different sometimes depending on where I think it's where we were educated. Like I've said diastasis since school. Um, and so let's just talk a little bit about like really quickly, like what is it? Um, what is happening? Because I think that makes more sense to give that context before we talk about the problem with social media. And I think we all describe this a little bit differently. I'm interested for you to share, like, so let's say I come into your clinic and I'm um wanting to work on my abdominal strength, or I'm worried about diastasis. What how do you describe anatomically what's happening to someone when they're experiencing this? Like, what is it?

SPEAKER_01 7:47

So that's a great question. And I guess our current understanding of it is that it refers to the thinning and widening of specifically the linear elbow, which is that connective tissue down the midline of our abdominal wall that joins the two rectus abdominis muscles together. So if a patient's coming in, I say, do you know the six-pack muscles that we um you know think of in terms of muscle definition? Well, there's connective tissue that is in the middle of those, which is completely normal, and it serves to join those muscles together. And that tissue is supposed to expand. So I'm really big into normalizing the fact that it's not supposed to be stock or rigid or um any, I suppose, certain like minimalistic metric in terms of the particularly for women, when we go through that perineatal transition and we have quite exponential stretch in that abdominal wall, it's a really clever bodily design and piece of tissue that allows that abdominal wall to expand. So what we know from the research is that all women by the end of pregnancy will have some degree of thinning and widening of that connective tissue, and that's absolutely normal. Um, what we consider to be diastasis or diastasis is when in the weeks following postpartum and months following postpartum, if that thin and widening persists, and we have certain metrics that we, I suppose, measure against in terms of what width is considered to be persistent indirectly distance widening, but there's debate and there's different metrics that you can go by depending on which research group you look at. Um and so more contemporary research is saying anything up to 34 millimeters could be considered normal, which I think is great and is welcoming because, like I suppose as a pelvic health clinician and thinking of other aspects that I treat as well, including pelvic floor dysfunction, we know that women's pelvic floor tissues will most likely change to some degree following pregnancy and particularly vaginal childbirth, and we don't need to always over-pathologize that. And so it's about finding out um what's what's problematic. Now, from a research perspective, um I've been involved with several research groups and had the really fun opportunities to work with different researchers across Europe, which is always really exciting. So one of the studies I did was with Montergiano Campo and team, and we looked at the impact of diastasis on women, and the we did a systematic review, and the domains that were coming up as being problematic were things like confidence and body image, um, abdominal bloating and discomfort. Um so that you know sometimes women complain of that, and also um some degree of uh abdominal wall dysfunction where they felt weaker um or less functional. And um, so it's really about trying to take a holistic lens and look at who is having persistent indirectly distanced widening that is also either leading or corresponding with some of those biopsychosocial symptoms that are problematic and that we can hopefully as rehabilitation specialists help them overcome.

SPEAKER_00 10:58

Totally. I think I think the fact, yeah, exactly. The fact that it's just there isn't always the issue, but how it affects you. And it's funny, like what same thing. When someone comes in, I bring up different images on my computer and stuff, and I'll show them like the connective tissue and show them what it looks like. But also like this this tissue over here, this red stuff is muscle. Like there's different things going on here, and explain to them like I often use the word adaptation, and I have different thickness of theraband in my office, and I can show them like before we're pregnant, maybe like more of like this um strength or this thickness, and then and then look at how we have this cool adaptation that we're gonna get more stretch. But look at this red stuff on here is muscle. Like this is a whole nother factor. And so you're gonna have this change in your tissue, but muscles. So I often say, like, if I want ripped arms, what do I have to do to my muscles? I have to exercise them. And I say, what do wit most pregnant women do with their muscles in their core? And pretty well everyone says, avoid them. Like, yes. So there's other things going on there too, and all of a sudden you can see their wheels turning, like, oh, but I think that's what we've kind of put so much emphasis on this tissue and this, you know, I see I often say, do you hear the difference between the words damage and stretch versus or sorry, damage and tear and separate versus stretch? Right. Because if you just used a different word, it might not sound so scary, but you're right. It's more kind of like, what does this, not just is it happening, but how does it make you feel, right? And what it does it make you feel nervous? Does it make you feel subconscious? Does it make you feel um weak? Does it do you feel like it gives you some sort of pain? And what what does that mean? But yes, I think that's what I think a lot of people come in and you think about their question, it's often like, is it normal, right? If you really get down to the they're wanting to know, like, am I supposed to have this? What am I supposed to do about it? There's a lot, yeah.

