Use of Exercise in the Management of Postpartum Diastasis Recti: A Systematic Review

Berg‐Poppe, Patti; Hauer, Michaela; Jones, Cassandra K; Munger, Mattison; Wethor, Cassidy

doi:10.1097/jwh.0000000000000231

Cited by 8 publications

(10 citation statements)

References 28 publications

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“…This is likely due to the fact that the PPR group received extra individual specified physical trainings during the first four weeks after delivery, led by experienced physical therapists. This finding is consistent with previous studies that specified post-partum physical exercises may be effective for reducing the prevalence of diastasis recti [41,42].…”

Section: Resultssupporting

confidence: 93%

Impact of a postpartum care rehabilitation program to prevent postpartum depression at a secondary municipal hospital in Qingdao China: a cross-sectional study

Zhang¹,

Zuo²,

Matheï³

et al. 2023

BMC Pregnancy Childbirth

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Background The emerging postpartum rehabilitation (PPR) program in Chinese hospitals characterized by applying ongoing medical care through traditional cultural practices shows a protective effect in early puerperium in China. This study explores the benefit of PPR program practices to postpartum depression (PPD) and the influencing factors for PPD among Chinese women during the first postnatal six weeks. Methods The cross-sectional study included 403 participants and was conducted in a Secondary Municipal Hospital in Qingdao, China, from 01 to 2018 to 31 December 2021. Information on this PPR program was collected during the six-weeks postpartum consultation, including the Edinburgh postnatal depression scale (EPDS) scores, the measurement results for diastasis recti abdominis, and the international physical activity questionnaire (long form) (IPAQ-L) scores. Logistic regression models were used to examine the effect of the PPR program on PPD among the local population. The secondary aim of this study was to investigate possible influencing factors for PPD, such as coronavirus disease 2019 (COVID-19), physical exercises, etc. Results PPR program has shown a positive effect in preventing PPD (p < 0.001) and diastasis recti prevalence (p < 0.001) during the six-weeks postnatal control in Qingdao, China. Better post-pregnancy weight reduction (p = 0.04) and higher metabolic equivalent of task (MET) value (p < 0.001) were noticed in the non-PPR group. Furthermore, lower PPD risk was associated with factors such as longer relationship duration years (2–5 years) (p = 0.04) and exercising one to three times a week (p = 0.01). A higher PPD risk was related to factors such as urinary incontinence during the postpartum period (p = 0.04) and subjective insomnia (p < 0.001). No significant effect was shown between COVID-19 and the EPDS score in this study (p = 0.50). Conclusion Our results suggested that the PPR program provided protection against PPD and diastasis recti during the first six weeks after delivery. Urinary incontinence and subjective insomnia were the main risk factors for PPD, while longer relationship duration years and exercising one to three times a week gave protective effects to PPD. This study emphasized that a comprehensive ongoing medical care program, such as the PPR program, effectively improves women’s mental and physical health in the early postpartum in China.

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Section: Resultssupporting

confidence: 93%

Impact of a postpartum care rehabilitation program to prevent postpartum depression at a secondary municipal hospital in Qingdao China: a cross-sectional study

Zhang¹,

Zuo²,

Matheï³

et al. 2023

BMC Pregnancy Childbirth

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“…Core stabilizing training is still the recommended first-line treatment and has been reported to improve core stability in many cases 27 . Several core training programmes have been presented with varying results regarding reduction of the inter-recti distance and abdominal core function 13 . Due to the heterogenous studies and varying outcomes, several management recommendations have been presented 28 .…”

Section: Discussionmentioning

confidence: 99%

“…Participants were either recommended a specific core stabilization training programme or had already participated in a specific core training programme without improvement in core stability or relief of symptoms. The training programme was a minimum of 3 months of specific deep core muscle exercises 13 . These began with light loads to gain effective force transmission and technique.…”

Section: Methodsmentioning

confidence: 99%

“…Management of RD differs widely regarding core training, indication and method of surgical repair, and postoperative rehabilitation. Core training is recommended as first-line treatment 13 , followed by surgical repair if symptoms persist 14–17 . Improvement in functional outcome after surgical reconstruction of RD has been observed, including decreased back pain, improvements in urinary incontinence, and gastrointestinal problems, improved abdominal core stability and body posture, as well as increased quality of life (QoL) 18 .…”

Section: Introductionmentioning

confidence: 99%

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The TOR concept (training, operation, and rehabilitation) applied to a cohort of postpartum women with training-resistant symptomatic rectus diastasis: evaluation 1 year after surgery

