The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health
The times are changing and moms have athletic goals, want to exercise at high-intensity or lift heavy weights, and want to be able to continue with their exercise routines during pregnancy, after baby and with healthcare providers that support them along the way.
In this podcast, we are going to bring you up-to-date health and fitness information about all topics in women's health with a special lens of exercise. With standalone episodes and special guests, we hope to help you feel prepared and supported in your motherhood or pelvic health journey.
The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health
The Truth About Coning Won't Destroy Your Core
The journey toward understanding diastasis recti has been filled with misconceptions, fear, and outdated advice. As a pelvic floor physical therapist who's witnessed this evolution firsthand, I'm sharing why our approach to core health in pregnancy needs a complete reframe.
What exactly is diastasis recti? It's not a tear or split, but rather a normal lengthening of the tissue between your rectus (six-pack) muscles to accommodate your growing baby. For years, we've defined it as a gap wider than two finger widths during a head lift – but recent research shows over 57% of the general population has this "condition," whether they've been pregnant or not. When more than half of us have this supposed "dysfunction," perhaps we need to reconsider what's actually normal.
The advice to avoid all "coning" (that visible dome shape along your midline during exercise) has scared countless pregnant people away from maintaining their core strength. This fear-based approach often leads to unnecessary deconditioning that makes postpartum recovery harder, not easier. I've seen this both in my clinical practice and in my own pregnancies – the pregnant athletes who maintained appropriate strength training often bounce back faster, even if they experienced some coning along the way.
Leading experts like Diane Lee are now suggesting we need completely new frameworks – perhaps only considering gaps of four finger widths or greater as clinically meaningful, while also incorporating functional strength assessments and quality of life measures. The gap measurement alone tells us very little about how well your core functions or how you feel in your daily activities.
Ready to rethink everything you've been told about your core during pregnancy? Join me as we explore the science behind these changing perspectives and discover how to stay strong through pregnancy without unnecessary fear.
What have you been told about diastasis recti? Share your experience or questions, and let's continue this important conversation about pregnancy, strength, and our evolving understanding of what's truly normal.
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Hello everyone and welcome to the Barbell Mamas podcast. My name is Christina Previtt. I'm a pelvic floor physical therapist, researcher in exercise and pregnancy, and a mom of two who has competed in CrossFit, powerlifting or weightlifting, pregnant, postpartum or both. In this podcast, we want to talk about the realities of being a mom who loves to exercise, whether you're a recreational exerciser or an athlete. We want to talk about all of the things that we go through as females, going into this motherhood journey. We're going to talk about fertility, pregnancy and postpartum topics that are relevant to the active individual. While I am a pelvic floor physical therapist, I am not your pelvic floor physical therapist and know that this podcast does not substitute medical advice. All right, come along for this journey with us while we navigate motherhood together, and I can't wait to get started. Hello everybody and welcome to the Barbell Mamas podcast, christina Previtt.
Speaker 1:Here and today, I wanted to talk a little bit about diastasis, reptile diastasis, diastasis and coning in pregnancy. It feels really exciting being in this space and unbelievably frustrating at the same time, in a lot of different ways. But we are truly at the beginning, I think, of what has been behind the scenes, especially in the research field. A very long journey around, been behind the scenes, especially in the research field, a very long journey around talking about core rehab in pregnancy, postpartum, but also very generally and, as I've been kind of alluding to over the last several podcast episodes, about exercise modifications in pregnancy in general. And so, before I get started on kind of the history, what our recommendations used to be around DRA and where I think we're going in the future, let's talk a little bit about what DRA is. So.
Speaker 1:Diastasis recti is a lengthening of the linea alba so that on a headlift, like you would do with a sit-up, there is a wider space between your two six-pack muscles than is considered normal. I don't even like that word. I don't even like that definition. What it means is that your two rectus muscles are sitting further apart from each other and the tissue in the middle is more stretched or lengthened. Notice that when I use that definition I didn't use split or separated. There's a lot of imagery, when we use words like that, that your linea alba is ripping or something like that term. Splitting, that feeling of coming apart, means that something is disconnected within your body and that there is some alarm bell that needs to go off in your body and the time and space where this becomes most commonly talked about is in the pregnancy and postpartum space.
