Role of Physiotherapy in DIASTASIS RECTI By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH Dr Sunita Patel PT, India

1. By: EDWIN CHEONG ZI CHOZN
IN ASSOCIATION WITH
Dr Sunita Patel PT, India
Role of Physiotherapy in
DIASTASIS RECTI

2. By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

3. WHAT IS DIASTASIS RECTI? (CAVALLI ET AL., 2021)
• IS AN ACQUIRED CONDITIONS OCCURS FROM WIDENING OF THE INTER-RECTI DISTANCE BETWEEN THE TWO
BELLIES OF THE RECTUS ABDOMINIS MUSCLE AT THE LINEA ALBA WHICH HAPPENS DURING AND AFTER
PREGNANCY
HOW COMMON IS DIASTASIS RECTI?
• DIASTASIS RECTI ABDOMINAL (DRA) OCCURS MOST FREQUENTLY DURING PREGNANCY AND REGRESSES
SPONTANEOUSLY AFTER CHILDBIRTH IN MOST WOMEN. HOWEVER, AT 12 MONTHS POSTPARTUM, 33% OF
WOMEN STILL EXPERIENCE DRA (SPERSTAD ET AL., 2016)
• DRA MOST COMMONLY OCCURS DURING AND POST PREGNANCY AND ITS REPORTED INCIDENCE VARIES
BETWEEN 66% AND 100% IN THE FINAL TRIMESTER OF PREGNANCY, 53% POST-DELIVERY (WITHIN 24 HOURS)
AND UP TO 36% POST-NATALLY (UP TO 12 MONTHS)
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

4. MECHANISMS
• RECTUS ABDOMINUS AKA "SIX-PACK MUSCLES" RUNS VERTICALLY ALONG FRONT OF STOMACH IS DIVIDED
BY CONNECTIVE BAND CALLED LINEA ALBA. AS UTERUS EXPANDS INDIRECTLY INCREASE INTRA-ABDOMINAL
PRESSURE (IAP), IAP CAUSES ELASTIC BAND TO GET THINNER AND BECOME WIDER RESULTS IN PUSHING
OUTWARDS. OVERTIME, OVERSTRETCHED BAND LOSES ITS ELASTICITY AND LEAVING THE GAP AT
ABDOMINAL WALLS
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

5. ETIOLOGY
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

6. CAUSES
2ND & 3RD TRIMESTER
• BABY DEVELOPED RAPIDLY AND INCREASE INTRA-ABDOMINAL PRESSURE (IAP), WITH EXCESSIVE IAP
STRETCHES AND WIDENS CONNECTIVE TISSUES BETWEEN LEFT & RIGHT SIDE OF RECTUS ABDOMINUS
MUSCLE
VAGINAL DELIVERY
• PUSHING CAN DEVELOP IAP EASILY FROM EXPANDING UTERUS WHICH HELPED ALONG BY PREGNANCY
HORMONES RELAXIN AND ESTROGEN
POSTPARTUM PERIOD
• OVERSTRETCHED LINEA ALBA ESPECIALLY FIRST EIGHT WEEK POST DELIVERY THAT WON'T RETURN TO ITS
ORIGINAL STATE AS IT LOSES ITS ELASTICITY LEAVING GAP OF ABDOMINAL WALL UNCLOSE
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

7. RISK FACTORS
MINIMAL OR NO RISK FACTORS
• IN THE PAST, BODY MASS INDEX (BMI), WEIGHT GAIN DURING PREGNANCY, WEIGHT OF THE BABY, AND
MATERNAL AGE WERE CONSIDERED RISK FACTORS. BUT FROM A STUDY FOUND NO CONNECTION BETWEEN
THESE FACTORS AND PREGNANT WOMEN BEING MORE OR LESS LIKELY TO EXPERIENCE THE CONDITION
(KESHWANI ET AL., 2016)
• NO STATISTICALLY SIGNIFICANT DIFFERENCES WERE FOUND IN PREPREGNANCY BODY MASS INDEX (BMI),
WEIGHT GAIN, BABY'S BIRTH WEIGHT OR ABDOMINAL CIRCUMFERENCE BETWEEN WOMEN WITH AND
WITHOUT DRA AT 6 MONTHS POSTPARTUM (PATRICIA ET AL., 2015)
THE ONLY RISK FACTOR
• C SECTION ONLY SEEMS TO BE A RISK FACTOR FOR WOMEN WHO HAVE GIVEN BIRTH TWICE. (PREGNANT
WITH MULTIPLE CHILDREN MULTIGRAVIDA) (CAVALLI ET AL., 2021)
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

