Which Exercises Close Diastasis Recti Abdominis In Parous Women? An Experimental Cross-sectional Study

Abstract

Diastasis recti abdominis (DRA) is defined as an impairment with midline separation of the two rectus abdominis muscles along the linea alba. The condition affects a significant number of women during the antenatal- and postnatal period and is hypothesized to cause abdominal-, pelvic-, and low back pain, decreased abdominal muscle strength, as well as cosmetic concerns. A study among US physical therapists found that the most commonly used exercises in treatment of DRA were indrawing and pelvic floor muscles (PFM) exercises. However, experimental studies have found that both indrawing and PFM contraction increase the inter-recti distance (IRD). Randomized controlled trials (RCT) are few, and both interventions and results differ between studies. PURPOSE: To investigate the immediate effect of different abdominal- and PFM exercises on IRD in women with DRA. METHODS: Following power calculation of sample size, 38 parous women were included in this cross-sectional study. 2D ultrasound was used to measure IRD at rest and in random order of eight different exercises. A paired t-test was used to compare IRD at rest with IRD recorded during each of the exercises and differences between exercises. Means with 95% confidence intervals (CI) are reported. P-value was set to <0.05. RESULTS: Head lift and twisted crunch significantly decreased the IRD, both above and below the umbilicus. Above the umbilicus, the mean difference between rest and head lift was 10 mm (95% CI: 7, 13.2, p˂.001) and twisted crunch 9.4 mm (95% CI: 6.3, 12.5, p˂.001). Below the umbilicus, the mean difference between rest and head lift was 6.1 mm (95% CI: 3.2, 8.9, p˂.001) and twisted crunch 3.5 mm (95% CI: 0.5, 6.4, p =.02). PFM contraction, maximal in-drawing and PFM contraction+maximal in-drawing increased the IRD below the umbilicus, mean difference; -2.8 mm (95% CI: -5.2, 0.5, p =.02), -4.7 mm (95% CI: -7.2, -2.1, p˂.001) and -5.0 mm (95% CI: -7.9, -2.1, p˂.001), respectively. CONCLUSION: Head lift and twisted crunch decrease, while maximal in-drawing and PFM contraction increase the IRD. RCTs are needed to investigate whether head lift and twisted crunch are effective in permanently narrowing the IRD. The Norwegian Women`s Public Health Association fully founded the study.