Speaker 1:I think it's pretty common knowledge now that as your body progresses through pregnancy there is a stretching of that linea alba and a moving away of your rectus muscles because your baby has to grow right. As the fetus gets into the second trimester, a little bit further towards the third trimester, gets into the second trimester, a little bit further towards the third trimester, baby's going to grow outside of your pelvis because you know baby starts really small, you're not really showing a lot. And then, after that first trimester getting into your second trimester, most of the organ systems have laid down their initial circuitry and now they're proliferating or growing and then we finish into that end of second trimester. Third trimester and fetal growth very generally is the big predominant factor and why we see that. You know, baby can can gain half a pound or so a week as they get towards term. What that means is is that as baby's coming out of the pelvis into the belly contents is that your body needs to make room and your body makes room by this beautiful mechanism at which those two six pack muscles, that rectus muscle, lengthens the space between them lengthen and it gives baby more room. What you're also going to notice is that depending on your anthropometrics, your body shape and size, how much that lengthens and how big you are showing wise is different.
Speaker 1:I am blessed in a pregnancy, from a pregnancy perspective, that I have quite a long torso. I feel like I'm kind of even my top length, my torso length, to my leg length. But what that meant was is that I was never really big during my pregnancies. But those that are part of the short torso club, who always joke around that their rib cage touches their hip bones, those are those individuals who are going to pop forward because we've got to make room for baby and they may have a bit more of that stretch along their linea alba because of the way that their body is proportioned. So there's a lot of differences between individuals and their pregnancies and what that looks like from a lengthening of the linea alba perspective. But what we can pretty much guarantee is that about 100%, almost every single person as they get towards term, if you lift your head up in a sit-up position, is going to have at least two finger breaths apart. And that kind of leads me to my next point, like what is considered a DRA and what isn't.
Speaker 1:Again, from a history perspective, classically what we are thinking about is when you do a head lift, your two six pack muscles are going to come together. They do every single time you do any type of flexion movement, flexing forward and if your top range, your two six-pack muscles, are more than two centimeters apart, or approximately two finger breadth, you're considered to have a mild diastasis, dra diastasis I never know which one's the actual right answer. Then from there the level of severity increases with the size of the distance between those two six-pack muscles. On a headlift, when it came to DRA, the only patient population at which it was being talked about was pregnancy, postpartum. Just because it was the loud noise or the people who are talking a lot about it in social media spaces and mom groups does not mean that it is the only patient population at which we see diastasis. Two other big spaces where I will see this is one in my aging male population, particularly some of my aging men who have that beer belly look, who have a bit more central weight gain. When they lift their heads again, they can see that increase in distance between those two recti muscles, that increase in distance between those two recti muscles but honestly they don't worry about it. I had one of my patients tell me that it's his party trick, that he just does this and it's been like that forever and he's never really stressed or worried about it.
Speaker 1:The other patient population that we see this a lot is in newborns. When you have a baby who doesn't have the capacity to sit, roll, stand on their own, their ab muscles are not very strong. They just came out, they have to figure stuff out and what that means is that when they're grunting and moving around and trying to gain some of these motor patterns, we might see a little bit of that coning. What we have to be aware of too is that because a lot of moms or moms-to-be are a little bit nervous about what their bellies are going to look like after pregnancy, they're kind of on the lookout for that coning because providers like pelvic floor physical therapists like my profession, have said that it's something to cause alarm bells. Therapists like my profession have said that it's something to cause alarm bells, but in newborns that is absolutely 100% expected. There was a I remember in one of the Facebook groups with pelvic QT that they had had somebody who was referring a newborn for diastasis, recti and coning and it was this big conversation that we do not want to set alarm bells into something that is very normal in the newborn space and as they start to be able to sit up on their own and do some of their motor learning, that in 99.999% of cases that is going to go away and in the other 0.0001% it's just their anatomy right. And so we do not want to raise alarm bells. And this kind of brings me to the history, because what we have seen is a very big evolution in what we consider normal experiences in pregnancy and postpartum, and that has, I hope, started to bring down the heightened alarms even in pregnancy and postpartum. They are absolutely not needed in the newborn status. They really aren't needed as well in pregnancy and postpartum. But let's kind of talk about where we're at.