8. SIGN &
SYMPTOMS
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

9. SIGNS & SYMPTOMS (LAURA ET AL., 2021)
• DEGREES OF ABDOMINAL PAIN
• LOW BACK PAIN
• BLOATING/BULGE PROTRUDED AROUND BELLY BUTTON
• SOFTNESS OR JELLY-LIKE FEELING AROUND BELLY BUTTON
• PELVIC INCONTINENCE
• FEELING WEAK IN ABDOMENS (DECREASED TRUNK FLEXOR & ROTATERS
STRENGTH)
• POOR POSTURE
• DIFFICULTY LIFTING OBJECTS OR PERFORM DAILY TASKS
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

10. Assessment
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

11. SUBJECTIVE ASSESSMENTS
• PREGNANCY STAGES
• LABOR & DELIVERY HISTORY
• TYPES OF DELIVERY
• PAIN, AGGRAVATING & EASING FACTOR
• HISTORY OF ABDOMINAL ORGANS ILLNESS OR SURGERIES
OBJECTIVE ASSESSMENTS
• An adult is considered to have DRA when they present with an increased inter-recti
distance (IRD), characterized by an observable and palpable separation between the two
bellies of the rectus abdominis muscle (Keshwani et al., 2016)
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

12. PHYSICAL EXAMINATION
• LIE ON YOUR BACK WITH YOUR KNEES BENT. SLOWLY RAISE YOUR
HEAD AND SHOULDERS, REACHING TOWARD YOUR KNEES WITH
OUTSTRETCHED ARMS.
• WHILE MAINTAINING THIS POSITION, PLACE ONE HAND
HORIZONTALLY ALONG THE “CENTRE SEAM.” YOU SHOULD FEEL A
SOFTER REGION BETWEEN THE TAUT RECTI MUSCLES ON EACH
SIDE.
• MEASURE HOW MANY FINGERS FIT INTO THE SOFT GAP OR
BULGE.
• ONE TO TWO FINGERS IS NORMAL AND YOU MAY PERFORM
CURL-UPS. IF YOU CAN FIT THREE OR MORE FINGERS, YOU HAVE A
DIASTASIS
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

13. (Qu et al., 2021)
• There is no agreement as to the size of IRD considered to be pathological. The following parameters are given: 10
mm above the umbilicus, 27 mm at the umbilical ring and 9 mm below the umbilicus (below 45 years of age) and 15
mm, 27 mm and 14 mm respectively (above 45 years of age), above 2 cm, and in some older studies a less precise
parameter — above the 2 — finger width when measured in a crook lying position.
(Michalska et al., 2021)
• Another study shows a criterion to diagnosis Diastasis, an IRD of >2 mm at 3 cm below the umbilicus, >20 mm at the
umbilicus, and >14 mm at 3 cm above the umbilicus is considered as Diastasis
• A recent study by Mota and colleagues (2015) which studied 84 first-time pregnant women, found that 100% of
these women had DRA by gestational week 35 when using a diagnostic criterion of 1.6cm at 2cm below the umbilicus.
The prevalence decreased to 52.4% at 4-6 weeks postpartum and continued to decrease to 39% at 6 months.
(Sabine et al., 2021)
• Our present results revealed moderate-to-substantial reliability for the assessment
• Diastasis recti abdominis width can be measured by calliper, with an SEM of 4–5 mm and an MDC of about 1.2 cm.
However, assessment using this instrument requires some training and experience.
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