SPEAKER_01 12:56

Totally agree. And I actually think too, it's it's so interesting because like other areas that we as pelvic health visitors treat, the lived experience of it is quite individual. So you can have some people who have very little adaptation and stretching, but are quite worried and fearful about it and maybe um have limited what they're doing. And you can have other um postpartum women come in with you know a much more uh substantial widening or stretch and they're just cracking on and getting on with it. So it's it's a really individual thing, and it's definitely fueled by other biopsychosocial factors, which I find I find that part of things fascinating because um I find trying to figure out how something is impacting someone on an individual level and what factors are maybe feeding into that, I think that's where we can really come into our own as rehabilitation coaches, so to speak.

SPEAKER_00 13:53

So, why do you think so? Why did you, with all the with the very little time that you have and and this group of people that decided to look at this, like, what made you decide to do? Like, let's actually study because the the effects of what social media does for people, because um, this is a huge one. I think that it's what you're gonna do with this information in your body that kind of dictates how it changes partially, right? What what made you decide to do this?

SPEAKER_01 14:24

Well, this was actually the concept of Dr. Sylvia Giaggio, who is the first author on the paper that you will have seen. And Sylvia reached out and asked, Would I be interested in collaborating on this project? And I was like, Yes, this is so interesting to me. Um so she already had the project plan in place where she wanted to look and do mixed methods in terms of actually look and analyze some of the um diasis-related content on Instagram and see how it compares and matches up to what we know about the current state of science for the topic. And then she wanted a qualitative aspect to it where we actually sit down with the women and discuss and find out their lived experience and how the information they're seeing on Instagram impacts their perception of diastasis and their exercise behaviors. So I actually led the interview parts of it, and so I had the one-to-ones with the women, and it was an absolutely fascinating process and one in which I learned so much even just doing so talk more about that.

SPEAKER_00 15:28

So talk okay, yeah, talk more a little bit about that because people are gonna identify with this.

SPEAKER_01 15:35

So when I came to doing the interview part, we interviewed 20 postpartum women with diastesis, so with either self-reported or um self-defined diastesis. Um and we wanted to find out, we had it was semi-structured interviews, so we had some questions trying to I suppose bring up the topic of what sort of content they've seen on diastasis, who they follow, why they follow who they follow, um, whether they're seeking health-related information on Instagram or if it's just something that incidentally comes up. And we wanted to find out how what they've seen on social media influences their thoughts and beliefs about diastasis and what they can do. And it was really, really interesting for me because it was very apparent that social media can be a really good thing and a really empowering thing, or a really bad thing and a really disempowering thing. And there was no recipe for basically finding which which which lean you take, because I I typically think that a lot of it might be to do with the algorithm. So when women fell on something, they say the first few posts they came across were something that was very evidence-based, um, was by a qualified professional and was putting out good evidence-informed information, if they were engaged in that, they tended to either follow more people that person follows and also get suggestions of posts that were more in keeping with that. So it becomes a bit of an echo chamber in that way. So they became more empowered, more empowered, more empowered. Whereas when women were falling on something that was either quite fear-inducing, not based on contemporary science, that was either trying to sell something or very influential type um posts, they tended to find more and more of that. And again, they fell down that echo chamber and went further into it. So we had a group that was either really empowered and like, you know what? I know I've done a system, I know I don't need to be afraid of it. I it's good to exercise. I just love keeping strong, so I'm just cracking on. And then you had the other ones who were like, Oh, I'm really afraid to move just in case I do an unseen movement, or if I undo all the progress I've done, so I just don't do X, Y, or Z. It was just, it was incredibly frustrating to see the difference because you were seeing how useful it can be and how harmful potentially it can be.

SPEAKER_00 17:58

And I even find like I've I've stopped believing things I see online. Like when I see like anything about the current events, I just don't even believe it. I'm like, it might be true, but now I all of a sudden get overwhelmed with like, I think I'm just like not gonna read it because I don't have the time to look into this to see that if it's if it's real or not. So I can imagine, you know, how hard this is. Um, I had a woman come in the other day, 12 weeks pregnant, and that like you just kind of said exactly what she said. She said, I'm here. I've always been active. I've stopped everything because I my mind is swirling. Like I hear no planks, no crunches, no jumping, no rotating. Um, I'm going to meet a trainer on Friday, but I don't know if she knows what she's talking about. Like this, just this, like, oh my paralyzed fear, right? Yeah. And so um, I'm curious to know what did you learn more about? Like, why? So, why did they follow what m what are some of the things that made them follow? Like, is it number of followers? Like, what are some more things like about what attracted people to certain information?

