The linea alba is a complex structure of decussating collagen fibers that physiologically must be able to withstand high tension and at the same time be elastic and stretchable. The importance of the integrity of the linea alba is receiving new attention, not least due to a holistic view of the abdominal core health concept (Poulose 2023). The anatomy of the linea alba is discussed in this book in ► Chaps. 29 and 47 . What about its physiology? Tensions and forces in the abdomen are increased by coughing; in one study in which intravesicular pressure was measured in healthy probands, the resting intravesicular pressure was 17 ± 5 mmHg, increasing to a maximum of 112 ± 35 mmHg during forceful coughing, more than achieved by the Valsalva maneuver (mean 77.1 mmHg) or by lifting 40lbs/18 kg from the floor (mean 69.8 mmHg) (Guttormson et al. 2008). Each attempt to reconstruct the linea alba after laparotomy, during repair of incisional hernias or approximation of a diastasis needs to follow principles, that eventually lead to functional stability and resilience to tension forces of the linea alba on the long run.