Effect of Exercise on Inter-Recti Distance and Associated Low Back Pain Among Post-Partum Females; A Randomized Controlled Trial

Abstract

Objective: This study aimed to emphasize facilitation training and strengthening of abdominal and core muscles in improving the inter-recti distance (IRD) and associated low back pain (LBP) among young postpartum females.
 Materials and methods: A single-blinded randomized controlled trial, among forty young postpartum females, was conducted at a community health center. The females were divided into two equal groups through the envelope method where Group A received abdominal crunch training protocol whereas group B received double straight leg raise (DSLR) exercise protocol for 6 weeks and pre and post IRD and Oswestry disability index (ODI) scores were recorded.
 Results: Group A showed improvement in IRD with a mean difference of 1.95±0.4 whereas in group B it was found to be 2.85±0.35 when assessed through finger palpation method. The mean difference of IRD, when measured through digital nylon caliper method in abdominal crunch and DSLR exercise group was 4.06±0.74 and 1.2±0.49 respectively. Moreover, ODI scores of group A were 2.70±1.05 whereas, group B scores were found to be 1.1±0.06 showing that LBP reduced in participants who performed abdominal crunch exercise.
 Conclusion: This study reveals that 6 weeks of exercise protocol was observed to be effective in the management of DRA. Thus, abdominal crunch exercise seemed to produce promising results in a reduction of IRD and associated LBP.

Diastasis Recti Abdominis Rehabilitation in the Postpartum Period: A Scoping Review of Current Clinical Practice

“…The reviewed studies had varying sample sizes (3–129) and used different cut-off points for DRA diagnosis, such as 2.0 cm [ 29 – 32 ], 2.2 cm [ 12 ], or 2.5 cm [ 33 – 37 ] above the umbilicus during rest, and 1.5–3.0 cm above the umbilicus during a head-lift or curl-up [ 38 – 40 ]. Three studies proposed cut-offs of two finger-widths at the umbilicus [ 21 ] or anywhere in the midline [ 23 , 41 ] during a head-lift and subsequently assessed with ultrasound, whereas 12 studies did not use any cut-off points [ 22 , 37 , 42 – 51 ].…”

“…2 ). Although most samples had ultrasound-measured [ 12 , 21 – 23 , 30 – 34 , 36 , 37 , 41 , 43 , 46 – 51 ] or caliper-measured [ 29 , 35 , 38 – 40 , 42 – 45 , 52 ] IRDs between 2.5 and 5 cm, two studies [ 43 , 47 ] encompassed IRDs <2.5 cm, whereas one case series [ 52 ] included women with IRDs >7 cm. However, 7 studies [ 21 , 23 , 32 , 34 , 37 , 45 , 48 ] included postpartum women with combined normal and borderline IRD, according to established classification systems [ 1 ].…”

“…In clinical trials, the IRD was assessed under various conditions, including rest [ 23 , 33 , 37 , 47 , 48 ], head-lift [ 35 , 38 , 52 ], curl-up maneuver [ 29 , 39 , 40 , 42 – 44 ], or combinations [ 21 , 45 , 46 ]. Observational studies also utilized combinations of rest and head-lift/curl-up maneuvers [ 30 , 32 , 49 ] with additional conditions, such as TrA [ 12 , 50 , 51 ] and PFM contractions [ 31 , 36 ], sit-ups [ 38 ], leg raise or side planks [ 41 ], and abdominal hypopressive exercises (AHEs) [ 22 ].…”

“…Time postpartum varied broadly (Fig. 3 ), including women who were between 6 h and 6 months postpartum [ 21 , 23 , 29 , 33 , 39 , 40 , 42 , 48 ], less than 2 days postpartum [ 40 , 42 ], less than 4 months postpartum [ 23 , 33 ], between 1 week and 6 months postpartum [ 21 , 29 , 39 , 48 ], between 2 and 8 months postpartum [ 34 , 44 , 46 ], over 6 months postpartum [ 45 , 47 , 52 ], whereas two studies [ 32 , 43 ] enrolled women at 3 months to 3 years postpartum.

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The Effects of Conservative Interventions for treating Diastasis Recti Abdominis in Postpartum Women: a Review with Meta-analysis

“…In the first study [ 31 ], exercise induced reductions in IRD statistically significantly larger than in the passive control group (SMD = 2.32; CI: 1.50–3.15; p < 0.001), however, there was no difference between exercise and control groups in the second study [ 32 ] (SMD = − 0.47; − 1.47 to 0.53; p = 0.360). In addition, abdominal crunch exercise was very effective to improve IRD in postpartum women (SMD = 4.47; CI: 3.26–5.57) in another study [ 33 ], who used caliper measurements, but did not specify if the IRD was assessed at rest or during contraction.…”