Speaker 1:I've kind of been in this space in various degrees, definitely more intensely over the last six years, but like I've been a physical therapist for 10, 11. I graduated in 2013. So I've been in practice for a couple of years now. I can't I honestly can't even believe that it's been over a decade, and when I was first graduating I didn't hear anything about DRA. That was not something that I knew anything about.
Speaker 1:I started my career not thinking that I was going to do pelvic at all, which is hilarious to think that not only am I very much in the pelvic space, but now I'm a researcher in that space, but I never thought that that was going to be me, and because I wasn't paying attention to pelvic health, it was a little black box, one that I was not educated to be able to talk about or assess. Then that became something that was not a concern for me as social media came to be a bigger part of many people's practice and with the rise of, you know, instagram becoming really popular as a search engine and a source where people get information. I started, you know, investigating pelvic health prior to me getting pregnant with my daughter, because my PhD brought me into a space where I was looking at how physical therapists could get involved in health and wellness, and pregnancy and postpartum was one of those spaces, and the messaging around diastasis at that point was very alarming. Make sure you do not load your core during pregnancy. If you are coning which we'll talk about that in a second, what that is it could be a sign that you are putting too much stress on that six-pack line. You could cause damage postpartum. And so here there's a lot of influencers and individuals online who are saying let me help you. Here are ways for us to safely exercise in pregnancy. Use this list and then you know.
Speaker 1:As it got more popular by this program and that was a huge advancement, right? As much as I can be critical of some of those messages now, I am also appreciative of going from absolutely no information around pregnancy, exercising in pregnancy and helping pregnant women and people navigate exercise in pregnancy was a big step forward, and it really has been the last 10 years where we have started to accumulate the vast, vast majority of our research in this space and we have tried to take an individualized and personalized approach to exercise and pregnancy and saying this is a protected time in your life. We want to make sure that you are feeling strong, supported, capable and not fearful of the way that you are moving your body, and I'm going to guide you and give you some things to think about from a safety and a specificity perspective to exercise at pregnancy. And then, as kind of the years have gone by, we had a lot more people who were athletes, who were getting pregnant because our fertility window and our athletic window directly overlapped, and I don't know if that's that there are more pregnant women who are exercising at a high level during pregnancy or just that social media enabled us to know about it. But there were these individuals who were starting to really push our thoughts and feelings and they were seen as this elite subgroup of exercisers who may have different rules, who might be able to load their core wall differently, who may push how much they can run and jump and lift during pregnancy and general thoughts around this by our medical colleagues, physical therapists. Speaking for physical therapists and the public in general was outrage, right, if I think about.
Speaker 1:You know, six or seven years ago, if you saw somebody who was coning in pregnancy or lifting heavy in pregnancy for that matter, the comment section was you are going to kill your baby, you are going to hurt yourself, your core is going to be permanently damaged. So anything that was higher intensity, anything that was really loading the core wall, there was a lot of thoughts and feelings about this causing harm. And so you saw that, like the comment sections, did not pass the vibe check. But as we've kind of moved forward over time. Right, we are starting to see, because there have been more and more examples of people who have continued to load up their core wall, as we have had more individuals in our pelvic health space who have done a better job. As we've learned more to bridge what we do in rehab for other areas of the body, like your shoulder or your knee, to what we're doing in pregnancy and postpartum rehab, this narrative has really started to change, and where it's probably changed the most is one in pregnancy, around things like coning. Or maybe this is me manifesting secret style into our world about what I've seen over the last two or three years in terms of this space.