SPEAKER_01 19:14

It really depended. So, when we asked women this, some of them uh were quite specific that they would look at the profile of the person putting information out and see what background they came from. So, if they came from a health professional background or if they were a fitness professional that seemed to have qualifications, that gave them more kudos as such. Other people were actually looking to relate to people who had diases themselves, so more that lived like they were looking for someone who could understand their thoughts and perceptions, which which I totally understand too. Like when we have anything, we probably do um we probably do look for someone who we feel can relate to us. And sometimes I think that uh that like for example, one of the podcasts I have uh from my own library of podcasts, because I do the same as what you do. I have um a library of podcasts that sometimes I supplement my education depending on what I find in clinical practice. And one of them is with a former um diastis patient who shared her journey publicly and um record a podcast about it. And it's really powerful. I often find when my patients listen to it, they they suddenly feel heard and seen or something in a way that I can't, even though I've assessed them, I've validated what they have, I've empowered them, but there's something about someone with that lived experience of it being so relatable to them that it that that's powerful. But and that's a good thing and a bad thing. So that's a good thing if someone who has that lived experience is putting out evidence-based information or signposts into evidence-based information. But if it's someone who has that n equals one experience who is a self-professed expert all of a sudden, that's where it becomes complicated. So it is really, really interesting. But and it was really apparent how much for those who felt disempowered, it was really apparent how much diastis impacts upon mental health and well-being, and it almost becomes all-encompassing where they are defined as a person by their diastes, which which was it just seemed like there was no escape from it.

SPEAKER_00 21:21

Listeners, I know many of you are physios that are perhaps new to the area of pelvic health and feeling like you could benefit from some guidance as the complexity of your caseload goes up. I offer mentorship and I'm here to help. Let's figure out a structure that works best for you. My contact details are in the show notes, so please do reach out. Yeah, it's interesting. I think um I think about that, and I actually because I ended up having um like I had a I had a diastasis repair, and I shared a lot about the experience because I was like, this is a black hole, and I know there's not a Lot of guidance, and I think there's a lot of shame, and and I can I can't I think I can share a lot here, but I did I was very mindful through the process that like my experience is not going to be your experience, and I'm not I don't I'm not recommending that you do what what I do. I'm not recommending you recover how I recover, but more just like these are things to consider, these are things I'm scared about, things like that. But I do realize that like a lot of people reach out because I have shared that, and um, I think that it's kind of the it's hard not to want to see yourself in someone else. Like I I have experienced that and I can see that you have to be careful what you share in that you aren't representing everybody. Um, but this is definitely a topic that I think is really hard to just get any type of guidance. But I th I use analogies all the time and I say think about parenting. Like you you have to get information from everybody if you're feeling stuck, but you're not gonna apply all that information. You're gonna sit there and think, like, do I like that? And do I want to try that? Versus, um, I don't think that's for me. And and I like I think we're hearing, and I want to talk a little bit more about some of the information that you pulled out of that um kind of like um from the data, like what did you hear about some of the posts? But you know, we have as as parents, you know, when our when our parents give us guidance for like that's so old fashioned. I'm like, sure, you kept your kids alive, but your information is so old fashioned I'm not pulling from that. And I think that's kind of what we've got mixed up in the diastasis world is like there's just a lot of old information out there that wasn't really based on anything, right? And so we're hearing some of that old suggestions versus like this new literature that's coming out saying, oh, whoops, we kind of have that bit wrong. Like we told you to avoid everything, right? But and same with parenting, it's like the old school versus like this new wave parenting, right? I think that's kind of what's going on, is like this this confusing time of old versus new. Yeah.

SPEAKER_01 24:08

I agree with that, and I would say a lot of that's down to so when we when I first think about when I got interested in diastasis, there was literally no research on it, very, very little. And there still is little research, but we've much more than we had when I started. And so when you don't know something and there's a lot of unknowns, that's oftentimes where there's nearly blanket rules and um um insights made. And so again, for clinical practice, that's how we were all maybe educated and brought up. But over time, as research methods and research understanding has developed, people have pushed the boundaries. So now they're researching people during pregnancy, which never used to happen. Jeez, they never used to even research women. Like, let's get real, like it's quite a fresh thing that women have been included in research trials because we're so complex, apparently. And so I find it really interesting now that as people start to push the boundaries and research things, we then actually do as what you've said, oh, actually, we were a bit restrictive there. We actually don't need to be as restrictive because this is not harmful. Um, and that's what actually Nina Newdors, who I mentioned earlier, that her research really transformed how we think about exercise during pregnancy. And she showed that exercise in all the abdominal wall muscles during pregnancy, including like resistance training type exercises, crunches, things that we were told not to do, they do not increase the odds of having postpartum diastasis. And so that's exciting because you've already touched on it, when we think of muscle tissue anywhere around the body, we keep it strong. And what we're essentially doing or have been doing with this population is deconditioning them. And yet they're one of few populations. I always use the example and analogy of if we think of a simple orthopedic sport surgery, like going in and getting maybe cartilage removed from the knee. Um, people go in, they usually have information to inform them about what's going to happen during this surgery. They're usually given information, certainly in the UK, about what the post-op expectations are, what restrict what movements might be restricted and for how long. And then they're also reassured, don't worry, you'll be referred for one-to-one physio to guide you. And so that's after microscopic knee surgery. And then I think of women who go and have nine plus months of physical, physiological, psychological changes and challenges, their body changes exponentially. They potentially have some degree of tissue trauma, whether that's abdominal, major abdominal surgery, whether that's quite a major vaginal delivery, and they're sent home with an extra job that they start immediately. Like it's unlike anything we we can compare to. So, really, that should emphasize the importance of keeping women physically active and strong because they're actually going to be expected to do more than what a simple knee procedure or something is expected to do going into hospital.

