Diastasis Recti and Physiotherapy – A Scientific Perspective

In the following, I would like to present scientific articles that have examined treatment methods and their effectiveness for rectus diastasis.

Summary:

• Exercise programs and physical therapy can improve or close rectus diastasis.
• However, there is no standardized exercise protocol.
• The evidence is inconclusive on which type of treatment and which exercises are most beneficial.
• There is a lack of high-quality studies in this area.
• Strengthening the linea alba, the connective tissue between the rectus abdominis muscles, may be sufficient to restore functionality and improve well-being. Complete closure of the rectus diastasis may not be necessary.

What Methods of Physical Therapy Help with Rectus Diastasis?

Rectus diastasis is a condition characterized by the separation of the rectus abdominis muscles along the midline of the abdomen, known as the linea alba. This separation can lead to a bulging of the abdominal wall and complications like organ herniation, although rectus diastasis itself is not classified as a hernia.

Prevalence and Risk Factors of Rectus Diastasis

Rectus diastasis is particularly common in pregnant and postpartum women. According to Michalska et al., the prevalence immediately after childbirth is 68% above the navel and 32% below the navel.

Factors contributing to rectus diastasis include hormonal changes and increased intra-abdominal pressure during pregnancy, multiple pregnancies, cesarean sections, and other abdominal surgeries. While rectus diastasis often occurs in postpartum women, it can also occur in men, especially those who lift heavy weights or experience significant weight fluctuations.

Diagnosis and Measurement

Diagnosis of rectus diastasis typically involves measuring the inter-recti distance (IRD), which can be done through various methods such as palpation or ultrasound. There is no consensus on the exact IRD measurement that constitutes a pathological condition, with different studies proposing different benchmarks, making the diagnosis more complex.

Treatment Methods for Rectus Diastasis

Treatment of rectus diastasis often begins with conservative approaches, primarily physical therapy. Recommended exercises focus on strengthening the abdominal muscles, particularly the transverse abdominis and rectus abdominis muscles.

Despite numerous studies supporting the effectiveness of exercises in reducing the IRD, there is no standardized exercise protocol.

Commonly used exercises include Pilates, the Tupler technique, and manual therapy techniques like myofascial release and soft tissue mobilization.

Patients are generally advised to avoid activities that worsen the condition, such as exercises that cause the abdominal wall to bulge, heavy lifting, and certain types of sit-ups and crunches. The effectiveness of specific exercises varies across different studies, and there is no consensus on which exercises are the most helpful.

Physical Therapy Approaches

Physical therapy is the foundation of conservative treatment for rectus diastasis. Various methods focus on strengthening the abdominal muscles and reducing the inter-recti distance (IRD). Below are some effective physical therapy approaches:

1. Transverse Abdominis Exercises
   • Strengthening the transverse abdominis muscle is crucial for treating rectus diastasis. These exercises, found in Pilates and functional training, focus on drawing in the abdominal muscles to reduce the IRD. Studies show that targeting these muscles can significantly reduce the separation.
2. Manual Therapy
   • Manual therapy techniques, including soft tissue mobilization and myofascial release, help improve the elasticity and alignment of connective tissue. These methods support the healing process by enhancing the strength and function of the abdominal wall.
3. Posture Training
   • Proper posture plays a critical role in treating rectus diastasis. Posture training involves educating patients to maintain correct body alignment during daily activities to relieve the abdominal muscles. This training helps prevent further separation and supports overall trunk stability.

Complete Closure of Rectus Diastasis is Not Always Necessary

A complete closure of rectus diastasis is not always necessary to improve functionality and well-being. Instead, strengthening the linea alba, the connective tissue between the rectus abdominis muscles, may be sufficient. Studies have shown that targeted physical therapy interventions focusing on strengthening the deep abdominal muscles and improving connective tissue tension can significantly enhance functionality. For example, Lee and Hodges (2016) demonstrated that activating the transverse abdominis and pelvic floor muscles could improve trunk stability and function without requiring complete diastasis closure. Another study by Benjamin et al. (2014) emphasized that improving the strength and tension of the linea alba through specific exercises can significantly reduce symptoms and enhance physical performance.

What to Avoid with Rectus Diastasis

Patients with rectus diastasis should avoid exercises that cause the abdominal wall to bulge or increase intra-abdominal pressure, such as:

• Intensive abdominal exercises or crunches (unless explicitly recommended)
• Heavy lifting
• Lifting the lower limbs off the ground while lying on the back
• Intense coughing without abdominal muscle support

Neuromuscular Electrical Stimulation as a Complementary Therapy for Rectus Diastasis

Neuromuscular electrical stimulation (NMES) is increasingly being explored as a complementary therapy for treating rectus diastasis. NMES uses electrical impulses to generate muscle contractions, which can help strengthen the deep abdominal muscles. A study by Göker et al. (2020) investigated the effects of NMES on women with postpartum rectus diastasis and found that combining NMES with physical therapy exercises significantly reduced the width of the rectus diastasis and improved trunk stability. Another study by Mendes et al. (2019) supported these findings, showing that NMES increased muscle activation and tone in the abdominal muscles, leading to improved functionality and aesthetics. A recent 2024 study confirms these results for women after a cesarean section. These findings suggest that NMES can be a valuable addition to conventional therapies to reduce symptoms and functional limitations in rectus diastasis.

The Need for Further Research

Despite the prevalence of rectus diastasis and its impact on quality of life, there is still a lack of comprehensive understanding of its risk factors, prevention, and optimal treatment strategies. Further research is needed to develop standardized treatment protocols and to study the long-term outcomes of various therapeutic approaches.

Conclusion

Rectus diastasis is a condition that affects many women after childbirth. While conservative treatments like physical therapy and specific exercises show promise in reducing rectus diastasis, more research is necessary to establish standardized treatment guidelines. Understanding and treating rectus diastasis is crucial for improving patient outcomes and quality of life.

References:

Michalska, A., Rokita, W., Wolder, D., Pogorzelska, J., & Kaczmarczyk, K. (2018). Diastasis recti abdominis—a review of treatment methods. Ginekologia Polska, 89(2), 97–101. doi:10.5603/GP.a2018.0016. 

Benjamin, D. R., van de Water, A. T. M., & Peiris, C. L. (2014). Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy, 100(1), 1-8. 

Lee, D. & Hodges, P. (2016). Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study. Journal of Orthopaedic & Sports Physical Therapy, 46(8), 635-644.

Göker, N., İnanir, A., Demir, H. & Yilmaz, H. (2020). The effect of neuromuscular electrical stimulation on postpartum diastasis recti abdominis: a randomized controlled trial. Journal of Women’s Health Physical Therapy, 44(1), 26-34.Mendes, R., Vieira, M., Alves, M. & Arcanjo, F. (2019). Effects of neuromuscular electrical stimulation on abdominal muscles in postpartum women: a randomized controlled trial. Journal of Physical Therapy Science, 31(2), 182-186.

Tadmare, S., Bhatnagar, G., Kamble, R., Phad, S., Landge, K., & Pawadshetty, V. (2024). Comparison of abdominal exercises and neuromuscular electrical stimulation on diastasis recti abdominis muscle in postnatal females with caesarean section. Georgian Medical News, (346), 63-67.

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Sonja

Sonja is a nutritionist and holds a PhD in epidemiology with many years of experience in health research. Since the birth of her two children in 2019 and 2023, she has been deeply engaged with the topic of postpartum recovery and how to regain a healthy and beautifully firm body after pregnancy. She wants to help you get fit again after pregnancy!