Background

Diastasis recti abdominis (DRA) is a separation of the rectus abdominis muscles along the linea alba, most commonly occuring during and after pregnancy. It is a highly prevalent condition, with studies showing that up to 60% of women experience some degree of DRA in the postpartum period. (Sperstad et al., 2016.) DRA may lead to functional impairments such as reduced trunk stability, lower back pain and difficulties in daily activities. In addition, it can negatively impact body image and quality of life (Benjamin et al., 2019).

The rehabilitation of DRA poses several challenges for both women and healthcare professionals. There is growing interest in conservative treatment methods, such as exercise-based physiotherapy as a first-line approach. However, the evidence on the effectiveness of these interventions remains limited and sometimes conflicting (Gluppe, Engh & Bo, 2021). This highlights the need for more high-quality studies and critical reviews of the existing literature.

The topic is particularly relevant for physiotherapy practice, as physiotherapists often play a key role in supporting postpartum women through safe and effective rehabilitation programs. Understanding which exercise interventions are beneficial can help guide clinical decision-making and improve long-term outcomes.

This article is part of a series produced within the course Professional in Physiotherapy, which is included in the physiotherapy degree programme. The article was created as part of the evidence-based physiotherapy section of the course. In small groups, students practice elements of a systematic literature review, including systematic information retrieval, critical appraisal using the Pero Scalia tool, and writing up the results in the form of a scientific article.

Our research question “Are exercise interventions effective in reducing diastasis recti abdominis in postpartum women?”, was structured using the PICO framework. The aim of this article was to summarize and critically reflect on the current evidence, offering insights into how physiotherapy may contribute to recovery after childbirth.

Methods

The population of interest was postpartum women, mostly between 6 weeks and 24 months after childbirth, with confirmed diagnosis of diastasis recti abdominis (inter-recti distance ≥ 2). Participants were generally healthy, reproductive-aged women. Exclusion criteria included neurological, musculoskeletal or systemic disorders affecting core function, severe pelvic floor dysfunction or untreated medical complications and prior involvement in structured abdominal rehabilitation programs.

For our search strategy, we used specific keywords to capture relevant studies. The population/problem was defined using terms “diastasis recti”, “abdominal muscle separation” and “rectus abdominis diastasis” combined with “postpartum” or “after childbirth”. The intervention of interest was described with keywords such as “exercise therapy”, “abdominal exercises”, and “physical therapy”. To ensure methodological quality, we limited the study type to RCT (randomized controlled trial). PubMed was the primary database that we used. As it provided an accessible and efficient platform for identifying suitable studies. For study selection and data extraction, we screened titles, abstracts and full texts according to predefined criteria. Eligible studies included randomized controlled trials on postpartum women with diastasis recti abdominis. Data extraction focused on study characteristics, intervention and comparison groups, outcomes and key findings relevant to rehabilitation methods aimed at reducing diastasis recti. The studies included were assessed with Physiotherapy Evidence Database (PEDROs Scale). The tool evaluates key aspects of study design such as randomization, blinding and data reporting.

Results

Recovering after childbirth can be challenging, especially when it comes to regaining core strength and reducing diastasis recti abdominis (DRA)—the separation of the abdominal muscles. Recent research sheds light on how different abdominal exercise programs can help new mothers recover more effectively.

A review of five studies suggests that targeted abdominal exercises can reduce the distance between the rectus abdominis muscles (IRD) and improve overall abdominal muscle function. Programs that focus on deep core stability or specific activation of the abdominal muscles—like those examined by Thabet and Alshehri (2019) and Simpson and Hahne (2023)—tend to produce better results than general or less targeted exercises.

However, not all findings are entirely consistent. Soto-Gonzalez et al. (2024) reported that both hypopressive and conventional exercises were effective, while Shohaimi et al. (2019) found only moderate improvements without significant differences compared to control groups. In some cases, even a four-month supervised program did not significantly reduce DRA prevalence (Gluppe et al., 2018). These differences may relate to variations in exercise type, program length, intensity, participant characteristics, and adherence.

