Split Tummy Exercise Program for Reducing Diastasis Recti in Postpartum Primigravidae: A Randomized Controlled Trial

Background Diastasis rectus abdominis (DRA) involves the separation of the midline abdominal muscles and linea alba and affects more than half of postpartum women. This study aimed to assess the effect of a split tummy exercise program (STEP) on DRA closure in postpartum mothers. Methods A randomized controlled trial was conducted from 2008 to 2020 at the Obstetrics and Gynaecology Clinic of the Universiti Kebangsaan Malaysia Medical Centre. Primigravida mothers diagnosed with DRA were selected and randomly assigned to the intervention (n=21) or control (n=20) group. The intervention group underwent a home-based STEP consisting of three phases of nine abdominal exercises. DRA size was assessed at baseline and at 8 weeks postpartum using two-dimensional ultrasound. Results The mean age of the participants was 28 years (standard deviation, 3.6), with the majority of Malay ethnicity (87.8%) and working mothers (78%). After 8 weeks, the intervention group showed a significant reduction in DRA size of up to 27% (mean difference, 6.17 mm; 95% confidence interval, 3.7–8.7; P<0.001). No significant intergroup DRA changes were observed after 8 weeks of follow-up. Conclusion Early postpartum screening for DRA should be advocated to allow early STEP intervention to ensure favorable outcomes. STEP intervention is an effective postnatal training program for managing DRA.

[1]  A. Carita,et al.  Normal width of the inter-recti distance in pregnant and postpartum primiparous women. , 2018, Musculoskeletal science & practice.

[2]  G. Hilde,et al.  Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: Prospective cohort study , 2017, Neurourology and urodynamics.

[3]  P. Hodges,et al.  Behavior of the Linea Alba During a Curl-up Task in Diastasis Rectus Abdominis: An Observational Study. , 2016, The Journal of orthopaedic and sports physical therapy.

[4]  L. Walton,et al.  The effects of a 6 week dynamic core stability plank exercise program compared to a traditional supine core stability strengthening program on diastasis recti abdominis closure, pain, oswestry disability index (ODI) and pelvic floor disability index scores (PFDI) , 2016 .

[5]  Changho Song,et al.  Comparison of changes in the mobility of the pelvic floor muscle on during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction , 2016, Journal of physical therapy science.

[6]  D. Hande,et al.  Effects of Abdominal Exercises on Reduction of Diastasis Recti in Postnatal Women. , 2016 .

[7]  R. K. Kutty,et al.  ABDOMINAL EXERCISE WITH BRACING, A THERAPEUTIC EFFICACY IN REDUCING DIASTASIS-RECTI AMONG POSTPARTAL FEMALES , 2015 .

[8]  A. Carita,et al.  Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. , 2015, Manual therapy.

[9]  C. Peiris,et al.  Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. , 2014, Physiotherapy.

[10]  J. Dragoo,et al.  The effect of relaxin on the musculoskeletal system , 2013, Scandinavian journal of medicine & science in sports.

[11]  Adel F. Elbegawy,et al.  Effect of Abdominal Exercises versus Abdominal Supporting Belt on Post-Partum Abdominal Efficiency and Rectus Separation , 2013 .

[12]  G. Pascual,et al.  Understanding the Passive Mechanical Behavior of the Human Abdominal Wall , 2013, Annals of Biomedical Engineering.

[13]  Deborah L Lowe,et al.  Diastasis Recti Abdominis: A Survey of Women's Health Specialists for Current Physical Therapy Clinical Practice for Postpartum Women , 2012 .

[14]  V. Turan,et al.  Prevalence of diastasis recti abdominis in the population of young multiparous adults in Turkey. , 2011, Ginekologia polska.

[15]  A. Hsu,et al.  The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study. , 2011, The Journal of orthopaedic and sports physical therapy.

[16]  B. Seifert,et al.  The normal width of the linea alba in nulliparous women , 2009, Clinical anatomy.

[17]  L. Mclaughlin,et al.  Stability, continence and breathing: the role of fascia following pregnancy and delivery. , 2008, Journal of bodywork and movement therapies.

[18]  M. Stokes,et al.  Postpartum characteristics of rectus abdominis on ultrasound imaging. , 2008, Manual therapy.

[19]  N. Novo,et al.  Ultrasonography for measuring rectus abdominis muscles diastasis. , 2007, Acta cirurgica brasileira.

[20]  F. Leong,et al.  Prevalence of diastasis recti abdominis in a urogynecological patient population , 2007, International Urogynecology Journal.

[21]  R. Sapsford.  Rehabilitation of pelvic floor muscles utilizing trunk stabilization. , 2004, Manual therapy.

[22]  P. Hodges,et al.  Contraction of the pelvic floor muscles during abdominal maneuvers. , 2001, Archives of physical medicine and rehabilitation.

[23]  Sue Jones,et al.  Natural resolution of rectus abdominis diastasis. Two single case studies. , 2000, The Australian journal of physiotherapy.

[24]  R N Pierson,et al.  Appendicular skeletal muscle mass: effects of age, gender, and ethnicity. , 1997, Journal of applied physiology.

[25]  W. Gilleard,et al.  Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period. , 1996, Physical therapy.

[26]  P. Thompson,et al.  ACSM's Guidelines for Exercise Testing and Prescription , 1995 .

[27]  J. Boissonnault,et al.  Incidence of diastasis recti abdominis during the childbearing year. , 1988, Physical therapy.