SPEAKER_00 27:04

And that's it, like sometimes I use the example of like to show them that abdominal like the picture of the abdominal wall and just explain the difference between connective tissue and muscle tissue, and then say, like, picture right now, let's say I've had a cast on my leg for a month or something like that, and we're gonna take it off today and I'm gonna stand up in front of you. What's the difference gonna be between my two legs? And I often say, I'm gonna have a chicken leg on one side. Like you're gonna see some muscle wasting because that's what happens when we don't use muscles. Um, but would you ever what would do you think it would make sense if I waited for them to get stronger? Like, do I have to wait for them to get stronger? What do I have to do? I have to start strengthening them. Um, but I also wouldn't start with the hardest exercises. That doesn't make sense. I'm gonna probably hurt myself. And not that I'm gonna break my bone or something catastrophic like that, but I'm gonna hurt something in the area if I start too hard. And abdominal strengthening is the same postpartum. Like you're gonna have weaker muscles simply from changes in the abdomen, but also if you've not been exercising, then that's what happens to muscles. We can't wait for them to get better. We have to start somewhere, but we have to make it harder because if in my leg, like I probably would start with just like squeezing my muscles on, letting them off, squeezing them on, let them off. But if I stay there, I'm not gonna be good at running. Like that doesn't translate to enough exercise to be good at running. And same with the abdomen. Like, if you're just sitting there kind of like touching your toes down forever, that doesn't give you the most strength. And and I think that when you explain that to people, um, it makes sense to them. But the amount of like sometimes the amount of unlearning they have to do is where I'm going from, from what they've heard on social media, because generally they're getting the information to just like just wait for it to get better, and then you can start strengthening, right?

SPEAKER_01 28:58

Absolutely. And even thinking about like I look back at myself in earlier clinical practice when I was doing what I was taught, you know, coming out as an undergraduate, and like we were restricting women, like really deloading them, even postpartum. And it makes no sense, even from the from the standpoint of, you know, we might be giving them, as you say, toe taps or bent fallouts or something, and like not giving them anything stronger than that, and then they're lifting a baby in a car seat, and they're you know, they're deadlifting in as part of their day-to-day life, and they're squatting as part of their day-to-day life, and like so there was a disconnect there, like you know, I'm like, we were restricting them from an exercise base, and they better not do this because it's not safe, but then throughout their day, they're having to react as their mom duties and do these functional tasks, which are normal tasks. So, and I I I do love this era we're in with challenge and the status quo on this topic, in the sense that like it kind of, you know, everything we do to kind of say, okay, actually, we don't need to be that conservative, really reinforces that our bodies are more resilient than current society and um health messages let us think. And we are made for this. It is a normal bodily process, so to speak. Um, it's just that it can have different impacts and different degrees of stretch and different degrees of um side effects afterwards, but we need to reduce the fear and the scariness of those and also just be like, okay, this just highlights what you need to work on and you know, pre-turn that into a problem-solving approach and a positive approach.

SPEAKER_00 30:37

Exactly. Okay, I just really want to I want to touch on, I've got the image in front of me where you broke down from you know the interviews that you did, kind of what the percentage of kind of good quality evidence-based information versus just non-evidence-based information, um, which I'll I'll share this link in the show notes. But can you for people that are listening, can you just talk a little bit about like summarize some of the points in here? Do you have it in front of you, actually, Grania?

