Pregnancy-related diastasis rectus abdominis: Impact of a multi-component group-based intervention

Abstract

Purpose: To explore the feasibility and effect on outcomes of a one-time multi-component group-based intervention among women with pregnancy-related diastasis rectus abdominis (DRA). Methods: Women with clinically diagnosed DRA and minimum 8 weeks postpartum participated in a pre-post cohort pilot study. Subjects participated in a group workshop consisting of education and exercise prescription. They were assessed before the workshop and 8 weeks later with a booster session at 4 weeks. The following assessments were used: inter-recti distance (finder width), linea alba (LA) integrity, LA tension generating capacity, active straight leg raise (ASLR), Pelvic Floor Disability Index (PFDI-20), and global rating of change scale(GRC). Results: Thirty participants were enrolled in this study and 16 completed both pre and post measurements (53.3%). Following intervention, all outcomes measures improved with statistically significant changes in IRD (finger width), LA integrity, and LA tension generation. The average GRC score was 1.7. Issues with loss to follow up point to lack of feasibility of this intervention in its current format. Conclusion: We found one-time multi-component group-based intervention improved pregnancy-related DRA outcomes. Future studies need to further explore the effect of the different components within this intervention, particularly behavioural strategies. Further, the benefit of applying self-management principles in DRA interventions as well as further investigating assessment techniques is also warranted.

Use of Exercise in the Management of Postpartum Diastasis Recti: A Systematic Review

“…However, type of exercise varied across studies (Table 3). Studies tested the effects of abdominal draw-in/static abdominal contraction exercises,18,22–24,26 bridging,19,29,30 head lift,18,25,28 4-point arm lift,19 forms of controlled leg raise/lift,19,23,25,27,29 pelvic clock rotations,18 pelvic floor muscle exercises/Kegels,20,22,26,31 plank,22,23,25,26,29–31 posterior pelvic tilt,18,26,27,31 postural positioning/correction,23,25 reverse trunk twist/u-seat/Russian twist,26,28,31 sit-ups/reverse sit-ups,22,26–28 and squats 18,28. Adjunct modalities included abdominal binding22,23 controlled breathing/exhalation,19,25,26,28 education,19,21,30 electrical stimulation,27,28 and taping 24…”

“…Several studies19,21,22,26,30,31 implemented deep core protocols to treat DRA, and 3 of these studies22,26,31 incorporated pelvic floor muscle strengthening/retraining into the core protocol. All but one19 of these studies was a randomized controlled trial.…”

“…Several studies19,21,22,26,30,31 implemented deep core protocols to treat DRA, and 3 of these studies22,26,31 incorporated pelvic floor muscle strengthening/retraining into the core protocol. All but one19 of these studies was a randomized controlled trial. While all but 1 study found significant IRD reduction associated with deep core exercises, studies comparing deep core protocol against a traditional abdominal strengthening protocol reported conflicting results.…”

“…Outcome measurements for IRD were variable across studies, as well. Five studies [18][19][20]22,25 used 2-finger palpation to measure IRD; 6 studies 21,23,24,28,29,31 used ultrasonography to determine IRD; and the remaining 3 studies 26,27,30 used dial calipers for IRD measurements.…”

“…Diastasis rectus abdominus-qualifying criteria varied across studies (Table 2). Six studies [19][20][21][22][23][24] considered an IRD of 2 finger widths the diagnostic threshold. Two studies 25,26 used a 2-cm IRD threshold, and 2 studies 27,28 used a 2.5-cm threshold.…”