# The effect of physiotherapy on postpartum diastasis recti abdominis

> The Influence of Physiotherapeutic Interventions on Postpartum Abdominal Muscle Separation.

## Introduction
Diastasis recti abdominis (DRA) is a separation of the rectus abdominis muscles along the linea alba, most commonly occurring 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).

## Methodology
This article was produced as part of the "Professional in Physiotherapy" course at Savonia University of Applied Sciences. The research question, “Are exercise interventions effective in reducing diastasis recti abdominis in postpartum women?”, was structured using the PICO framework.

*   **Population:** Postpartum women (6 weeks to 24 months after childbirth) with a confirmed diagnosis of DRA (inter-recti distance ≥ 2).
*   **Exclusion Criteria:** Neurological, musculoskeletal, or systemic disorders affecting core function, severe pelvic floor dysfunction, untreated medical complications, and prior involvement in structured abdominal rehabilitation programs.
*   **Search Strategy:** PubMed was the primary database used. Keywords included "diastasis recti", "abdominal muscle separation", "rectus abdominis diastasis", "postpartum", "after childbirth", "exercise therapy", "abdominal exercises", and "physical therapy".
*   **Study Selection:** Limited to randomized controlled trials (RCTs).
*   **Quality Assessment:** Studies were assessed using the Physiotherapy Evidence Database (PEDro) scale.

## Findings
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 focusing on deep core stability or specific activation of the abdominal muscles (e.g., Thabet and Alshehri, 2019; Simpson and Hahne, 2023) tend to produce better results than general exercises.

However, findings are not entirely consistent:
*   **Soto-Gonzalez et al. (2024):** Reported that both hypopressive and conventional exercises were effective.
*   **Shohaimi et al. (2019):** Found only moderate improvements without significant differences compared to control groups.
*   **Gluppe et al. (2018):** Found that a four-month supervised program did not significantly reduce DRA prevalence.

The quality of the studies (PEDro scale) ranged from 6/10 to 8/10. While higher-quality studies offer more reliable evidence, issues such as lack of blinding and high drop-out rates persist.

## Conclusion
Across the five RCTs reviewed, exercise interventions for postpartum DRA showed mixed but generally positive trends. While some studies reported measurable reductions in IRD and improvements in muscle strength, others found no significant differences compared to control groups. No single exercise approach emerged as clearly superior. Future research requires more robust trials with standardized measures and longer follow-up periods.

## 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

## 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. [Link](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. [Link](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. [Link](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. [Link](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. [Link](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. [Link](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. [Link](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. [Link](https://doi.org/10.1093/ptj/pzy008)