Speaker 1:Coning is something where we see a popping up or a tenting of the six-pack line when we are actively contracting our core. And traditionally and I can't even say traditionally because I just saw a huge influencer tell you not to sit up out of bed normally because of coning influencer tell you not to sit up out of bed normally because of coning yeah, my goodness. But what we see some recommend is that you should avoid coning at all costs in pregnancy because it's a sign of strain on the body and if you put too much strain on your body in pregnancy, it could slow down or negatively influence your recovery postpartum. I do not agree with that statement. I blatantly disagree with that statement. But Christina of 2020 was way more conservative and would modify away from it, erring on the side of being conservative. Christina of 2025 does not do that and I'm going to kind of explain a little bit why.
Speaker 1:So the thought was is that popping up that coning is pressure that your body isn't ready for or isn't able to handle, handle and therefore it should be avoided, and this is especially true in pregnancy. And then it's seen as you should stop now when you are loading your core postpartum. Here's why I disagree. In pregnancy, right, baby is going to grow and we have this mechanism of lengthening up our linea alba. I think almost everybody agrees with us there of lengthening up our linea alba. I think almost everybody agrees with us there. But if I take a stretched out piece of string and I bring those two rectus muscles together, it's going to pop up. If you even do that with a piece of paper right, and you put a piece of paper together and you take each end and you smush them towards the middle, you're gonna see that popping up of pressure because it's on lengthened tissue. That lengthened tissue has to stay there until you are postpartum because baby has to sit in your belly and therefore some coning is totally fine.
Speaker 1:Right, in my patient caseload I have stopped telling people that any and all coning is problematic, right, and this started with my own pregnancy. When I was pregnant with Quinn, I loaded up and I didn't worry about coning, I just worried about bracing properly and contracting my core properly. And if I coned, I coned. If I didn't, I didn't, and I approximated. And then I tried with some of my clients. If I didn't, I didn't, and I approximated. And then I tried with some of my clients whether they were my online clients or my clients in my clinic and they did really well. And then some of my colleagues we were talking about it and so they started trying it. It was going well.
Speaker 1:And then Nicole Beamish's work came out and they were talking. She was talking about how some of the biggest modifiable risk factors postpartum for continuing to have a bigger space in between those two rectus muscles was lower oblique strength and lower rectus strength and that really started to get my mind thinking and have a lot of us kind of having these conversations more readily and have a lot of us kind of having these conversations more readily. And so what that meant was that by modifying too much, what could happen is we can make our core wall weaker and we see this all the time. Right, we see this all the time. And what that means is is that if we're weaker at the end of our pregnancy, then we have more strength that we have to gain back postpartum, which can make that early postpartum period, which already feels very vulnerable and can feel really trashy and you have no idea what's going on with your body that little bit worse.
Speaker 1:And the reframe that I've been talking about a lot in a lot of different areas of pregnancy, exercise and rehabilitation has been around limiting, deconditioning. And when I did a obstetrical grand rounds to our obstetrical team at the local university that I am in my town, that was my messaging If we are going to take something away, we have to make sure that, one, we know that we're taking it away for a good reason and, two, we have to think about the cost of that modification. And not for everybody is modifying away going to make your core weaker, but for some it will, because they're so afraid that they're afraid of progressive overload, like if your abs are sore in pregnancy. A lot of people can freak out and think of that something negative, but it isn't, and your ab muscles can still get DOMS while you're pregnant. What that means to think about is a very different shift in our mindset.
Speaker 1:This has gotten to be a lot more commonplace and last week, two weeks ago, I posted a reel with a client of mine, with her permission of course, of her finishing up her pregnancy. She was 38 weeks and I think she went into delivery just before 39. She delivered just before 39 weeks and she was doing butterfly pull-ups. She had a little bit of coning but she was doing really well. She was still doing a lot of strict pull-up work, so her upper body was ready for that movement. As she was still doing a lot of strict pull-up work, so her upper body was ready for that movement and I saw her three weeks postpartum and all of her um ab muscles had that. The distance between her ab muscles was was one finger and she still had a little bit of of weakness in terms of how much uh spring intention was created around that uh six pack line. But girl was three weeks postpartum.
