Curl-up exercises improve abdominal muscle strength without worsening inter-recti distance in women with diastasis recti abdominis postpartum: a randomised controlled trial

Key Points

1. Abdominal exercises do not appear to worsen or increase Diastasis rectus abdominis (DRA).
2. Abdominal exercises do increase the strength of abdominal muscles in people with DRA.
3. Women should not be discouraged from participating in abdominal exercises.

BACKGROUND & OBJECTIVE

Diastasis rectus abdominis (DRA) is a common phenomenon that occurs during pregnancy and may persist in the post-partum period. While very common, there is not yet standardized approaches for measuring, diagnosing, or treating DRA in the post-partum population (1).

This study aimed to evaluate the effect of a 12-week home-based abdominal exercise program on the inter-recti distance (IRD) in women 6 to 12 months post-partum. An additional aim of the study was to see if the intervention impacted abdominal muscle strength or endurance, rectus abdominis thickness, pelvic floor disorders, pain, or global perceived change.

There is not yet standardized approaches for measuring, diagnosing, or treating Diastasis rectus abdominis in the post-partum population.

Abdominal exercises may not reduce the Diastasis rectus abdominis (DRA), but the abdominal exercises did make the abdominal muscles stronger without worsening the DRA.

METHODS

• Women diagnosed with DRA 6 to 12 months post-partum were included in this assessor-blinded, two-arm, parallel-group randomized controlled trial.

• The control group was discouraged from doing any specific abdominal exercises, but other physical activity was not discouraged.

• The intervention group received a standardized, progressive exercise program to be done independently for 10 minutes per day, five days a week for 12 weeks.

CURL-UP EXERCISES FOR ABDOMINAL MUSCLE STRENGTH IN WOMEN WITH DIASTASIS RECTI ABDOMINIS POSTPARTUM

• A total of 35 participants were included in each group.

• Outcome measures included change in IRD, observed movement of the abdomen, global rating of change, rectus abdominis thickness, and abdominal muscle strength and endurance.

• Participants were also questioned about the presence of any pelvic floor disorders, low back pain, pelvic girdle pain, or abdominal pain.

RESULTS

There was little to no difference in IRD found in either group, indicating the exercises did not significantly impact IRD. There was no worsening of the IRD noted in any participants, though participants in both groups reported improvement. The exercise group demonstrated improved maximal isometric strength compared to the control group, but the effects were small. There was also no significant impact on reports of pain or pelvic floor dysfunction.

LIMITATIONS

The unsupervised nature of the interventions may have reduced adherence or intensity of the training. The reliability of the abdominal strength tests is unknown. Another limitation is the small sample size of women, especially the small number of women with severe diastasis. This limits the generalizability of the findings to women, especially with more severe diastasis.

CLINICAL IMPLICATIONS

The prevalence of DRA in women is unknown, but DRA is a common occurrence during pregnancy and in the postpartum period. Most women experience spontaneous recovery from DRA, but many express concerns about their lack of recovery. For example, it was found that 72% of women were excluded from this study because while they believed that they had a significant DRA, they did not meet the inclusion criteria for having a DRA of at least 2.5cm during a curl-up.

DRA has been identified as having a negative impact on women for various reasons, such as a negative body image and reduced physical functioning (2). While DRA has not been correlated with pelvic organ prolapse, pelvic pain, urinary incontinence, or low back pain, DRA may cause women to avoid or discontinue physical activity. The benefits of physical activity are well established, and the World Health Organization recommends women start or continue exercise programs throughout pregnancy and the post-partum period (3).

Current evidence does not support the belief that physical activity or exercise, particularly abdominal exercises, could make the DRA worse. This study has shown that abdominal exercises may not reduce the DRA, but the abdominal exercises did make the abdominal muscles stronger without worsening the DRA.

+STUDY REFERENCE

Gluppe S, Engh M, Bø, K (2023) Curl-up Exercises Improve Abdominal Muscle Strength without Worsening inter-recti Distance in Women with Diastasis Recti Abdominis postpartum: a Randomised Controlled Trial. Journal of Physiotherapy, 69(3), 160–167.

SUPPORTING REFERENCE

1. Cavalli, M, Aiolfi, A, Bruni, PG, Manfredini, L, Lombardo, F, Bonfanti, MT, Bona, D & Campanelli, G 2021, ‘Prevalence and Risk Factors for Diastasis Recti abdominis: A Review and Proposal of a New Anatomical Variation’, Hernia, vol. 25, no. 4, pp. 883–890.
2. Fuentes Aparicio, L, Rejano-Campo, M, Donnelly, GM & Vicente-Campos, V 2021, ‘Self-reported Symptoms in Women with Diastasis Rectus Abdominis: a Systematic Review’, Journal of Gynecology Obstetrics and Human Reproduction, vol. 50, no. 7, p. 101995.
3. Evenson, KR, Mottola, MF & Artal, R 2019, ‘Review of Recent Physical Activity Guidelines During Pregnancy to Facilitate Advice by Health Care Providers’, Obstetrical & Gynecological Survey, vol. 74, no. 8, pp. 481–489.