SPEAKER_01 31:08

Because I um look, and I should do. I know that it was like 60% of the posts were not um evidence-based from memory. So we use the quest tool to really evaluate social media content. Um, and it's a really difficult one because social media is great in a way, but you can post anything and no one's placing it. So that's where there's a difficult, there's no standards which anyone has to go, oh, I must check that it meets the quest guidance or criteria. Um, and so that's why we did it. But when we found out, like I was surprised at the at that percentage, like that's 60%, that's huge, really. Like, so I actually got it 61% not supported by the evidence, with the median quest score being 10 out of 28. And so what that meant is that the majority of information out there that we surveilled, and uh was the um, you know, there was quite a lot. We used the hashtag diastasis to really get the the posts coming up that were relevant to this topic. Um, I'm just looking to see. Sorry, bear with me. Yeah, it was the first 1000 posts. So, like if we think about it, it's quite a significant substantial number. 60% of those not evidence-based. That's alarm bells to me. And it was more so making me concerned when I was asking the women, like, are they seeking information on Instagram? And they'd be like, Yeah, and I'm like, why are you know, why is Instagram your go-to uh for this? And they were like, Well, I can't get in to see my doctor, or I can't access so access to services was a huge thing, or like, or I've accessed my doctor and asked them, and they just told me this was nothing to worry about, or it's a normal part of pregnancy. So they were either um not listened to, nearly gaslit in many ways. Um, so they're not getting the information that they want from this from the sources that we as clinicians would feel or should feel is credible. So therefore, survival mode means that they're going to the sources that they can access some form of information. And some of the women also describe the fact that, like, obviously they're busy as postpartum moms are either pin breastfeeding or they're doing 20 million things. And so that form of access to information is almost instant, like it's fast-paced, it's quick. And we live in a world now where we want information now, we don't want the kind of the nitty-gritty to have to go weed through it and find it. So it was that idea of instant information so that I can find out right now what I need to know. And therefore, when you think about that, I'm like, well, it has such potential to be such a good thing if we can just get the right information out there. So, how do we as clinicians make sure the right information goes out there? And I often debate with other health professionals and researchers because there's, you know, there's a school of thought that we shouldn't even be using social media, that you know, that's just there shouldn't be health information in social media. That's not where it's not scientific, that's not where people should be going. But whether we believe that or not, we can't take that approach because that's where women are going, whether we like it or not. So, so we either leave that as a problem festering or we say, right, we need to do something about it so that we can increase the odds of them landing on some good information.

SPEAKER_00 34:17

Totally. I'm just gonna read some of the stuff that kind of shows up in that non-evidence-based category just so people can just hear the difference. So it I'm just reading this from this um chart that you've got here. Avoid any exercises you have that um when you're pregnant, like crunches, planks, sit-ups, push-ups, any exercises that generate pressure on the core, which is everything, or involving twisting, strenuous activities like heavy lifting, high impact cardio, poses that stretch the abdominal area, yoga with spinal extension and chest openers, Pilates, bar classes, and that you should perform only modified and safe abdominal exercises. That's kind of in the not that's in the non-evidence-based category. But that is what like that. I listened to that, I'm like, that's like everything. That's everything. And it's no wonder that people like cancel their gym membership or that they avoid core. Like that's crazy. Do you know how many people come in and say, I ask them if they're active? Okay, what do you do? Um, I do home workers or go to the gym, but don't worry, I avoid core, they say to me. And I'm like, oh shoot. Okay. So um, but yeah, so that's yeah, that is that's too bad.

SPEAKER_01 35:34

That is too bad. And that's as I said, we I think as healthcare providers, we have a huge opportunity to change the narrative in this because like if we can create, if we can flood social outlets with evidence-based information, if we can all nearly agree on hashtags and things to use so that you know what I mean, things start coming up and flooding it, I think that could be really useful. But also, it's it's just such a shame. Like, you know, who regulates these social bodies? Like, can someone, you know, could there be some sort of indicator for health assured information? You know, we we have the blue tick um on Instagram to verify that someone's the person that they say they are, but could we have a could there be other levels of ways of indicating that someone is striving to put out the best information ever? And it's a hard thing because healthcare science, current understanding, it's fluid. It's never, you know, someone doesn't know it and they always know it all. They might be up to date with the contemporary science at a moment in time, but unless they keep moving with the science as it develops and evolving with it, they too could be out of date at some point. So it's something that's an ongoing process that needs to be, I suppose, um, monitored. It it's a really difficult one.

SPEAKER_00 36:54

It all it's the same, like, and I'm not coming down on any providers that like I think it's up to us if we're gonna put ourselves out there that we make sure that we're up to date. But I think about this in the world of, let's say, menopause right now, and everybody's kind of like down on their family doctor because they don't know enough about it. It's just sometimes there's only so much we can keep up with. And I think like you call also have to know what you're gonna get from your family doctor if they don't see like they're seeing so many conditions that maybe you have to go outside of that family doctor for some more information about your menopause or what have you. And it's the same in this world too. Like, I'm a physiotherapist that has to happens to work in this area a lot. My husband is a physiotherapist that doesn't really see any of this. So you can't just like look at, oh, he's a physio, he's gonna. This is this is where we have to kind of, as clients, also do our due diligence and do our research, right? Because it's hard. If I could just kind of show the contrast to the evidence-based statements and and kind of like what we do know are kind of healthy statements, but progressively improve and overload core strength and capacity, including wide range of exercises and functional activities, try a variety of movements and positions during exercise, adapt the exercise if necessary instead of get rid of it, get back to lifting, include overall exercise, and that there are no established contraindicated exercises in sports. Like that's what I always say is there's nothing off the table, but sometimes we have to figure out what level you're at, if you will. Yeah, and and if that I find that people get there, but I have to do a lot of talking first, which is again why I think like I like this medium for education to help like kind of hopefully people catch this before they come in, or you know what I mean? And then, anyways, I I I find myself kind of really thinking like I feel like I'm not getting anywhere, Grania. Like, do um that sounds a little bit negative, Nancy, but that like I feel like I've been talking about this for a long time, but nobody comes into the clinic and is necessarily like, I've been exercising and and um not worried about my core. Like, I don't think that's happened yet. So this is where I'm a little bit discouraged.

