The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health

Rethinking Diastasis Recti

• Christina Prevett

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Challenging long-held beliefs about diastasis recti, this episode dives deep into groundbreaking research that's transforming how we understand abdominal separation during pregnancy and postpartum recovery.

As a pelvic floor physical therapist and researcher, I've watched the online conversation around diastasis recti create unnecessary fear and restriction for active mothers. The truth? Most of what you've heard about "coning," "safe exercises," and postpartum recovery timelines isn't supported by current evidence. A shocking 60% of social media content about diastasis recti contains incorrect information according to new research by Dr. Sylvia Gaglio and colleagues.

Contrary to popular advice, the evidence doesn't support that coning causes harm or worsens abdominal separation. What's more surprising: exercises that move through range of motion (like sit-ups) may be more effective for reducing inter-recti distance than static holds like planks or bird dogs. This challenges the conventional approach of keeping postpartum women in neutral positions for extended periods.

The parallels between how we underdose exercise for seniors and postpartum women are striking. Out of fear of causing harm, we may be holding new mothers back from building the strength and resilience they truly need for the physical demands of parenthood. The goal isn't to eliminate all strain on your abdominal wall—it's to build a core strong enough to handle the inevitable strains of daily life and movement.

Whether you're currently pregnant, navigating postpartum recovery, or working with prenatal clients, this episode offers evidence-based perspectives to help you approach core training with confidence rather than fear. Subscribe to the Barbell Mamas podcast for more myth-busting conversations at the intersection of motherhood, strength, and movement.

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Speaker 1:

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 want to talk about some new research that is coming out surrounding diastasis recti. So, if you are kind of new to this space, what diastasis recti is, by classical definition, is a lengthening of the line of our six pack, which makes the muscle bellies of our rectus, that six pack muscle, sit a little bit further apart and is a really big concern for individuals in the pregnant and postpartum period. Now, a long time ago, we used to say that it's a separation or a splitting of your abdominals. That is not true, and we have done a lot of exploration around diastasis recti in the last couple of years, and so today I want to talk a little bit about what we know, or what we have previously known, about diastasis recti, what some of our new research is showing and what that means for us going forward and where I would like to see us going forward. Now, most of the time, we don't really worry about where our muscles are sitting until we are pregnant and we have this big stretch of our ab wall, a very necessary, beautiful mechanism that our body has gone through in order to make room for baby as baby grows and fetus grows outside of the pelvic bowl, the bones of our pelvis and into our belly contents, because baby's getting bigger and that is okay and that is expected, and so what our body does is our six-pack line. As I said, it lengthens and stretches so that we can make more room in the front of our bodies, and the amount of stretch that happens depends on a lot of factors, genetics being a very big one where if you tend to be a bit more hypermobile and you tend to be part of the short torso club, baby's going to pop out further in front. You don't have a lot of room for baby to grow or into your rib cage because your ribs are pretty much touching your hip bones and you can have a bit more stretch required in your pregnancy and that's why we see that some women carry more in front. Some people look smaller in their pregnancy. There's a lot of differences in how you're carrying, based on the size of your baby, your genetics, weight gain, your body shape and size and just the segments of your body and your anthropometrics. So that happens in pregnancy.

Speaker 1:

When we are thinking about exercise in pregnancy, preventing that lengthened tissue from staying lengthened in the postpartum period is a very big cause of stress for a lot of my patients, a lot of people that are reaching out to me via DM, on Instagram and on TikTok. I'm on TikTok and what that has done has placed a microscope onto the core wall, has created a lot of advice online about how and what to do in pregnancy and returning to exercise postpartum in order to try and close the gap, returning to exercise postpartum in order to try and close the gap, and unfortunately it's also created a lot of hesitancy and a lot of kind of fear around the exercise you can do, the exercise you can't do, and places a lot of blame onto you and what your exercise choices are if, say, something like this persists postpartum. So when we are thinking about this, it's funny because I feel like I have a lot of thoughts and feelings that are blurring around in my mind. But I think the first thing to start this conversation off with is that diastasis shouldn't even be called a dysfunction or a problem in pregnancy, because it is a necessary part of physiology of pregnancy, of how your body adapts to a growing little one, and there is nothing wrong with that. Like your body is supposed to go through those changes. So even saying that you have diastasis in pregnancy feels wrong to me because you're pregnant. It's not that you have anything wrong with your ab wall. Your ab wall is stretched right. It's supposed to be. You know, you're 29 or 32 or 38 weeks pregnant. There is nothing wrong with your ab wall pregnant. There is nothing wrong with your ab wall.

