Physiotherapy Diastasis Recti

May 8, 2022

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Physiotherapy Diastasis Recti

What should exercise therapy include?

The treatment approach depends on your condition, and in particular, the extent of abdominal separation.

For separations that are smaller than 4 finger widths, corrective exercise is the best first line approach in order to help draw the two bellies of the rectus abdominus together. Exercise is typically done for 2 to 6 weeks until the separation is closed or less than 2 finger widths.

Corrective exercises should include strengthening your inner core and support muscles. The diaphragm is the main breathing muscle, multiifidus the deep back muscle and transversusAbdominus the body’s equivalent for a corset.

Strengthening the transversus abdominis muscles may be one of the best therapeutic targets, as it has been the subject of the majority clinical trials (ref10).

Research has shown that fascial connections between the transversus Abdominus and the rectus Absdominus are strong. Strengthening of this muscle can therefore help draw the two rectus abdominus muscle bellies together and increase fascial tension (ref8). This allows loads to move more easily through the pelvis, whether they are lifted or exercise. The strengthening of the transversus Abdominus may be done in a variety of ways. Unfortunately, no consensus has been reached.

Physiotherapy for diastasis recti should consider more than just the separation. It is important to address the problem of pelvic floor muscles retraining. Retraining the pelvic floor muscles is an important area of treatment that often goes untreated. More than 70% cannot contract their pelvis in the presence rectus diastasis. This makes them more susceptible to incontinence and prolapse (ref11). Poor movement patterns can also be caused by poor posture and body mechanics. Seeking the guidance of a physiotherapist, in particular one with training in pelvic floor physiotherapy, can be beneficial.

A corset or binder can help with larger separations, which are typically 4 inches or more. It can be worn all day long and then taken off when you need to bathe or do other exercises. If you have exhausted all options for exercise and fulfill a variety of other criteria, abdominoplasty may be an option. Some symptoms such as low back pain may be relieved by surgery (ref12), although it can also have aesthetic advantages.

References

Coldron Y., Stokes M., Newham D., et al. The ultrasound imaging of the postpartum rectus abdominis shows different characteristics. Man Ther. 2008; 13:112-121.

Benjamin D.R., van de Water A.T., Peiris C.L. Studies of the effects that exercise can have on the diastasis of rectus Abdominis muscle, both in the post- and antenatal phases: A systematic review. Physiotherapy. 2014 Mar;100(1):1-8.

Boissonnault J.S., Blaschak M.J. Diastasis recti abdominalis is a common condition in the first year of childbearing. Physical therapy. 1988; 68:1082-1086 abstract Rath A.M., Attali P., Dumas J.L., et al. Anato-radiological and biomechanical studies of the abdominallinea alba. Surg Radiol Anat. 1996;18:281-288.

Gunnarsson U., Stark B., Dahlstrand U., et al. Correlation of abdominal rectus distasis width with abdominal muscle strength. Dig Surg. 2015;32(2):112-6.

Lo T. Janssen T. Candido G. Janssen A. Diastasis through pregnancy of the recti abdominalis: treatment and risk factors Physiother Can. 1999;44:32-37.

Gilleard W.L. Brown Jr. Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period. Phys Ther. 1996;76:750-62.

Lee D.G. Lee L.J. McLaughlin L. Stability. Continence. and Breathing. J Bodywork Move Ther. 2008;12:333-48.

Mota P., Pascoal A.G., Carita A.I., et al. The immediate results of the inter-rectus distance between abdominal crunch exercise and drawing-in during pregnancy, and after delivery. J Orthop Sports Phys Ther. 2015 Oct;45(10):781-8.

Pascoal A.G., Dionisio S., Cordeiro F., et al. A preliminary case-control study has shown that inter-rectus distance can be decreased in post-partum women by isometric contractions of the abdominal muscles. Physiotherapy. 2014 Dec;100(4)344-8.

Spitznagle T.M., Leong F.C., Van Dillen L.R. Diastasisrecti Abdominis prevalence in a urogynecological patient group. Int Urogynecology J Pelvic Floor Dysfunct. 2007 Mar;18(3):321-8.

How is Physiotherapy for Diastasis Recti Therapy?

Physiotherapy is a concept that is relatively new to most Singaporeans. Most Singaporeans don’t fully know the meaning and purpose of physiotherapy. Physiotherapy refers to the study and treatment of the musculoskeletal system. This includes muscles, bones joints ligaments and tendon. The goal of physiotherapy is to relieve pain, improve mobility and restore full physical function. This means helping our clients get back to their level of physical activity. Others may be able achieve a higher treatment goal than they have previously been able. Individualised physiotherapy treatment can be very effective and tailored to the individual. This is why it’s important for you to discuss with your therapist the root cause of your problem and what your treatment goals will be.

One example is a runner who could only manage 5km without feeling knee pain. He may consider physiotherapy to treat the problem. His goal might be to run a marathon of 21 km without experiencing any knee pain. Depending on our client’s objectives, our physiotherapists develop a treatment plan to help them get there.

There may also be other problems, such as back pain or incontinence depending on the severity and extent of diastasisrecti. These symptoms can also be treated with physiotherapy.

What is Physiotherapy’s role in diastasis recti treatment?