SPEAKER_01 39:18

It well, I do think from doing the study, as I said, being the two sort of very polar opposite journeys that people take, like there were it didn't seem to be people in the middle, if you know what I mean. It was either one or other. So I think that you're you're getting the ones on one extreme, if you know what I mean. There's a whole other lane out there that that that you're not tapping into, and maybe that's because they're cracking on with it and they're not as high priority to need the rehabilitation. Maybe maybe people who are really struggling with the diastys are lucky enough to find you because they're searching and they know that you're topical in this, so you're the person that they need to go to outside of their usual network. Um, so you're getting quite a condensed cohort of a certain type. But um, it's interesting. I have had more recently, but I agree with you. It's probably been it's probably been a long time coming in the sense that when I think of when I first got into diastasis, it was way back when I was a junior physio and I got a real interest in it, and I started to kind of treat it, and I felt like other physios weren't treating it when I was treating it, you know, it was something that people shied away from, but it's probably only in more recent years that people are finding me possibly through the likes of podcasts and post-it scene. So they're already starting to challenge the narratives, and which is exciting. So you get someone in and you feel like they're already over the first few hurdles and you're picking up where they are. Um and I and when I see that, I'm like, oh yes, the narrative is changing, like we're we're getting we're making an impact. But then I'll have someone who's comes in and they're back right back at that real fear-injo, fear-inducing um information that they're accessing. I'm like, how is this information still out there? Like, how like how are people being told that they have to hold their head to get up or they've roll on their side? And I'm like, oh my goodness, like you know, we are not fragile. Um, and you know, you sometimes speak to them and go, Well, like, do you cough or you know, sneeze at times? Like, yeah, I'm like, that's a lot of pressure on your abdominal wall. And do you worry about that? They're like, no, and then you're kind of also aware when you're talking about this that you don't want to give them a complex now, they're worried about coughing, but you're like, that's a normal bodily process and we're not fragile. Um it's it's very, very interesting. I I don't know, I find that like I think that a lot of it coincides with, and especially in the social media context, a lot of it coincides with this snapback phenomenon that we have, where we have women have these unrealistic ideas of what entering pregnancy and postpartum is like. So, like, you know, we look at social media and it seems that people have a baby and almost like day one or day two, they're back in their genes and they were they have a flat tummy and they've not one sign that would indicate that they had a pregnancy, like no skin changes or anything. And the reality of it is that, gosh, for weeks after pregnancy, you look like you're still pregnant. You know, you know, people seem to be surprised at this, and I'm like, that's so normal. Like, you know, you've had such exponential changes, your organs have been stretched and they've been sitting higher, it don't just go straight back down. And we do have natural weight changing pregnancy, which isn't something to be afraid of or or stigmatized. That's actually essential for that pregnancy process. So I'm big into trying to normalize body image. And I'm not sure if it was you before on your podcast that we discussed this, but I remember one time after having baby number four, I had my three older but young kids um around me. And my little girl was went, Mommy, how come you still have a tummy? You how come you still have a a baby tummy? And I was like, Oh god, you know, it doesn't matter how informed you are and how aware of um normal body image, but you're like, oh god, no, right? And it was my son at the time who turned around and was like, Emily, it doesn't just go down. She had a baby, it takes time because like it was such and I remember thinking what he said, yeah, yeah, yeah. And like I need to hear that from my like three-year-old at the time. Yeah, what he said. I was like, that's so powerful, and I'm so glad that he as a guy is seeing that, and that's obviously kind of the messaging that he's picking up because I want him to be a guy that goes out into this world and has normal expectations of bodily processes and what women do. And and I so I think it's really important that from society we get that messaging out there, but I can see even from my daughter who's now at an age where she's the first one in the house to get a phone, and it's been a huge transition from us as parents. But I can see she's as much as we said, we were going to limit scrolling and all, she's scrolling and social media and things, and um I can see her all of a sudden she was getting a bit more conscious of body. Image and how she fits in clothes, and she must have said something about nearly her lower tummy and the shape of it. And I was like, and like she is lean, she's quite an athletic. Um, like I was like, That is not that is not fat, that is normal shape, like we are around there, we have organs there, and she's like, Do we? And I'm like, Yeah, we are not supposed to go straight flat up, and she was like, Okay, but social media is telling her that we are supposed to have these ridiculously flat abdominal walls completely down that never change in dimension. Like, and that's the other thing. Outside of pregnancy, we have to remember that men have linealba, women who never get pregnant and have babies have a linealba, and it serves a purpose in everyone because there may be times across our life course whether we are severely constipated, whether we have some reason that we have abdominal distention, whether we're carrying extra fluid, whether we have a medical condition, that our abdominal wall has to expand and it allows for that. And throughout our days as women, naturally we're going to expand through digestion, even if it's like not that big of a change, we're still gonna have changes in dimension, and that's normal, and we have to be better at normalizing this 100%.