Olsson

Woxnerud²,

Kiwanuka

et al. 2023

BJS Open

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Background Rectus diastasis is a common sequela of pregnancy and is associated with functional disabilities such as back pain, abdominal core instability, abdominal muscle weakness, urinary incontinence, and psychological issues such as a negative body image. The aim of this study was to evaluate the effect of the TOR concept (training, operation, and rehabilitation), a novel concept for treating abdominal wall insufficiency combined with rectus diastasis, after pregnancy. TOR consists of preoperative evaluation of symptoms and custom-designed abdominal core training, tailored rectus diastasis repair, and individual progressive postoperative rehabilitation. Methods A consecutive series of women diagnosed with rectus diastasis and core dysfunction resistant to training, underwent plication of the linea alba between 2018 and 2020. After surgery, all patients participated in an individually designed rehabilitation programme over a 4-month interval. Physical function was recorded before surgery and 1 year after surgery using the disability rating index questionnaire. Symptoms associated with core instability were recorded before and 1 year after surgery. Quality of life was assessed using the SF-36. The abdominal wall anatomy was assessed with ultrasound before and 1 year after surgery. Results Seventy-one women were included and all attended 1-year follow-up. Response rate was 81.7 per cent (58) for the disability rating index, and 59.2 per cent (42) for SF-36. Self-reported physical function (disability rating index) improved in 54 of 58 patients (93.1 per cent), with a median score reduction of 91.3 per cent. Core instability symptoms decreased significantly. All SF-36 subscales improved significantly compared with preoperative scores, reaching levels similar to or higher than the normative Swedish female population. No recurrence of rectus diastasis was seen at the 1-year follow-up. Conclusions Surgical reconstruction within the TOR concept resulted in significant improvements in physical function and quality of life as well as a significant decrease in symptoms of core instability.

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“…A clinical diagnosis of DRA is most commonly made using palpation, and is established by determining whether the distance between the rectus abdominis heads, i.e. the IRD, is wider than normal (Noble 1982;Beer et al 2009;Van de Water et al 2016;Berg-Poppe et al 2022). Although ultrasound imaging (USI) has been found to be a more precise and reliable measure of IRD than palpation (Mota et al 2012;Keshwani et al 2015Keshwani et al , 2016Van de Water et al 2016;Hills et al 2018a), there is no consensus on a cut-off to diagnose or characterize this condition using any form of measurement, and a clinically meaningful distance has yet to be determined (Akram & Matzen 2014;Benjamin et al 2014;Sperstad et al 2016;Dufour et al 2019).…”

Section: Introductionmentioning

confidence: 99%

Does research support the current conservative care recommendations for pregnancy-related diastasis rectus abdominis? A scoping review

Dufour,

Petrusevski

2024

JPOGP

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Pregnancy-related diastasis rectus abdominis (DRA) is a widespread condition. The current evidence for its conservative management is contradictory, as are the criteria for making a diagnosis, which has stimulated debate among practitioners. The aim of this scoping review was to synthesize the existing peer-reviewed literature to determine whether there is evidence to support or refute recently published recommendations for the conservative care of perinatal DRA. These guidelines suggest that it should be approached from the perspective of considering the linea alba (LA) as an integrative component of the thoracopelvic abdominal system, which assumes functional relationships between the structures of the thorax and pelvis. Specifically, the present authors explored whether relationships exist between: (1) the LA and breathing mechanics; (2) pelvic floor muscle (PFM) function; (3) lumbopelvic pain (LPP) control; and (4) aspects of the structure and function of the abdominal wall. Of the 31 studies included, none were found relating to the LA and breathing mechanics, 11 investigated PFM function, 10 explored LPP, and 18 examined the LA with respect to the structure and/or function of the abdominal wall. The research reviewed does not appear to substantiate several of the recommendations for the conservative care of DRA, but does align with cited gaps in knowledge about this condition. The studies included neither support nor necessarily refute the relationships between breathing, PFM function and LPP. This scoping review also highlights the limitations of the current characterization of DRA and related assessment strategies, particularly the reliance on heterogeneous measurements of inter-recti distance as the primary and sometimes only measurement to inform clinical reasoning with respect to the condition.

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Use of Exercise in the Management of Postpartum Diastasis Recti: A Systematic Review

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 8 publications

References 28 publications

Impact of a postpartum care rehabilitation program to prevent postpartum depression at a secondary municipal hospital in Qingdao China: a cross-sectional study

Impact of a postpartum care rehabilitation program to prevent postpartum depression at a secondary municipal hospital in Qingdao China: a cross-sectional study

The TOR concept (training, operation, and rehabilitation) applied to a cohort of postpartum women with training-resistant symptomatic rectus diastasis: evaluation 1 year after surgery

Does research support the current conservative care recommendations for pregnancy-related diastasis rectus abdominis? A scoping review

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