Speaker 1:Of course there was still some recovery that was necessary to recover the body from pregnancy. That comment section I was ready for there to be a lot of people who were distressed by that because you know, three years ago when Tia Claire Toomey, who's a very popular CrossFit games athlete and now high rocks athlete and a national level, international level weightlifter and a bobsledder, she was doing um, jumping, kipping, pull-ups and she had some coning and her comment section was a lot of very I hope that they were trying to be helpful, but they were putting a lot of scary messages and she had re-approximated very early postpartum too, like she was shirtless in the gym and you could just see that her resting tone of her six pack muscles were right beside each other, again similar to where she was prior to getting pregnant. And what that means is is that we are now at a place where loading the core is seen as something to be encouraged. Limiting coning for most is maybe still a conversation. We haven't abandoned that, nor am I at the point where I'm going to completely abandon it. Where my thought process is is that coning we can see it as a movement fault that we are going to try and minimize versus something that is damaging. And at the end of pregnancy we're looking at optimal over perfect, optimal over perfect, because we're not going to get that perfect. Two rectus muscles touching because there is a baby and similarly, postpartum we're not going to have all these movements where we're never going to have any coning, and coning doesn't have to be a sign that something's bad. Where that's going to lead us is to a place where some of our goals around exercise and pregnancy is to limit deconditioning so that we can feel strong and supported in our own body in that earlier recovery process. And that's in line with some of the new guidelines saying that that six-week medical clearance is not necessary. We shouldn't have to wait to begin some movement in the early postpartum period, and I'm in the place where I think early postpartum movement is to be encouraged. What that's going to mean is going to be different for each person, based on so many different factors right, sleep, nutrition, social support, expectations at work, other family members at home, other dependents at home, et cetera. But one of those considerations shouldn't be that my doctor said I need to wait until this amount of time, and so that's really great rate.
Speaker 1:The next thing that I think brought this really front of mind for me for today is do we need to change the definition of what diastasis is? I mentioned at the beginning that from our history we think that a two-finger breath is considered DRA. But here's the problem. We know we now have studies that have come out in the last two years that when we test everybody in I hit my microphone when we test everybody in our general population right different ages stages have had kids, have not had kids we know that about 57% when we did our this is just one study 57% of individuals have at least a two centimeter gap. When more than half of the population has this distance, can we label it as something that is a quote, unquote, dysfunction or problem? Yeah, the answer is probably not.
Speaker 1:I was at a conference this last weekend at the Orthopedic Symposium. I was doing a keynote address in the geriatric space. It was super fun, which was great, but one of the other things that was super cool is I got to meet one of my role models, my pelvic health girl crushes, and that is Diane Lee. Diane Lee has been so revolutionary in her thought processes around the ribs and the core complex and DRA and she was presenting a poster and so I got to bounce a lot of these ideas off of her and she's kind of been coming to these conclusions as well, which is very cool to see that other people who are incredible thought leaders in this space are having some of these similar conversations. And she was presenting a poster on diastasis and she said we didn't even include you in this DRA study unless you were at least four finger breaths. Two finger breaths versus four is a very big difference and I was thinking about the conversation that I had with her a lot. Was thinking about the conversation that I had with her a lot, and I think when we use two finger breaths, we freak people out and it is a normal change and so many people if 57% of us, before you get pregnant, are going to have that two finger gap most people don't know what that finger gap is before they get pregnant and then we freak out about it, which may be them coming back to their baseline if they're two and a half or three finger breaths apart on a head lift, because they were like that before.
Speaker 1:They just didn't know it and they weren't aware of it and it wasn't something that they were looking for. Because of that. Wouldn't it be interesting if we changed our definitions or if we looked at the relative risk of things? Because the first reasons why DRA was studied so much is that there was a thought that those who had a bigger gap between those two rectus muscles're at higher risk for urinary incontinence, low back pain, prolapse, et cetera. And the thing is, for every study that says there is a relationship at a two finger breath cutoff, there's another that doesn't, and so that relationship has not panned out. But at four finger breaths maybe there would be. And what that would show as well is there are some connective tissue issues going on for a lot of these individuals. Because of that, lengthening that may create unique considerations or things for us as rehabilitation providers that we want to be thinking about, for us as rehabilitation providers that we want to be thinking about. We would have to then start thinking about amending our definitions.
