Pilates guide
A tummy gap (diastasis recti) is common after pregnancy: the two sides of the six-pack muscle move apart, and the gap usually narrows by itself over the following months. Pilates is one good way to rebuild your tummy and pelvic floor afterwards, and it's what pelvic health physiotherapists teach, starting with breathing and gentle tummy work.
In studies, exercise narrowed a gap by a few millimetres on average: more than no exercise, but not enough to close it, and Pilates hasn't been shown to beat other exercise. Curl-ups, which many people are told to avoid, didn't widen gaps in a 12-week trial.
This guide covers what the gap is and how to check it, what the studies found, what doming means, the moves to start with and the ones to leave until later, and when to see your GP or a pelvic health physiotherapist.
In pregnancy the two sides of the six-pack muscle usually separate by about 2 finger widths. The NHS says the gap usually goes back to normal by the time your baby is 8 weeks old; in a study of 300 first-time mothers, a gap of 2 finger widths or more was still there in about a third at a year.
In reviews of trials after birth, exercise narrowed the gap by about 4 to 8 mm more than no exercise, measured within weeks or months, with low to moderate certainty. It hasn't been shown to improve back pain or everyday function.
UK pelvic health physiotherapists teach Pilates after birth. The Pilates research is thin: one small study that wasn't randomised, in mothers whose gaps were mostly under 2 cm, and a network analysis based on a few small trials.
In 70 women with a gap, 12 weeks of head lifts and curl-ups didn't widen it and made the tummy muscles stronger. If the middle of your tummy bulges or domes during a move, make the move easier, as the physiotherapists' Pilates booklet advises.
See your GP if the gap is still obvious 8 weeks after the birth, or for tummy pain, bulging when you exercise, leaking, or a heavy feeling in your vagina, and ask about a pelvic health physiotherapist.
The six-pack muscle (rectus abdominis) runs down the front of your tummy in two halves, joined by a band of tissue called the linea alba. As the womb grows, it stretches the tummy wall and the halves move apart. The NHS says: "It's common for the 2 muscles that run down the middle of your stomach to separate during pregnancy", usually by about 2 finger widths. UK pelvic health physiotherapists call it DRAM (diastasis of the rectus abdominis muscle).
The European Hernia Society says a gap of 2 cm or less "might be considered physiologically normal", and calls it a diastasis when it's wider. Six months after a first baby, normal widths on ultrasound went up to about 2 cm just below the belly button and nearly 3 cm above it. In 329 men and women scanned for other reasons, 57% had a gap wider than 2 cm above the belly button, and the authors suggested changing the definition to avoid over-treatment.
In 300 first-time mothers, a gap of 2 finger widths or more was present in 33% at 21 weeks of pregnancy, 60% at 6 weeks after the birth, 45% at 6 months and 33% at a year. On ultrasound, all 84 first-time mothers in another study had a gap at 35 weeks of pregnancy; it narrows most in the first 2 months after the birth, and in a study of 504 women it kept narrowing between 3 and 12 months, whether or not they exercised.
In one study, women who lifted heavy loads 20 or more times a week were about twice as likely to have a gap. Weight gain and the baby's weight weren't linked, and across 113 studies, exercise in pregnancy wasn't linked with a gap. Men can have one too: 30% of 1,575 men in a hospital study had a gap wider than 2 cm, more often with age, higher weight and smoking.
The physiotherapists list a bulge or dome down the middle when you sit up, discomfort along the midline, a feeling of a gap, back pain, leaking and prolapse as possible symptoms, and say that although these problems are common, they are not normal. In studies, a gap wasn't clearly linked with back pain, pelvic girdle pain or leaking; it went with more tummy pain or discomfort, and with how women felt about their bodies.
From the NHS self-check. Finger checks are rough: in studies, two people measuring the same gap agreed only about 63% of the time, so a physiotherapist may measure it with calipers or ultrasound.
See the movement on the 3D figure: Chest lift (Pilates curl-up)
Reviews of trials in women after birth compared exercise with no exercise or usual care. The gap narrowed by an extra 4.3 mm in a 2023 review of 16 trials (moderate certainty), 5.2 mm in a 2025 review (low certainty), 4.8 mm in a network analysis of 21 trials, 6.8 mm in another 2025 review (very low certainty) and 8.1 mm in a 2026 review of 9 trials. Follow-up was weeks to a few months, the trials varied a lot, and they used different ways of measuring the gap.