14. TREATMENT
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

15. ELECTRICAL
STIMULATION
Figure: Surface electromyography
• Electrical stimulation
benefits in treating
diastasis recti and more
effects can be seen
during first month of
postpartum and
decreases with time
(Ahmed et al., 2021)
• Rutuja et al. (2019)
provided evidence in his
study concluded that
group that underwent
electrical stimulation
followed by exercises
showed greater changes
in reduction of inter recti
distance
• Kamel and Jousif
(2017) showed that
neuromuscular electrical
stimulation with
abdominal exercises
was more effective in
reducing IRD (MD =
−0.65, 95% CI: −0.85,
−0.46) compared to
conventional abdominal
exercises alone
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

16. CORE STABILITY TRAINING
• Core stability exercise is one type of physical exercise that can be performed
on diastasis recti abdominis and this exercise is isometric (Gluppe et al., 2021)
• Core stability exercise performed routinely has been shown to be effective in
treating diastasis recti abdominis and is effective in reducing the distance
between diastasis recti abdominis and has the potential to reduce back pain
caused by diastasis recti abdominis (Yalfani, 2021)
• This exercise can be given to both groups of pregnant women or mothers after
normal delivery that can improve quality of life (Thabet & Alshehri, 2019)
• Condition may be reduced through implementation of a special training
programme focusing on strengthening anterior abdominal wall (Dominika &
Alexandra, 2018)
Dead bug exercise
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

17. PELVIC FLOOR TRAINING
Although immediate effect of
PFM contraction has shown a
widening of the inter-recti
distance (IRD) , but widening only
minimal (mm) and probably does
not influence diastasis recti
abdominus (DRA). Therefore
should not be discouraged from
doing PFM training in the
postpartum period. (Gluppe et
al., 2021)
Incorporate pelvic floor
muscle strengthening into
core stability protocol in
targeting pelvic floor,
transverse abdominus,
multifidus and diaphragm
significantly reduced IRD
(Thabet & Alshehri, 2019)
A RCT study concluded that
postpartum programme
including electromyographic-
biofeedback-assisted pelvic
floor muscle training (BAPFMT)
for women with diastasis recti
is feasible and improves the
quality of life (Liang et al.,
2022)
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

18. DRY NEEDLING
• A VERY THIN, SOLID MONOFILAMENT NEEDLE THAT INSERTED DIRECTLY
INTO THE MUSCLE BELLY
• IS A SAFE, QUICK, AND EFFECTIVE TREATMENT
• BEST TO RESOLVE VARIETY CONDITIONS EG: PELVIC INCONTINENCE,
DYSFUNCTION AND DIASTASIS RECTUS ABDOMINUS
• COULD BE APPLIED OVER MUSCLE GROUPS OF LOWER BACK, TL
JUNCTION (THE PART OF YOUR SPINE IN YOUR MID-BACK), GLUTES/HIPS,
ABDOMEN, AND INNER THIGH MUSCLES. By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

19. KINESIOTAPE
Applications (Maha, 2018)
(A) First pair of Kinesio taping strips applied over the
right and left recti from origin up to the insertion at the
xiphoid process.
(B) Second pair of Kinesio taping applied 4.5 cm
above and below the umbilicus centered on the site of
diastasis of rectus abdominus muscles.
In a study conducted by Lucyna et al. (2021) revealed that statistically significant reduction in rectus abdominis diastasis at
each of the observed sites after the application of KT tapes in the intervention group (p < 0.05). This concluded that through
application of KT tapes using the corrective technique can contribute to reducing diastasis recti in women up to 12 months
after delivery.
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

20. BREATHING EXERCISE
• The natural movement from
diaphragmatic breathing
technique (belly breath) trigger
the core muscle to lengthen and
contract naturally
• Oxygenated breath supplies
the core muscles to work
ideally, efficiently & grow
stronger
• Exercises that designed to
perform diaphragmatic
breathing technique & teach on
how to control muscle of
abdominal complex, include
transverse abdominus may be
able to minimize width of
existing diastasis recti
abdominus (Faith et al., 2021)
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