Speaker 1:And then the next thing that she was saying and I think a lot of us are on board with this is that it is not just the gap. It is not just the gap. It is not just the gap, it is how much strength can you generate in your core muscles and that leads to function. And she was presenting a poster around a distortion index which basically looked at not just the gap but how much your core muscles were recruiting and how much they were drawing in or contracting, and did that change with an active rehabilitation program versus not? And what she saw was that the gap didn't change but the distortion did. And she was talking about how there is a need for a new framework around DRA and, my goodness, could I not agree more Because it's making people afraid because of the two-finger gap.
Speaker 1:That two-finger gap we're not seeing in the research is actually dictating outcomes. We are using an active headlift and so many of my mamas maybe you who is listening to this is way more concerned with what their resting position is or the fact that life feels really hard, right, because of, maybe, that weakness that they're feeling in their core or that feeling that they don't have support around their middle. And we've also made a lot of people afraid because of that messaging around DRA and that two-finger gap, despite the fact that a very big portion of the population is going to have that two-finger gap at some point along their core line with a head lift. And what that means is is that, as I'm finishing up this podcast, there is definitely a big need for more research. It's going to be a multi-pronged approach.
Speaker 1:So, number one, the first thing that we absolutely need to do, is we need to step back as researchers and as clinicians and think is a two finger distance clinically meaningful and is that the only thing I should be using to test if a person has DRA or not? I'm going to say that I think two finger breaths is too narrow based on what we know, and there should be some sort of composite that also has a strength measure and a quality of life measure for the person that you are working with and those three things combined right. So some sort of like quality depth plus function and then a quality of life measure. In combination with that interact eye distance. I think that is going to give us a much better research picture and clinical picture about how you are doing, because if I think about a person who's coming in to see me for DRA, I will do that test. But what's going to give me so much more information is when I test your max plank, I test if you can do a sit up, I test your max side plank and I look at your bracing mechanics. So those are the five things that I look at for DRA interact I, distance bracing, max plank, max core, uh, max side plank and looking for some of that quality tissue. And that is telling me a lot, especially in combination with what you are telling me about how well you feel like you are meeting the demands of your life, of your job, of your parenting and of your workouts.
Speaker 1:But we still have a far way to go from there. And then when we do that, that creates a new foundation at which we apply or meta-analyze our previous research on DRA, especially if somebody can tease out now maybe those that have a two finger gap as their criteria versus a four finger gap, maybe I don't. I don't know if a four finger gap I'd have to think about that a little bit more, but I trust Diane Lee because she's a rockstar right, maybe that is what it is versus a composite index that has a strength measure and see how those individuals do going forward and then pull that through our research to date and then have that as a launching pad for our research going forward. But it's really hard when something has already been brought into the research or brought into clinical practice as the standard. I guess it's really hard to change the standard Something that I'm pushing against a lot and it becomes really difficult, but it's definitely something that we need to be noodling on.
Speaker 1:If you are a coach or provider who is listening to this, I want to know your thoughts, because I think this is how we're going to truly change practice going forward and something that we need to be thinking about within our spaces around DRA. All right, I hope you found that helpful. It is very cool when you get to meet your heroes and talk to researchers, clinicians, people that you just really respect in the space and you know sometimes you're going to agree with everything they talk about. Sometimes you're going to take nuggets from them and blend in your own stuff. But gosh, it's epic. It was so great. I hope you all had a wonderful weekend. I am finally done. I had five weeks of traveling out of six weekends and the only weekend I was home was Easter, where we had two Easter dinners and a kid's birthday party. So I am so excited to be a slug this weekend. I hope you all are enjoying some of the nice weather and we will see you all next time.
