The Effects of Conservative Interventions for treating Diastasis Recti Abdominis in Postpartum Women: a Review with Meta-analysis

Intraobserver Reliability of Two-Dimensional Ultrasound Measurements of the Linea Alba in Parous Women During Different Abdominopelvic Exercises

OBJECTIVE

To assess the intraobserver reliability of Diastasis Recti Abdominis (DRA) measurement by ultrasonography during four specific abdominopelvic exercises, evaluating interrecti distance, Linea Alba (LA) thickness, and distortion index in parous women.

METHODS

Fifty-four parous women were assessed using ultrasound imaging for the LA. Four exercises were evaluated: crunch, abdominal drawing-in maneuver, pelvic floor muscle contraction, and one exercise based on the de Gasquet Method. Each exercise was performed three times. The ultrasound probe was placed 3 cm above and 2 cm below the umbilicus. Interrecti distance (IRD), distortion index, and LA thickness were measured and analyzed using ImageJ software by independent researchers. Intraobserver reliability was evaluated using the intraclass correlation coefficient (ICC) with a 95% confidence interval.

RESULTS

ICC values for the IRD ranged from 0.84 to 0.99 for the four exercises. The distortion index showed moderate to high reliability (ICC: 0.77-0.98), while LA thickness also demonstrated moderate to high reliability (ICC: 0.75-0.98).

CONCLUSION

The results demonstrate the reliability of ultrasound in measuring key parameters, including LA thickness, distortion, and IRD in women with DRA during various exercises. As a non-invasive tool, it supports evidence-based interventions in postpartum recovery and clinical practice.

Reliability of transversus abdominis thickness and inter-recti distance during forced expiration with limb adduction in primiparous women following vaginal delivery

INTRODUCTION

The postpartum period involves significant biomechanical changes that impact maternal health, particularly in the activation of the transversus abdominis (TrA) and the inter-recti distance (IRD), which may contribute to lumbo-pelvic pathologies. While lumbopelvic exercises are beneficial, it remains unclear whether upper or lower limb adduction combined with forced expiration is more effective in activating the TrA. Therefore, the primary objective of this study is to analyze changes in TrA thickness and IRD during four conditions. The secondary objective is to evaluate the intra-observer reliability of these ultrasound measurements.

METHODS

This cross-sectional study, conducted with a sample of 32 participants, assessed TrA thickness (primary outcome) and IRD (secondary outcome), quantified under four conditions: (1) resting position, (2) forced expiration, (3) forced expiration with upper limb adduction, and (4) forced expiration with lower limb adduction. Differences between the four conditions were analyzed using repeated measures ANOVA. The intra-observer reliability of these measurements was evaluated using intraclass correlation coefficients (ICC).

RESULTS

A total of 32 primiparous women between January and April 2024 were included in this study with a mean postpartum period of 9 ± 2.33. Significant variations in TrA thickness were observed across conditions (p < 0.001). Differences were noted between resting and forced expiration (MD = -0.17, p < 0.001) and forced expiration with lower limb adduction (MD = -0.20, p < 0.001) on both sides. For the right TrA, forced expiration differed from upper limb adduction (MD = -0.04, p = 0.007), while no difference was found between upper and lower limb adduction (MD = -0.005, p > 0.05). For IRD, no significant differences were detected across conditions, including resting and lower limb adduction (MD = -0.018, p = 0.727). Excellent intra-examiner reliability was demonstrated for all ultrasound measurements (ICC (1,3) 0.92-0.99).

CONCLUSIONS

There were no significant differences in TrA thickness between forced expiration isolated and when combined with adduction exercises. The high ICC values confirm the robustness of ultrasound measurements for TrA and IRD, highlighting the potential for future research in postpartum rehabilitation strategies.

Effect of hypopressive and conventional abdominal exercises on postpartum diastasis recti: A randomized controlled trial

BACKGROUND

Diastasis recti abdominis (DRA) is the separation of the rectus abdominis muscles along the linea alba, often occurring during pregnancy due to hormonal and mechanical changes. While DRA usually resolves post-childbirth, some women experience persistent issues. Exercise may help reduce the inter-rectus distance, though more research is needed.