SPEAKER_00 45:12

I think of it kind of like we need to, yes, normalize that. And I think I think too, again, I take away from this, like we want to um promote strength and and promote feeling good in your body and um you know promote getting back to the goals that you have for yourself, and a lot of people reach out to other people to help. Like I think about some of the classes they like to go to Pilates or strength training classes, and sometimes um it's just again that that is a very well, well-intentioned instructor. Like I always say, like, it's very well-intentioned, but sometimes maybe for where they are in their learning, they've heard like I a lot of women come in and say, like, I've been uh modifying everything because the instructor said if I have diastasis, I can't do certain exercises. And so I think, ah, shoot, but I wonder if and then the last thing you want to do is contact the instructor and say, just so you know, you're giving the wrong information. But sometimes I think maybe that would be a place is just to offer to people that are providing classes, like just some education or something, because that would also help them get more people at their class to strengthen. Some people are afraid to go to their class because they want to be strong, but they're worried about what they should do. And so maybe if they are more educated to provide good information, they get more people in their class. I just think that I'm just trying to think of like how to go upstream a little bit to catch more people because what else are we supposed to do about this? Before, you know, we're like, yes, we've talked about like on a one-on-one level, we have a role that we can help people. Um, we've talked about how we can use things like podcasts or or or put out our own social media material. Um any other messages that you think are kind of like, what do you want this, like, what do you want this research to even do? Like what what are you hoping people that are listening will do with this?

SPEAKER_01 47:08

I hope first of all, that it'll bring awareness to people, to the to the general public out there who are maybe searching for information that they will at least consider the source of the information and where the information's coming from. Um, and and that they will look for a breadth of people and not just follow the same people who are following the same people who are following the same people, so that they can look and kind of weigh it up. I would hope that they would reach out to and look for conversations like this and podcasts where you're getting researchers and clinicians with experience um discussing it and discussing the current status of it because what the discussion we're having now might we should be and hopefully is even more progressed than if we ever had a previous conversation on diastasis because we pushed the boundaries a little bit more, so there's probably more to glean now. And if you were to have a conversation in five years' time, hopefully there'd be even more to learn that that Grona of 2025 didn't know. Um, but the other thing is that I actually have started saying when I know that people are self-defining themselves with diastasis, and I see them in clinic, and I'm like, well, really, like, yeah, there might be some slightly increased um indirect distance, but actually I wouldn't pathologize this. You know, your abdominal wall is functioning really well and you just need to crack on, even if they have some very mild omen, I would be like, I wouldn't be like if you're entering an exercise class, I wouldn't be defining yourself as having diastesis. There's nothing problematic here. So if anyone asks and checks, you can say you've been seen by a specialist. Yeah, so you've been seen by a specialist, they've said that you have no, that you do not have any diastys that needs any restrictions. You are not restricting, you're to be treated as normal. And so sometimes I think that's a nice way that hopefully if they do have that conversation with their fitness provider. Fitness provider, oh interesting. Who's that you've seen? I'd love to talk to them rather than I, you know, I'm because I'm always afraid, kind of like you, like of going, I don't want to contact someone and go, by the way, stop telling that person not to do this because it sounds like you're you're picking someone up for doing wrong. But like rather I'm more like, do you know what? I actually used to do that. I used to restrict people too, but now we know more, and it's really exciting because guess what? And send them information. And that's why I always say when I'm sending podcasts to my clients because I'm looking to reinforce messages. I'm like, share this with them. I mean, share it with fitness professionals, anyone you think could be interested in diastys. This is something interesting that they might take something from too.

SPEAKER_00 49:33

Totally. Um, now before we wrap up, I'm gonna do quick, it's gonna feel like left field for a second, but um I I'm fascinated. Like another area that we're you're working in is the area of compression. And you talked about like using compression for like postpartum return to running. But on the note of diastasis, just like what are you I'm curious to know, like what are some of the neat things you're finding out about using compression in this population?

SPEAKER_01 50:02

In in diastasis?

SPEAKER_00 50:04

Yeah.