Speaker 1:

Where a lot of the concern comes is around doming, coning, all of these words that we use for that air pocket that comes along that six-pack line when we start to contract our abs, when we are pregnant and when we have more lengthened tissue postpartum. What we know right now is a whole lot of nothing about coning and doming. My stance, my stance as Christina of 2025, and it has changed a lot as we know more as I've experimented with different ideas, more as I've gone into the research, more is that I do not see coning as something that is bad. I see it as something that I am aware of but not worried about. If you are 37 weeks pregnant, you are going to have some doming or coning, that is fine. You are not causing dysfunction. You are not to have some doming or coning, that is fine. You are not causing dysfunction. You are not causing issues. I expect you to have that because your baby is taking up a lot of room in your belly. But what we see online is that so many people are so afraid now of doming and coning that they absolutely freak out if they are, or they stop doing any exercise altogether if they are doming or coning in pregnancy or postpartum, in late stage pregnancy. I am not at a place where I'm going to say I don't take it into consideration. I do, but it's more a can we minimize this versus you cannot pass go if you have any doming.

Speaker 1:

I broke the internet with my client, georgia, because I showed a video of her doing butterfly pull-ups. I think she was like 38 plus four weeks. She went into labor a couple of days after that and then she had complete coming together of her two like her rectus muscles. There was only a one finger distance between the two edges of her ab wall at two weeks postpartum when I was evaluating her, and so we do not have any research that says that if you avoid coning in pregnancy, that you are not going to have or you're going to be less likely to have issues with diastasis recti postpartum and I wish that I could scream this from the rooftops and similarly postpartum like you are not making anything worse. Right, you are not making anything worse. We do not have any research for that. It can be a sign that you're hitting a tiredness point, a fatigue point. We can maybe try and get you to recruit different muscles a little bit better, but you are not going to cause worsening of your symptoms if you cone or dome Like, please hear me.

Speaker 1:

And so the really interesting part of this is that a study just came out by Sylvia Gaglio I really hope, sylvia, that I said that right. Dr Sylvia Gaglio. I really hope, sylvia, that I said that right. Dr Sylvia Gaglio and a group of collaborators. Garni Donnelly is a colleague friend of mine. She was on the author list and talked about this messaging around diastasis recti online, and I loved this study because this is why this podcast exists is I was getting so frustrated with all the way that messaging was online that I just wanted to have a longer form way to have more nuanced conversations, because I think they're important.

Speaker 1:

And the first thing that this study showed was that about 60% of the messages when they searched diastasis recti on TikTok and Instagram were incorrect messages. Based on our evidence, that is an absolutely massive number. Now, some of those messages, I think are more harmful than others, and the second thing that I really loved about this paper is that they did this big table of. Here is what we do have evidence to say and here is what we don't, and the ones that were the biggest culprits was about coning causing harm. These lists of safe and unsafe exercises in pregnancy.

Speaker 1:

A lot of the trying to help but subtly unfortunately being kind of harmful messages online, and what was evidence informed was progressively loading the ab wall, working on ab strengthening, general exercise in pregnancy and postpartum being super helpful, and really it was keep working within your tolerance. There's going to be personalized, individualized ways that you're going to be able to do that, and that is where I think we are going to be going with our return to exercise and our pregnancy. I don't even want to say protocols, because it's not a protocol, right, it's personalized and individualized to you based on your fitness, your experience, your circumstances, your injury history, your obstetrical history, your family support, etc. And so I loved this study and I posted it on my social media this week and you all loved it because I had so many people who interacted with that post and it was cool because I got to tag every single one of the authors on the team in the captions so that we can get more people following scientists online, which is super cool. More people following scientists online, which is super cool.