OBJECTIVES

Analyze the immediate and long-term effects of hypopressive and conventional abdominal exercises on inter-rectus distance (IRD) in postpartum women, focusing on parity differences.

METHODS

Twenty-eight women who met specific inclusion criteria were randomly assigned to either the hypopressive group (n = 14) or the conventional group (n = 14). The exercise programs for both groups lasted 6 weeks. Ultrasound measurements were taken of the IRD at two locations above the umbilicus, 2 cm (AB2) and 5 cm (AB5), before and after exercise programs.

RESULTS

The IRD decreased after both exercise programs compared to baseline measurements in AB2 (mean difference: 3.06 mm, 95% CI: 1.06 to 5.05) and in AB5 (mean difference: 2.88 mm, 95% CI: 1.59 to 4.17), confirming the long-term effect of exercise. No differences were found between the application of the conventional exercise program or the hypopressive exercises, indicating that both had a similar positive effect. Regarding the immediate effect, after the performance of both programs, the IRD was greater during rest compared to abdominal contraction. This effect was more pronounced at AB5 location (mean difference: 1.00mm, 95% CI: 0.97 to 1.89). Conventional exercises result in a reduction during resting condition (mean difference: 4.52mm, 95% CI: 2.62 to 6.79), whereas with hypopressive exercises, the reduction occurs during muscle contraction (mean difference: 3.43mm, 95% CI: 1.21 to 5.65). With regard to parity, multiparous women benefit most from the application of exercise programs.

CONCLUSION

A reduction in IRD has been achieved with the implementation of both exercise programs in postpartum women, with multiparous women benefiting the most. Specifically, at 5 cm above umbilicus, conventional exercises result in a reduction during the rest condition, whereas with hypopressive exercises, the reduction occurs during muscle contraction.

TRIAL REGISTRATION

Clinical trial registration: NCT05439668.

Immediate effects of corrective exercise versus curl-up in women with diastasis recti abdominis

BACKGROUND/AIM

It is still unclear what types of exercise, beneficial to prevent and/or decrease diastasis recti abdominis (DRA). This study purposed to examine immediate effects of corrective exercise versus curl-up exercise on interrecti distance (IRD) and linea alba (LA) distortion in women with DRA.

MATERIALS AND METHODS

Twenty-three women with DRA were included. The IRD and the LA distortion (with distortion index formula) were measured with ultrasound imaging at rest, during curl-up and corrective exercise.

RESULTS

The IRD, measured at above and below umbilicus, and the distortion index were different between the measurements at rest, during curl up and correction exercise (p < 0.05). In corrective exercise, the change in the IRD at above umbilicus decreased more than rest (p = 0.009) and curl-up (p = 0.004). The change in the IRD at below umbilicus decreased more in corrective exercise than rest (p = 0.033) and curl-up (p = 0.028). The distortion index increased more in corrective exercise than rest (p = 0.006). The index increased more in curl-up than rest (p = 0.029).

CONCLUSION

The corrective exercise may be helpful in the treatment of DRA. Moreover, different muscle contractions that will provide the LA distortion should be taken into account in the treatment of DRA.

[Medical recommendations from primary care on physical exercise in the postpartum]

There is evidence that demonstrates the benefits of practicing physical activity/exercise for the mother after childbirth. However, this postpartum period (PP) is often a missed opportunity in a lifetime for women to start or resume physical exercise and get the great benefits that it can bring them. The objective of this article was to analyze the benefits of physical exercise during PP; the prescription of physical exercise; recommendations on when to resume your practice; barriers and facilitators; physical exercise during breastfeeding; as well as its role in the most frequent illnesses and discomforts in this period, always keeping in mind that the work of the primary care doctor is essential to motivate and encourage women to perform physical exercise in the PP.