21. References
By: EDWIN CHEONG ZI CHOZN IN ASSOCIATION WITH
Dr Sunita Patel PT, India

22. • CAVALLI ET AL., (2021) PREVALENCE AND RISK FACTORS FOR DIASTASIS RECTI ABDOMINIS: A REVIEW AND
PROPOSAL OF A NEW ANATOMICAL VARIATION 25(4): 883–890.
HTTPS://WWW.NCBI.NLM.NIH.GOV/PMC/ARTICLES/PMC8370915/
• SPERSTAD ET AL. (2016) DIASTASIS RECTI ABDOMINIS DURING PREGNANCY AND 12 MONTHS AFTER CHILDBIRTH:
PREVALENCE, RISK FACTORS AND REPORT OF LUMBOPELVIC PAIN. BR J SPORTS MED. 2016;50:1092–1096.
DOI: 10.1136/BJSPORTS-2016-096065. HTTPS://WWW.NCBI.NLM.NIH.GOV/PMC/ARTICLES/PMC8370915/
• PATRICIA ET AL., (2015) PREVALENCE AND RISK FACTORS OF DIASTASIS RECTI ABDOMINIS FROM LATE PREGNANCY
TO 6 MONTHS POSTPARTUM, AND RELATIONSHIP WITH LUMBO-PELVIC PAIN ;20(1):200-5
HTTPS://PUBMED.NCBI.NLM.NIH.GOV/25282439/
• KESHWANI ET AL. (2016) INTER-RECTUS DISTANCE MEASUREMENT USING ULTRASOUND IMAGING: DOES THE
RATER MATTER?. PHYSIOTHERAPY CANADA. ;68(3):223-9. HTTPS://WWW.PHYSIO-
PEDIA.COM/DIASTASIS_RECTI_ABDOMINIS#CITE_NOTE-:0-9
• LAURA ET AL. (2021) SELF-REPORTED SYMPTOMS IN WOMEN WITH DIASTASIS RECTUS ABDOMINIS: A SYSTEMATIC
REVIEW 101995 HTTPS://WWW.SCIENCEDIRECT.COM/SCIENCE/ARTICLE/ABS/PII/S2468784720303652
• QU ET AL. (2021) THE ULTRASOUND DIAGNOSTIC CRITERIA FOR DIASTASIS RECTI AND ITS CORRELATION WITH
PELVIC FLOOR DYSFUNCTION IN EARLY POSTPARTUM WOMEN. QUANTITATIVE IMAGING IN MEDICINE AND
SURGERY ;11(2):706. HTTPS://WWW.PHYSIO-PEDIA.COM/DIASTASIS_RECTI_ABDOMINIS#CITE_NOTE-10
• MICHALSKA ET AL. (2021) DIASTASIS RECTI ABDOMINIS—A REVIEW OF TREATMENT METHODS ;89(2):97-101.
HTTPS://JOURNALS.VIAMEDICA.PL/GINEKOLOGIA_POLSKA/ARTICLE/VIEW/GP.A2018.0016/43304
• MOTA ET AL. (2015) PREVALENCE AND RISK FACTORS OF DIASTASIS RECTI ABDOMINIS FROM LATE PREGNANCY
TO 6 MONTHS POSTPARTUM, AND RELATIONSHIP WITH LUMBO-PELVIC PAIN. MANUAL THERAPY ;20(1):200-5.
HTTPS://WWW.PHYSIO-PEDIA.COM/DIASTASIS_RECTI_ABDOMINIS#CITE_NOTE-:2-4