Speaker 1:

What this is all showing is that there is still a very big knowledge translation gap, and so, yes, we are seeing that the use of experience as expertise. I've talked about that on previous podcasts. Obviously, this is something that I've been thinking about a lot, and part of it, I do not think, is the internet's fault, because we also have knowledge translation gaps. There are still very well-known exercise, pregnancy and postpartum certifications that are using outdated information. In medicine, we see that there can be a 10-plus year gap from what is happening in the research space to what is happening with clinicians, coaches and people who are taking in and utilizing that information. And so where the nuance of the study comes in and I think it's really important to talk about is that sometimes it's not even the nuance of the study comes in, and I think it's really important to talk about is that sometimes it's not even the influencer's fault. It's the fact that we're not getting research out very well, and this research is changing very quickly, which is very exciting if you are in the perinatal space or you are in that time of your life, and so I want to kind of it's so easy for us to be like, oh, those stupid influencers or, you know, get up on our high horse a little bit, but I don't want that to be the messaging. I think the messaging is that? One we have to make sure that we're taking information from credible sources, right, we always have to vet our sources of information from credible sources, right, we always have to vet our sources of information. Number two as scientists, it's really important that we work on knowledge translation, which is getting the information into the hands of the consumers, and that's something that I'm really passionate about as a clinician researcher not just to clinicians, but to my patients. That, I think, is super important. And the third is to make sure that we are doing more research so that we can continue to advocate for people. So, when we are thinking about this information, we also have to be able to have online conversations and talk about hey, like, research here is new and did you know? Blah, blah, blah. So I think having this continual conversation is really going to be helpful. So we have this.

Speaker 1:

Then we get into the postpartum space, and when we're thinking about postpartum, we are always thinking about rehabilitation of the core wall and the pelvic floor. Love that. What me, as pelvic health, can do is sometimes we can underdose the core wall and the pelvic floor, and this has been kind of a new area that I've been thinking about a lot more. I have a PhD in geriatric rehab and if you have followed any of my older adult content, one of our biggest tenants that we are fighting in our older adult world when I go out on courses, is the underdosage of exercise of our aging seniors. Right when their goal is to walk, we have them doing leg swings and trying to squeeze the tops of their legs or ankle pumps, where we underdose them because we are afraid of hurting them. I see that exact same thing that I am seeing with my 90-year-old happening in the pregnancy and postpartum space. We spend so much time getting moms lying on their backs trying to contract their deep core muscles and the question becomes would that time be better used doing strength training in general rather than getting into the weeds? And I think the answer is somewhere in the middle. But I think that most of if you're in pelvic health, you can probably agree that in general, we go pretty slow in the postpartum return to movement space, and probably too slow, and so the second research study that I wanted to talk to you all about was one that I posted today. It was a systematic review that was looking at conservative methods for helping with diastasis recti postpartum. So conservative method means no medication, no surgery, nothing like that. Conservative means how you are moving your body, kind of in that holistic wellness, allied health space, kind of in that holistic wellness, allied health space.

Speaker 1:

The cool thing about this study is that they didn't just compare doing exercise to doing no exercise. And one of the things that I hate on a lot in research is that we have spent a lot of money comparing doing something to doing nothing and then being surprised that doing something is better than doing nothing, doing nothing. And this study looked at I think it was 16 different papers and came to the conclusion that abdominal exercise in the postpartum period is going to help reduce the distance between those two recti muscles compared to no intervention. Right, I think we can all get on board there. What I liked about this study is that they then did co-intervention subgroup analysis, or they did different abdominal exercise plus co-intervention subgroup analysis, and so what that means is is that out of that 16 groups, they took different pockets or different types of exercise interventions and clumped them together and said is this type of exercise better than this type of exercise? And this is the first time I have seen that done, which not to say that I can never guarantee that. I have seen all studies, but this is the start of a dose response curve and where I would love to see research go, which I'll finish up with this.

Speaker 1:

At the end, what they saw was where exercise is the most beneficial is when you are moving through range. So what it showed was that isometric, which is that staying in neutral and doing core work so planks, dead bugs, bird dogs those did not reduce the distance between our two ab muscles, but going through range, like flexion and extension, doing sit-ups did. And this is a very big finding, right, because so often doing sit-ups with diastasis is a no-no, like people say, do not do this. But it doesn't make any sense because our six-pack muscle, that rectus muscle, comes closer together when we flex, when we flex forward and bend forward like we do in a sit-up or a crunch, and so if we are trying to bring those two things together on a sit-up, shouldn't we be doing sit-ups? But we don't and I was really. I want to be really careful and say that I don't think that we should not be doing any dead bugs or bird dogs or planks. They are going to help your core feel strong and be able to resist force and do more. All those things.