In the reviews that measured disability, the narrowing didn't come with a clear improvement. Types of training didn't differ clearly. Training aimed only at the deepest tummy muscle showed no clear effect in a 2026 review of 15 studies, after an earlier review of 7 trials had found a small effect from very low-quality evidence.
In 35 first-time mothers who weren't randomised, 4 weeks of Pilates (50 minutes, 5 times a week) narrowed the gap by 0.3 to 0.65 cm against 0.06 to 0.18 cm without it, and the waist by about 3 cm; most of the gaps were under 2 cm to start with. A network meta-analysis of 17 studies ranked Pilates highly at the level of the belly button, but we could read only its abstract, which doesn't name the Pilates trials. Our search found no other Pilates studies of the gap in PubMed.
In a trial of 21 women aged 50 to 65, not after a recent birth, 12 weeks of mat Pilates 3 times a week narrowed gaps by about 2 cm, measured with calipers while the women curled up. That is far more than any other trial has found, in a tiny group, so treat it as an outlier rather than what to expect.
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In 70 women with a gap 6 to 12 months after the birth, 12 weeks of head lifts, curl-ups and twisted curl-ups at home, about 10 minutes 5 days a week, left the gap unchanged (a difference of 1 mm, somewhere between 1 mm narrower and 4 mm wider) and made the six-pack muscle thicker and stronger. In pregnancy, adding tummy exercises, crunches included, didn't widen the gap more than general exercise, in trials of 96 and 63 women.
On ultrasound, a head lift or curl-up narrows the gap while you do it: by about 10 mm above the belly button in one study of 38 women. Drawing your tummy in as hard as you can widens it slightly below the belly button, by about 3 to 5 mm, in women after birth and in pregnancy.
Curl-ups can make the band down the middle sag or bulge more than gentler exercises, and drawing the tummy in first reduced this in one study. Nobody knows yet whether this affects how the gap heals, and the way it's measured hasn't been validated.
Gaps narrow most in the first 2 months after birth and keep narrowing through the first year. In 175 first-time mothers, a weekly postnatal class with pelvic floor and tummy strengthening from 6 weeks didn't change how many had a gap at 6 or 12 months.
Pelvic floor exercises after birth lowered the odds of leaking urine by about a third in a 2025 review, and the NHS and the physiotherapists' booklets recommend them for everyone after a birth.
Exercise with electrical muscle stimulation or a corset narrowed the gap a little more than exercise alone in some trials. Hypopressive breathing exercises didn't narrow it more than ordinary tummy exercises in two small trials, though one found better body image and fewer pelvic floor complaints.
Doming, or coning, is a ridge or bulge along the middle of your tummy when you lift your head or legs, or sit up from lying. The physiotherapists list it as a sign of a gap, and their Pilates booklet says your tummy "should not bulge upwards or dome" during the exercises.
Make the move easier. The booklet's advice is to put your fingers on your pelvis and concentrate on drawing your lower tummy "in and wide"; keep your head down, make the lift smaller or go back a step. We found no study showing that doming during exercise harms the gap, so treat it as a signal to adjust, not a sign of damage.
A gentle tummy contraction, held for 2 or 3 breaths, is what the physiotherapists' booklets teach. Drawing in as hard as you can briefly widens the gap below the belly button, and training that only does this didn't narrow the gap in the newest review.
Breathing and pelvic floor exercises can start within hours of the birth, once any catheter is out. The physiotherapists' 2024 booklet: work up to 10 long squeezes held for 10 seconds, then 10 short ones, at least 3 times a day; a gentle tummy contraction held for 2 or 3 breaths; then pelvic tilts, knee rolls, heel slides and head lifts, building up to 10 repetitions 3 times a day. The NHS side-lying stomach exercise: hold for a count of 10, up to 10 times. Walk a little further each day.
Alternate knee bends (the knee fold), single knee fall-outs and bridging: build up to 2 sets of 5 to 10, every other day, the dose in the same booklet.