Diastasis Recti, a common musculoskeletal disorder that can sometimes be resolved with physiotherapy. The treatment of physiotherapy does not include painkillers. Instead, manual therapy and exercise therapy are used. These could include muscle releases, stretches and strengthening exercises. Diastasisrecti is a condition where core strengthening exercises are recommended by a physiotherapist. These will be suitable for pregnant women and can also be used to strengthen the pelvis.

Based on your diagnosis, the therapist will create a plan of treatment that best suits your needs and help you return to normal. The primary goals of physiotherapy treatments to fix diastasisrecti are:

Determining The Severity Of Your Condition

The first step in a successful, effective recovery process is establishing a diagnosis. Because this is the foundation for any future treatment, accurate diagnosis is vital. Core Concepts recognizes the importance treating the root cause, not only the symptoms. Thus, our physiotherapists take the time to fully grasp the situation based on the symptoms that occur before coming up with a diagnosis.

Diastasisrecti is caused by a separated rectus abdominus. Strengthening your core muscles is the key focus. As we mentioned in the previous article, weak core muscles can cause the separation due to your growing belly. You are at greater risk if there have been multiple births and if your baby has been particularly heavy.

A physiotherapy session can be used to help strengthen core muscles. This involves an assessment of how severe the problem is and the development of a plan for strengthening them.

Diastasis Recti could cause instability of the pelvic floor due to weak abdominal muscles. Pelvic floor instability can cause incontinence and result in inconvenient instances such as urine leakage. Our team can assist you in strengthening your pelvic muscles, so these problems do not happen again.

Abstract

Scope: The aim of the study was to examine the feasibility and effectiveness of two physiotherapy interventions that treat diastasisrecti recti (DRA) in women who present with DrA within the post-partum time period. Based on the recruitment of study participants, their compliance, attrition and rates, feasibility was calculated. Also, treatment effect sizes were computed for each intervention in comparison to none. Inter-rectus distance was determined using ultrasound. Body image and pain were also measured. Functional measures using questionnaires were used. Tissue flexion strength, endurance and muscle strength were all measured using clinical tests. Attrition rates of 16% and 50% respectively were the intervention adherence rates. The combination therapy group had both an abdominal binding only and combined therapy group that showed positive body images (Cohen’s effects d(d)) = 0.2-0.0.5) after 6 month. In the combination therapy, a positive effect was seen on trunk flexibility strength (d =0.7). It is possible to conduct a clinical trial with these interventions, however further research is suggested.

Keywords; Physiotherapy. Abdominal muscles. Body Image. Diastasisrecti. Pregnancy.

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The American Physical Therapy Association believes that consumers should have access to information that could help them make health care decisions, and also prepare them for a visit with their health care provider.

Here are some articles that provide the latest scientific evidence regarding physical therapy treatments for diastasisrectus abdominalis. They provide an overview and report on recent research, as well as information about the current standards of practice in America and abroad. The article titles are linked either to a PubMed* abstract of the article or to free full text so that you can read it or print out a copy to bring with you to your health care provider.

Thabet AA, Alshehri MA. Study of postpartum diastasis recti body inflicted women who have completed a deep core stability exercise program. J Musculoskelet Neuronal Interact. 2019;19(1):62.

Hills NF, Graham RB, McLean L. Comparison of trunk muscle function between women with and without diastasis recti abdominis at 1 year postpartum. Phys Ther. 2018;98(10):891-901.

Keshwani, Mathur, McLean L. Interrectus distance and severity of diastasisrecti Abdominis symptoms among women who have given birth in the first postpartum. Phys Ther. 2018;98(3):182-190.

Kamel DM, Yousif AM. Neuromuscular electrical stimulation and strength recovery of postnatal diastasis recti abdominis muscles. Ann Rehabil Med. 2017;41(3):465.

Benjamin DR, van de Water AT, Peiris CL. A systematic review of effects of exercise on the diastasis and rectus abdominis muscles in pregnancy, antenatal, and post-natal. Physiotherapy. 2014;100(1):1-8.

Abstract

Background: Diastasis (or diastasis) of the rectus abdominal muscle (DRAM), is a common condition that can occur during or after pregnancy. It has been associated with lumbopelvic instabilities and weak pelvic floors. Women suffering from DRAM often see physiotherapists to help them with their conservative management. However, little information is available about how effective these strategies are.

The objectives of this study were to determine whether non-surgical intervention (like exercise) can prevent or decrease DRAM.

Data sources: EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro were searched.

Study selection/eligibility: Studies of all designs that included any non-surgical interventions to manage DRAM during the ante- and postnatal periods were included.

Analyzing and synthesizing study data: A modified Downs-Black checklist was used for methodological quality assessment. A fixed-effect model was used to perform meta analysis. This allowed for the calculation of risk ratios (RR), as well as 95% confidence intervals, (CI) when appropriate.

Results: There were eight studies that included 336 women from the pre- and/or post-natal periods. From a case study to randomized controlled trials, the study design varied. Every intervention involved some exercise. The majority of the interventions were targeted at abdominal/core strength. Evidence showed that DRAM presence was reduced by 35% by exercise in the antenatal and postnatal period (RR 0.65; 95%CI 0.46- 0.92). This suggests that DRAM size may be decreased by working out during the antenatal and postnatal periods.

Limitations: The papers reviewed were of poor quality as there is very little high-quality literature on the subject.

Conclusion and implications

Keywords: Abdominal muscles. Diastasis recti. Weakness of the linea ala. Exercise.

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