Speaker 1:

It's such an important part of lifting too, and when we are thinking about core recovery, we cannot just be sitting or lying on our backs trying to do squeezes of our abdominal wall or just staying in that stacked position. We have to go through range, we have to load the core wall. I am going to get you holding onto weight and flexing and extending, and that is going to help because it's going to not only make you stronger, it's going to make you more resilient for life, because we cannot stay in a stacked position a lot of the times. With parenting, right, like putting babies in cribs, putting babies into car seats, carrying car seats, like you're going to be flexing, extending, rotating, like getting into odd positions, like that's just parenting life, and then you know if you're lifting, then I'm going to get you to be bracing and neutral. But I'm not only going to train your core in neutral and I'm not going to make it seem like going outside of neutral is bad. So this is really exciting, right. It's a really big finding, which is great, and then a cool thing too, which I don't know what I'm going to think about this. But they said that if you do that also with stim, like using a stim unit, and that might be to help kind of boost some contraction of those ab muscles early on, can help as well. But I don't know if there's like a like we can trial it, but I don't know if, like you know a lot of my anyways, like I have just a lot of thoughts that I want to think through about that part. So that's super exciting.

Speaker 1:

Where we don't know and what we want to think about for future research is how do we, or how fast can we, get individuals back to this type of exercise? Like, are we thinking right away that we should be doing sit-ups postpartum? I don't know the answer to that question. Is there like a wait, x amount of weeks period before we start doing other things? Again, I don't know. All I know right now is that in general, I would say that we hold back for a little bit too long and we scare people sometimes with our messages about how to move your body, and so what I would love to see and maybe this is just going to be on my researcher wish list is more work in the early postpartum period, and early can be four to six weeks or six to eight weeks postpartum on. If I compare doing all of that deep core recruitment like that is so common in all of our postpartum programs and I did six weeks of that versus six weeks of just generally loading right, going through sit-ups and planks and doing that without a big focus on how you are doing that recruitment and then at the end of that intervention which one would do better Like I would love to see that study done. I have a notebook full of ideas about research studies to do. I was just talking to my supervisor today about another study that we want to get up and running and just kind of brainstorming through. But that would be really exciting to see.

Speaker 1:

So where we're at right now is number one please do not be afraid to move your body out of fear of diastasis recti right. Where we're at with our postpartum research based on Nicole Beamish's work is that a weaker pelvic or weaker abdominal wall, you are more likely to have issues with your core than a stronger pelvic floor. First and foremost, number two is that we don't have to be as afraid of coning or doming as the internet and a lot of well-meaning individuals on the internet would have us believe right. We do not need to reduce strain on our ab wall. We need to make sure that our body is strong enough to handle the strain that we are putting on it, which is a lot in pregnancy and postpartum and motherhood and lifting and exercise. The third thing is that we don't want to stay in neutral when we are trying to rehab our core postpartum. Right, we can start in neutral, maybe stay there for a little while, but we don't want to stay there for too long and we want to start introducing range of motion early.

Speaker 1:

One of the big ones that I do early postpartum with my people is I get them to arch back over a wall ball and then go to neutral. So you're going from extension to neutral. That can be a good stretch on an early C-section scar. If we're doing big breaths, it can be a lot of just good when it feels just so good for moms who are feeding lots during the night and they're kind of all crunched over in deflection to get into extension. Like there's just a lot of good things, like that's one of my favorite lengthening exercises to do early postpartum. So there's a lot that we can do. There's a lot that we can do. I should put up a reel about like early, early through range exercises that I really like. There's an idea for you. But I think that what this is all showing is a lot of great progress in the right direction, and sometimes I get really frustrated with where we're at, with how advice is going, and I am just a person that is not patient, which nobody would say that I'm a patient person, probably, and that's okay. But this gives me a little bit of hope that the concerted effort of a lot of very smart researchers is trending in the right space and I am super excited to see that happen.

Speaker 1:

All right, if you have any questions about those research papers or if you want access to them, please just let me know. I post about them on my personal social media pages. On drchristina underscore private, there's a lot more clinician focused language, so it's a little bit hot and heavy with some of the data, but still, I think it's super helpful and I have all of the links to the research articles in those posts as well. If you want to do a bit more of a deep dive, all right, everybody, have a wonderful, wonderful week. We are going to have a guest on our podcast next week. Nutrition by Mel is going to be on talking about. She's an RD who focuses in the perinatal space. I'm so excited to have Mel on the podcast and it's been a while since I've done an interview, so I'm really excited to have her on there. Look for that next week. Otherwise, I will see you all next time.

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Christina Prevett

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