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The physiotherapists' Pilates booklet says it is safe to start gentle Pilates from 4 weeks if you have no concerns about bleeding, wound healing or your pelvic floor (leaking, or signs of prolapse); if you've been diagnosed with a gap, see a specialist pelvic health physiotherapist first. After a caesarean, take longer, and don't lift anything heavier than your baby for at least 6 weeks.
Once the first exercises are easy and your tummy doesn't dome, add the chest lift and its harder versions. The curl-up trial's home programme was 3 sets of 8 to 12 head lifts, curl-ups and twisted curl-ups, 5 days a week for 12 weeks; the Pilates study ran 5 sessions a week for 4 weeks. Our editorial starting point: 2 or 3 Pilates sessions a week, plus your daily pelvic floor exercises.
The physiotherapists advise avoiding high-impact exercise such as jumping or running until you're stronger. Their 2024 booklet points to a return-to-running guide that brings in low-impact running from about weeks 6 to 12 and a full return to running from about 12 weeks, once you can walk for 30 minutes and hop and jog on the spot without pain, heaviness, dragging or leaking. The weeks are a rough guide.
From the first days and weeks, with the 2024 booklet's doses above: pelvic tilts and heel slides up to 10, 3 times a day, then knee folds, fall-outs and bridges, 2 sets of 5 to 10, every other day. The breathing, pelvic floor and draw-in pages give their own doses, and 8 to 10 clams each side is our editorial starting point.
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoPelvic floor exercise (Kegel)Beginner · No equipment
3D demoSide-lying tummy draw-inBeginner · No equipment
3D demoSupine heel slideBeginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoKnee foldBeginner · No equipment
3D demoBent-knee fall-outBeginner · No equipment
3D demoClamshellBeginner · No equipmentKeep your head down at first in the hundred and the single-leg stretch, and add the criss-cross last. If the middle of your tummy domes, make the move smaller.
Leave the side plank until the first weeks have passed, and use fists if your wrists ache on all fours.
3D demoKnee side plankBeginner · No equipment
3D demoBird dog, one limb at a timeBeginner · No equipment
3D demoBird dogBeginner · No equipment
3D demoSwan (Pilates swan dive)Intermediate · No equipment
3D demoMermaid (Pilates seated side bend)Beginner · No equipment
3D demoCat-cowBeginner · No equipmentSit-ups, crunches, planks and high-impact exercise such as jumping or running: the NHS and the physiotherapists advise avoiding them to start with.
Long-lever and advanced mat moves: the double straight-leg stretch, teaser, roll-over, jack knife, boomerang, control balance and corkscrew, and moves that put your weight on your hands, such as the leg pull and side bend. This staging is our suggestion, following our diastasis recti guide; nothing needs to be banned for ever.
Postnatal exercises suit the first weeks; Pilates for your pelvic floor comes next, then the diastasis recti workout's curl-up programme. The postnatal strength workout adds loaded strength from about 6 weeks, and the pregnancy class is for while you're still pregnant.
A gentle 25-minute routine for the first weeks after birth: pelvic floor, breathing, tummy and hip exercises on the floor, sit-to-stands and a walk.
25 minBeginner12 movesA bench or box, Cardio machineA 20-minute Pilates workout for your pelvic floor, built on UK pelvic health physiotherapists' booklet: squeeze as you breathe out, move, then fully release.
20 minBeginner18 movesA wall, A bench or boxA 12-minute tummy routine copied from a trial in women with diastasis recti: head lifts, curl-ups and twisted curl-ups, 5 days a week for 12 weeks.
12 minBeginner5 movesNo equipmentA 25-minute strength workout from about 6 weeks after birth: sit-to-stands, deadlift practice, push-ups, rows, bridges and tummy work, with the knack.
25 minBeginner14 movesA bench or box, A kettlebellA 20-minute mat Pilates workout for complete beginners. It covers breathing, spine position and the foundation moves, each with an easier option.
20 minBeginner13 movesNo equipmentA 20-minute Pilates workout for any trimester: seated, standing, all-fours and side-lying moves, with no lying on your back or front and no jumping.
20 minBeginner15 movesA wall, A bench or boxThe postpartum plan builds week by week, with a caesarean version; the beginner Pilates plan suits you once the first weeks have passed.
A postpartum workout plan from the first days after birth to running and lifting again, week by week, with a caesarean track and readiness checks.