23. • SABINE ET AL. (2021) CLINICAL ASSESSMENT OF PELVIC FLOOR AND ABDOMINAL MUSCLES 3 MONTHS POST PARTUM: AN INTER-RATER
RELIABILITY STUDY HTTPS://BMJOPEN.BMJ.COM/CONTENT/11/9/E049082
• AHMED ET AL. (2021) A RANDOMIZED CONTROLLED TRIAL TO EVALUATE THE EFFECT OF ABDOMINAL ELECTRICAL MUSCLE STIMULATION ON
ABDOMINAL WALL RESTORATION IN POSTPARTUM WOMEN VOLUME 10, NUMBER 3, PAGES 59-66
HTTPS://WWW.JCGO.ORG/INDEX.PHP/JCGO/ARTICLE/VIEW/755/471
• RUTUJA ET AL. (2019) EFFECT OF ELECTRICAL STIMULATION FOLLOWED BY EXERCISES IN POSTNATAL DIASTASIS RECTI ABDOMINIS VOL.9
HTTPS://WWW.IJHSR.ORG/IJHSR_VOL.9_ISSUE.3_MARCH2019/13.PDF
• KAMEL AND JOUSIF (2017) NEUROMUSCULAR ELECTRICAL STIMULATION AND STRENGTH RECOVERY OF POSTNATAL DIASTASIS RECTI
ABDOMINIS MUSCLES AND REHABILITATON MEDICINE, 41 (3) , PP. 465-474 HTTPS://PUBMED.NCBI.NLM.NIH.GOV/28758085/
• DOMINIKA & ALEXANDRA (2018) EXERCISES FOR PREGNANT AND POSTPARTUM WOMEN WITH DIASTASIS RECTI ABDOMINIS – LITERATURE
REVIEW 32(3):27-35
HTTPS://WWW.RESEARCHGATE.NET/PUBLICATION/330656852_EXERCISES_FOR_PREGNANT_AND_POSTPARTUM_WOMEN_WITH_DIASTASI
S_RECTI_ABDOMINIS_-_LITERATURE_REVIEW
• GLUPPE ET AL. (2021). WHAT IS THE EVIDENCE FOR ABDOMINAL AND PELVIC FLOOR MUSCLE TRAINING TO TREAT DIASTASIS RECTI
ABDOMINIS POSTPARTUM? A SYSTEMATIC REVIEW WITH META-ANALYSIS. BRAZ J PHYS THER. 25(6): 664-675. DOI:
10.1016/J.BJPT.2021.06.006. HTTPS://WWW.SCIENCEDIRECT.COM/SCIENCE/ARTICLE/PII/S1413355521000733
• THABET & ALSHEHRI (2019). EFFICACY OF DEEP CORE STABILITY EXERCISE PROGRAM IN POSTPARTUM WOMEN WITH DIASTASIS RECTI
ABDOMINIS: A RANDOMISED CONTROLLED TRIAL. J MUSCULOSKELET NEURONAL INTERACT. 19(1): 62–68.
• YALFANI (2021). THE EFFECTS OF SUSPENSION (TRX) VERSUS CORE STABILIZATION TRAINING ON POSTURAL STABILITY, LUMBOPELVIC
CONTROL AND PROPRIOCEPTION IN WOMEN WITH DIASTASISRECTI ABDOMINIS : A RANDOMIZED CONTROLLED TRIAL. RES. SQUARE. 1–21.
• LIANG ET AL. (2022) REHABILITATION PROGRAMME INCLUDING EMG-BIOFEEDBACK- ASSISTED PELVIC FLOOR MUSCLE TRAINING FOR
RECTUS DIASTASIS AFTER CHILDBIRTH: A RANDOMISED CONTROLLED TRIAL HTTPS://PUBMED.NCBI.NLM.NIH.GOV/36219918/

24. • MAHA (2018) EFFECT OF KINESIO TAPING THERAPY ON WAIST CIRCUMFERENCES IN POSTPARTUM WOMEN
VOLUME : 1 ISSUE : 1 PAGE : 48-53 HTTPS://WWW.JMSR.EG.NET/ARTICLE.ASP?ISSN=2537-
091X;YEAR=2018;VOLUME=1;ISSUE=1;SPAGE=48;EPAGE=53;AULAST=MADY
• LUCYNA ET AL. (2021) IMMEDIATE EFFECTS OF KINESIO TAPING ON RECTUS ABDOMINIS DIASTASIS IN
POSTPARTUM WOMEN—PRELIMINARY REPORT 10(21): 5043
HTTPS://WWW.NCBI.NLM.NIH.GOV/PMC/ARTICLES/PMC8584338/
• FAITH ET AL. (2021) POSTPARTUM EXERCISE INTERVENTION TARGETING DIASTASIS RECTI ABDOMINIS 14(3):
400–409. HTTPS://WWW.NCBI.NLM.NIH.GOV/PMC/ARTICLES/PMC8136546/#B14-IJES-14-3-400

25. By: EDWIN CHEONG
ZI CHOZN
IN ASSOCIATION
WITH
Dr Sunita Patel PT,
India