The quality of the studies, measured using the PEDro scale, ranged from 6/10 to 8/10. Higher-quality studies (7–8/10), such as Simpson & Hahne (2023) and Gluppe et al. (2018), generally offer more reliable evidence, though issues like lack of therapist or participant blinding and high drop-out rates reduce internal validity. Moderate-quality studies (PEDro 6/10), like Thabet & Alshehri (2019), still show beneficial effects, but the evidence is less definitive.

Overall, the research suggests that abdominal exercises can support postpartum recovery, but no single exercise approach has emerged as clearly superior. Individualized programs, early guidance after birth, and well-structured interventions are key. High-quality studies indicate that focused abdominal training is effective, even if the exact degree of improvement varies between individuals.

Conclusions

Across the five RCTs reviewed, exercise interventions for postpartum diastasis recti showed mixed but generally positive trends, though with notable differences in design and outcomes. Several studies (Simpson & Hahne, 2023; Thabet & Alshehri, 2019; Soto-Gonzalez et al., 2024) reported measurable reductions in inter-recti distance and improvements in muscle strength or function, while others (Gluppe et al., 2018; Shohaimi et al., 2019) found no significant differences between exercise and control groups despite reductions within participants. Common features included relatively small sample sizes, short intervention periods (6–12 weeks), and varied assessment methods ranging from palpation to ultrasound and digital calipers, which complicates direct comparison. Importantly, while different exercise types—core stability, hypopressive, split tummy programs, and targeted abdominal activation—were tested, no single approach emerged as clearly superior. Together, these findings suggest that exercise may benefit postpartum recovery and DRA management, but more robust trials with standardized measures and longer follow-up are needed before strong clinical recommendations can be made.

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Authors:

Anna-Sofia Nuutinen, physiotherapy student, Savonia University of Applied Sciences

Laura Röntynen, physiotherapy student, Savonia University of Applied Sciences

Laura Seppä, physiotherapy student, Savonia University of Applied Sciences

Miia Tiihonen, physiotherapy student, Savonia University of Applied Sciences

Niklas Viskari, physiotherapy student, Savonia University of Applied Sciences

Marja Äijö PT, PhD, Principal lecturer of Gerontology and Rehabilitation, Savonia University of Applied Sciences

 

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References:

Benjamin DR, Frawley HC, Shields N, van de Water ATM, Taylor NF. Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy. 2019. https://pubmed.ncbi.nlm.nih.gov/30217494/

Gluppe S, Engh ME, Bø K. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis. Braz J Phys Ther. 2021 https://pubmed.ncbi.nlm.nih.gov/34391661/

Sperstad JB, Tennfjord MK, Hilde G, Ellström-Engh M, Bø K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med. 2016. https://pubmed.ncbi.nlm.nih.gov/27324871/

Shohaimi, S., Husain, N. R. N., Zaki, F. M., & Atan, I. K. (2023). Split Tummy Exercise Program for Reducing Diastasis Recti in Postpartum Primigravidae: A Randomized Controlled Trial. Korean journal of family medicine, 44(2), 102–108. https://doi.org/10.4082/kjfm.22.0035

Simpson, E., & Hahne, A. (2023). Effectiveness of Early Postpartum Rectus Abdominis versus Transversus Abdominis Training in Patients with Diastasis of the Rectus Abdominis Muscles: A Pilot Randomized Controlled Trial. Physiotherapy Canada. Physiotherapie Canada, 75(4), 368–376. https://doi.org/10.3138/ptc-2021-0111

Soto-González, M., Da Cuña-Carrera, I., Lantarón-Caeiro, E. M., & Pascoal, A. G. (2024). Effect of hypopressive and conventional abdominal exercises on postpartum diastasis recti: A randomized controlled trial. PloS one, 19(12), e0314274. https://doi.org/10.1371/journal.pone.0314274

Thabet, A. A., & Alshehri, M. A. (2019). Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial. Journal of musculoskeletal & neuronal interactions, 19(1), 62–68. https://pmc.ncbi.nlm.nih.gov/articles/pmid/30839304/

Gluppe, S. L., Hilde, G., Tennfjord, M. K., Engh, M. E., & Bø, K. (2018). Effect of a postpartum training program on the prevalence of diastasis recti abdominis in postpartum primiparous women: A randomized controlled trial. Physical Therapy, 98(4), 260–268. https://doi.org/10.1093/ptj/pzy008