5 training days25 minBeginner3 days a weekA free 4-week, 3-day Pilates plan for complete beginners. Two mat days and one wall day, with clear rules for when to move each exercise to its harder version.
3 training days25 minBeginnerIn the US, call 911 for 999, and use your doctor's urgent line or urgent care for NHS 111.
In the UK, ask your GP or midwife, or refer yourself where your area allows. In the US, ask your doctor about a pelvic floor physical therapist.
If your wound is oozing or getting more painful, or you feel feverish or unwell, contact your midwife or GP. Tell your doctor straight away if you have trouble peeing or the feeling that you need to go changes.
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In trials after birth and in pregnancy, curl-ups didn't widen the gap, and they narrow it while you do them. Leave them out of the first weeks, as the NHS advises, and ease off if your tummy domes.
The Pilates studies are small, and across trials exercise narrows a gap by a few millimetres on average. Most of the narrowing happens by itself in the months after birth.
Physiotherapists treat doming as a sign to make the move easier. No study has shown that doming during exercise harms healing.
A hard draw-in widens the gap below the belly button for a moment, and training that only does this didn't narrow the gap in the newest review. Physiotherapists teach a gentle contraction.
Gaps of up to about 2 cm, and wider above the belly button, can be normal. European guidance says physiotherapy may be considered before surgery, and an Italian consensus suggests surgery only for gaps wider than 2.5 cm, after exercise.
In a study of 28 popular Instagram posts about the gap, 61% weren't evidence-based, and many encouraged fear of exercise.
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It can help you rebuild strength after birth, and it's the kind of exercise pelvic health physiotherapists teach: breathing, the pelvic floor, then gentle tummy work. Exercise of any kind narrows a gap only a little, a few millimetres on average, and Pilates hasn't been shown to beat other exercise.
Not reliably. Most gaps narrow by themselves over the first year, and exercise adds a few millimetres on average. One small study found Pilates narrowed gaps that were mostly under 2 cm to start with.
There's no evidence that it does: curl-up exercises like the Pilates chest lift didn't widen gaps in a 12-week trial. If the middle of your tummy domes during a move, make it easier or keep your head down.
In the first weeks, skip sit-ups, crunches, planks and high-impact exercise. Until you can lift your head without doming, leave out long-lever and advanced moves such as the double straight-leg stretch, teaser, roll-over and jack knife, and moves with your weight on your hands. Nothing needs to be banned for ever.
UK pelvic health physiotherapists say gentle Pilates is safe from 4 weeks if you have no concerns about bleeding, wound healing or your pelvic floor. Breathing, pelvic floor and gentle tummy exercises can start in the first days. After a caesarean, take it more slowly and don't lift anything heavier than your baby for at least 6 weeks.
Doming is a ridge or bulge along the middle of your tummy when you lift your head or legs. It's a sign to make the move easier, not proof of harm: keep your head down, make the lift smaller or go back a step. If it keeps happening, see a pelvic health physiotherapist.
Lie on your back with your knees bent, raise your shoulders slightly and feel above and below your belly button for a gap, counting how many fingers fit. Check every so often to see it getting smaller. Finger checks are rough, so a physiotherapist may measure it with calipers or ultrasound.
The NHS says the gap usually goes back to normal by the time your baby is 8 weeks old. In studies, a gap of 2 finger widths or more was still present in 45% of first-time mothers at 6 months and 33% at a year. If it's still obvious at 8 weeks, see your GP.
No trial has tested the reformer for a tummy gap, so the same rules apply: build up from easier work, watch for doming and tell the teacher about your gap. Springs can support a move or make it harder, so ask for the easier set-up.
It can make your tummy muscles stronger: in the Pilates study, curl-up endurance improved and the waist shrank about 3 cm in 4 weeks, but the study wasn't randomised. Exercise narrows a gap by millimetres, and a tummy that still bulges months after the birth is worth showing to a pelvic health physiotherapist.
Almost everyone has a gap by the end of pregnancy, and in trials, tummy and pelvic floor exercises in pregnancy didn't widen it more than general exercise. The physiotherapists' Pilates booklet advises not lying on your back after 20 weeks; our Pilates in pregnancy guide covers the rest.
Yes. Men get gaps too, more often with age and higher weight, and the same build-up of moves applies. Our diastasis recti guide covers gaps in men and when to see a doctor.
Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.
