What is diastasis recti?

During pregnancy, the abdominal muscles stretch to make room for the growing baby. In the process, the connective tissue seam between the rectus abdominis muscles (the linea alba) can widen — this is known as diastasis recti. This process is normal in pregnancy and is usually not a disease but a physiological adaptation.

Why targeted training makes sense

Certain abdominal and pelvic floor exercises can measurably influence the distance between the rectus muscles (the inter-recti distance). However, studies using ultrasound measurement reveal an important detail: not every "abdominal exercise" has the same effect.

• Exercises that reduce the inter-recti distance: the head lift, the curl-up and the diagonal curl-up variation have been shown, in studies of pregnant women with diastasis recti, to acutely reduce the distance both above and below the navel.
• Exercises that can increase the distance: pelvic floor training on its own, the abdominal "drawing-in" manoeuvre, and the combination of the two led to a slight increase in inter-recti distance in the same studies.
• Important: the inter-recti distance increases physiologically over the course of pregnancy in any case — between weeks 27 and 37 of pregnancy, a mean increase of roughly 8 mm was measured, independently of training.

After birth, studies show that both classic abdominal exercises (e.g. crunches, drawing-in) and so-called hypopressive exercises can produce a sustained reduction in inter-recti distance over a period of several weeks, with multiparous women benefiting the most. A Cochrane-style network meta-analysis update further suggests that suspension training, Pilates, and the combination of an abdominal binder plus core stability training may be particularly effective depending on the measurement site (above, at, or below the navel) — though the evidence base here is still limited and heterogeneous.

The importance of correct execution

The direction of the effect (reduction versus widening of the distance) depends critically on execution technique. An uncontrolled head lift, or a curl-up performed with the wrong sequence of muscle activation, can fail to achieve the desired effect or may even worsen the diastasis. Likewise, incorrectly instructed pelvic floor activation can, considered in isolation, lead to an increase in the distance — even though it remains valuable in combination with other elements of pelvic floor training.

For this reason, the following principles apply in physiotherapy practice:

• Individual instruction and feedback (e.g. via palpation, ultrasound, or targeted cueing) markedly improve outcomes compared with self-instruction or general education alone.
• Excessive intra-abdominal pressure (straining, breath-holding, jerky movements) should be avoided throughout the exercise.
• The exhalation should be coordinated with the contraction phase in order to reduce pressure on the linea alba.
• Pain, visible "doming" (a bulge along the midline), or a loss of the ability to hold tension are warning signs at which the exercise should be modified or stopped.

Practical exercise selection during pregnancy

• Pelvic floor training: the foundation of any training programme during pregnancy and postpartum, regardless of its acute effect on the inter-recti distance.
• Controlled drawing-in (gently drawing the navel towards the spine): to activate the transversus abdominis, performed correctly and without forcing.
• Cautious curl-up variations: only under professional guidance, with the focus on technique rather than number of repetitions.
• General aerobic activity: classified by ACOG as safe and recommended for cardiovascular fitness, including during breastfeeding, with no adverse effect on milk production or infant growth.

A professional assessment of the diastasis recti and an individually adapted selection of exercises by specialised physiotherapists is recommended, particularly where musculoskeletal complaints are already present during pregnancy.

References

Committee on Obstetric Practice. (2020). Physical activity and exercise during pregnancy and the postpartum period: ACOG Committee Opinion, Number 804. Obstetrics & Gynecology.

Theodorsen, N. M., Moe-Nilssen, R., Bø, K., & Haukenes, I. (2023). Effect of exercise on the inter-rectus distance in pregnant women with diastasis recti abdominis: An experimental longitudinal study. Physiotherapy.

Gluppe, S. B., Engh, M. E., & Bø, K. (2020). Immediate effect of abdominal and pelvic floor muscle exercises on interrecti distance in women with diastasis recti abdominis who were parous. Physical Therapy.

Mota, P., Pascoal, A. G., Carita, A. I., & Bø, K. (2015). The immediate effects on inter-rectus distance of abdominal crunch and drawing-in exercises during pregnancy and the postpartum period. Journal of Orthopaedic & Sports Physical Therapy.

Soto-González, M., Da Cuña-Carrera, I., Lantarón-Caeiro, E. M., & Pascoal, A. G. (2024). Effect of hypopressive and conventional abdominal exercises on postpartum diastasis recti: A randomized controlled trial. PLoS One.

Zhu, J., Dong, B., & Liu, S. (2025). Comparative effectiveness of rehabilitation therapies for diastasis recti abdominis: A systematic review and Bayesian network meta-analysis. International Journal of Gynecology & Obstetrics.

Bigdeli, N., Yalfani, A., Doosti-Irani, A., & Qodrati, A. (2025). An evidence-based comparison of rehabilitation strategies for diastasis recti abdominis in postpartum women: A systematic review and network meta-analysis. Scientific Reports.

Beamish, N. F., Davenport, M. H., Ali, M. U., et al. (2025). Impact of postpartum exercise on pelvic floor disorders and diastasis recti abdominis: A systematic review and meta-analysis. British Journal of Sports Medicine.

Cabral, A. L., Diniz, A. L. D., Oliveira, E. H., et al. (2025). Transversus abdominis and rectus abdominis activation exercises do not alter inter-recti distance in pregnant women: A randomised trial. Journal of Physiotherapy.

Bruno, A., & Foti, R. (2026). When does rectus diastasis worsen the most? A pregnancy-order analysis of midline fascial failure. Aesthetic Plastic Surgery.

Wang, L., Yun, T., Zhang, D., et al. (2024). A prospective study of two-dimensional ultrasonography combined with shear wave elastography for pregnancy-related diastasis recti abdominis. Frontiers in Physiology.

Balasch-Bernat, M., Pérez-Alenda, S., Carrasco, J. J., et al. (2021). Differences in inter-rectus distance and abdominopelvic function between nulliparous, primiparous and multiparous women. International Journal of Environmental Research and Public Health.

Tuominen, R., Jahkola, T., Saisto, T., Arokoski, J., & Vironen, J. (2022). The prevalence and consequences of abdominal rectus muscle diastasis among Finnish women: An epidemiological cohort study. Hernia.