Abdominal Separation in Pregnancy
Should I train core exercises?
One of the most frequently asked questions I receive about pregnancy is regarding core exercises.
Up until late last year (2024), there was very little quality research to direct Women’s Health Physio’s on this topic, and so most of us took the ‘middle ground’ approach, recommending ‘pregnancy safe’ core movements such as “bird dog” or “glute bridges with a ball squeeze”.
Many Women’s Health Physios felt conflicted regarding the concept of ‘coning’ with some believing it could worsen ab separation, and more recently others feeling a certain degree of coning may be beneficial to maintaining strength in the abdominal muscle and connective tissue.
In todays Blog I am going to review the 2024 paper by Theodorsen et al., titled “Pregnant women may exercise both abdominal and pelvic floor muscles during pregnancy without increasing the diastasis recti abdominis: a randomised trial”.
Firstly, it is important to understand the Levels of Evidence in scientific research, because it influences our confidence in the results of any particular study. It is worth noting that the paper I’m reviewing today is Level 2, meaning we can be more confident in the results of the study than observational, or case control studies that have come before (Level 4).
Scientific Research Levels of Evidence (Walker, S. 2009).
Theodorsen et al., 2024 study included 96 participants, 48 pregnant women in each group, who had their inter-recti distance (IRD) measured at 24 and 37 weeks gestation, and 6 weeks postpartum.
To be included in the study they needed to have an IRD of >28mm either 2cm above or below the umbilicus.
The experimental group, completing the abdominal and pelvic floor exercises, were able to participant in 2x weekly face to face exercise sessions, and asked to complete 2 x weekly home based sessions.
The core movements included in this study involved positions such as: pully supported incline planks and incline crunch, and a four point hover (to name a few).
The control group were allowed to continue their chosen exercise for the 12 week study duration, including pelvic floor exercises.
Results:
This study found no difference in the inter-recti distance in the experimental or control group, during their pregnancy nor at the 6 week postpartum follow-up.
This result demonstrated that pregnant participants in this study with abdominal separation IRD >28mm did not worsen their separation by training core and pelvic floor exercises.
Whilst this study does have its limitations, it definitely adds to our profession, and I feel that reducing fear of core based training in pregnancy is a huge step forward in Women’s Health.
A final point I wanted to discuss about this paper was the adherence/ compliance within the two study groups.
For the experimental group, when asked who completed >80% of exercise sessions, only 51% were compliant to both the face to face, and home based sessions to this degree.
Whilst this number may appear low, when compared to the control group, only 17% of pregnant women reported doing regular core work (>2 x p week) over the 12 week period.
I feel this highlights an important thing about the role that Womens’ Health Physios, and fitness professionals with pre and postnatal qualifications play in supporting women to be consistent with their exercise during pregnancy.
To have regular contact with a health professional in pregnancy, may increase the likelihood of compliance by 3x according to this paper.
Considering the paper showed no harm in training core for women with diastasis rectus abdominus, and we know with the highest level of evidence (Level 1 Grade A) that pelvic floor muscle training is recommended in pregnancy – it is absolutely essential that more pregnant women have regular access to health-care professionals.
Written and edited by Caitlin Daley, Pelvic Floor Physiotherapist
March 2025