Exercise narrows the postpartum ab gap, and adding muscle stimulation works best

Diastasis recti abdominis, a separation of the paired muscles that run down the front of the abdomen, is common after pregnancy. It is often framed as a cosmetic concern, but the condition is strongly associated with functional problems too. Clinics offer a long menu of non-surgical fixes, from exercise programmes to corsets, electrical stimulation and acupuncture. Until now, nobody had properly ranked these options against each other, so women and their physiotherapists have been choosing largely on habit and availability.

The researchers swept seven databases and trial registers for randomised trials published up to April 2024. Eligible studies enrolled postpartum women whose gap between the abdominal muscles measured more than 2 cm, tested any non-surgical treatment lasting at least 2 weeks against no treatment, and reported the change in that gap plus how acceptable the treatment was. Twenty-one trials with 1195 women aged 18 to 45 made the cut. A network approach let the team compare treatments that had never been tested head to head and rank the probability of each being best.

Exercise paired with neuromuscular electrical stimulation produced the largest narrowing of the gap, 1.12 cm more than no treatment. Acupuncture (0.81 cm), a corset (0.65 cm) and exercise alone (0.48 cm) also beat no treatment. In the ranking, the stimulation plus exercise combination had a 91.0% probability of being the best option tested, with acupuncture plus exercise next at 71.1%. Across the board, treatments that included exercise ranked higher than the same treatments without it. Acceptability did not differ significantly between the groups.

This is a comparative ranking of a kind this field has lacked, and it broadly confirms that exercise is the backbone of conservative treatment while suggesting that add-ons can deepen the effect. The authors are candid about the weak points: participants varied, the gap was measured in different ways across trials, and data for some comparisons were sparse. That means the precise ordering of treatments could shift as more trials arrive. It also leaves open whether narrowing the gap translates into better long-term function.

If you are dealing with abdominal separation after pregnancy, the clearest message is that exercise sits at the centre of every option that worked: each treatment ranked better with exercise than without it. The top-ranked combination added neuromuscular electrical stimulation to exercise, which is typically delivered in a physiotherapy setting. The differences between options were fractions of a centimetre, so expectations should stay realistic. And because the trials varied in how they measured the gap, the exact ordering could change as better data arrive.