SPEAKER_01 50:05

So I haven't been researching in compression and diastasis, but I do have women come in all the time. And you know, some women really like the idea of having something supportive against them. Um, some women ask, you know, is it should I be wearing an abdominal binder or something postpartum? And I'm like, look at the evidence, there's no generic blanket rule that people need one of these. We're quite resilient, our bodies do respond and recover, especially if we start engaging in strength and conditioning. But if if you like the sensation and if you if wearing something supportive makes you move better and with less apprehension and fear, that's a good thing as a temporary measure, but you do not need it and you are not broken or fragile without it. So I kind of try to look at the individual and kind of make a uh sensible, um sensible, agreed sort of consensus as to whether they should have it. Um and if they do, I do advise them not to go for anything restrictive or like um structured, that it's just something that's just like like to be honest, I'm like, have you any nice sportswear in your water ball ready that gives you that feeling of like something against you that you like and see how they go? But I do think that there's no evidence to support that wearing anything enhances someone's um postpartum return to baseline, if that makes sense.

SPEAKER_00 51:26

Yeah, totally. I think a lot of times it's just like when someone puts it on and you can see that, like, ooh, I feel more, they'll say, like, I I do more, I feel more confident. Um, or I feel I I had this experience postpartum, like, and again, I had a lot of stretch to my abdominal wall, but I was like, my muscles feel different, like they feel I feel more aware of them. And so I think if that if it does that for you and you can like, oh, my brain likes that feeling, then I think that's a good thing. Um, but I do think, like you said, there's a lot of kind of like you need this, you don't need this, it's not, it's hard to find that black and white.

SPEAKER_01 52:00

And it's really interesting because in my um obviously I'm researching it from a pellet floor and return to run in context, but a lot of the women I'm I'm doing mixed methods with it too. So um some of the interviews I've been doing with women, some of the thing they don't like about the compression garments is how high they come up with the tummy. Some women hate the feeling of something tight against the tummy. So I'm having particularly runners, I'm finding the runners do not like that sensation of something against them. Um so it's so individual. And that's why I think, like everything in healthcare, we do have to look at that person in front of us and all their beliefs, their the information that's formulating where they're currently at. And we have to kind of look at all those different components and meet them where they're at and what's the best um start in rehabilitation program and advice for them, and then how do we progress that as we go? Because again, it's gonna be fluid, it's gonna move as they progress.

SPEAKER_00 52:51

Totally. So now I'm aware that you have to shift to mom mode here very quickly. And so, is there anything that you feel like I didn't ask you, Grania, that you think is like relevant for this conversation? Or yeah, anything that you you know, take-home messages that I haven't asked.

SPEAKER_01 53:07

Well, something really exciting to keep an eye out for is that um I mentioned Monsorigiano Campo and colleagues before. Um, I've done some research with them, and it was that systematic review where we where we found those different kinds of biopsychosocial components that women often report when they have diastesis. Um research building on that has really formulated or centered around developing a patient report outcome measure that we can hopefully use in practice that is going to be about measuring beyond the gap. So it's not just about interacted distance, it's about how someone's body image is impacted, how their self-confidence, how their ability to move or fear of movement. So it's basically a biopsychosocial tool. Um it was developed in both Spanish and then transculturally adapted to English. It's been pilot tested in both languages, and the validation in the Spanish language has been completed, and I'm currently still recruiting for the validation in English. So hopefully, we're going to have a validated tool that's going to be a more contemporary assessment of diastasis and will allow for catching individual impacts. So, for example, I'm sure we can know anyone who knows or manages population will be able to relate to the fact you can have someone come in with a very tiny um separation and have quite significant impact on life. They're very fearful, they have huge body dysmorphy over it, and traditional methods of indirect idance don't capture that. If you know what I mean, they'd be like, No, it's fine, but they're not allowing for actually how that lived experience is impacting them. So stay tuned for upcoming research, hopefully.

SPEAKER_00 54:46

That's cool. I was already thinking here of like the title for this episode, and I'm thinking something like diastesis, how social media is more damaging than planks. Like absolutely, yeah.

SPEAKER_01 54:59

You have to, yeah, that's yeah, you need your hook line to get them in because don't you? That's the type of hook line that they're getting on social media, but to sell them misinformation, so yeah, you can get them in and give them good information.

SPEAKER_00 55:10

Exactly. See? Okay, well, thank you so much for your time and uh everything that you do. And um, I hope that you survive mom mode now, slip from work work mode to mom mode.

SPEAKER_01 55:21

Thank you so much, and I look forward to chatting you soon.

SPEAKER_00 55:25

And that's a wrap. If you enjoyed the show, can I ask you a big favor? Would you do one of three things for me? Number one, leave a review because we could all use a little positive feedback sometimes. Number two, download the episodes because it helps me see what people are interested in. Or number three, share it with somebody else. Because sharing is caring. Catch you next time.