Diastasis Recti Abdominis in Pregnant Women

January 2013 Newsletter for FitBack and Bumps Instructors

Article by Samantha Gillard – Women’s Health Clinical Specialist Physiotherapist.

I have often been asked ‘what happens if we pick up a Diastasis of Recti (DRA) in a pregnant lady just about to join the FitBack and bumps antenatal education and exercise programme?’ Can she join the course? Will the exercises help? To answer this question I have reviewed the only researched abdominal exercise programme designed to train the abdominal muscles during pregnancy and assessed the effect of the exercises on the DRA.

Article: Chiarello C, Falzone L, McCaslin K, Patel M, Ulery K. (2005) The effect of an exercise program on Diastasis Recti Abdominis in Pregnant Women. Journal of women’s Health Physical therapy 29: 1 p11-16

Aim: To determine the effect of an abdominal strengthening exercise programme on the presence and size of DRA in pregnant women.

Study Design:

Quasi-experimental post-test design
2 groups – non-exercise (recruited from private obstetric clinic) and women post a 6-week abdominal exercise programme.
24 pregnant women recruited aged between 20-40 years.

Inclusion criteria: women with single, low risk pregnancy between 16 to 35 weeks.

Excluded: multiple pregnancies / high-risk pregnancy.

Withdrawn from the study – 6 women: 2 women excluded due to developing high-risk pregnancies, 1 excluded as did not maintain exercise criteria, 3 women DNA therefore.

Actual participants: 8 in exercise group / 10 non-exercise group


Exercise programme

An exercise programme designed to engage the whole of the abdominal muscular unit. Pregnant women completed the exercise course prior to their DRA being measured.

6 x 90 minute exercise classes included: Abdomen drawn in at umbilicus to spine with all exercises to engage TrA

  • Pelvic tilts – supine, standing, all-fours, sitting
  • TrA & PFMC in sitting – long & short
  • TrA in sitting using upper extremity using exercise band – military press, lateral raises, chest press, shoulder external rotation, scapular retraction, biceps curls, triceps extension, forward pull, overhead pull sitting.
  • TrA – side-lying – hip abduction, hip flexion, adduction.
  • Supine – bridging.


DRA Measurement / procedure

  • Nylon digital caliper used
  • Measured at 3 locations – at umbilicus, 4.5cm above the umbilicus, 4.5 cm below umbilicus.
  • Test: crook lying – head & shoulder lift arms reaching up knees. Measured in this partial curl up position. Two examiners – one took measurement – one supported ladies shoulders. Then they swapped – each not knowing the result.

Results

  • Descriptive statistics for subjects relative to height, weight, age, week of pregnancy.
  • Independent sample t tests – if differences between groups
  • Exercise group: DRA was statistically significantly less than the non exercise group (p=0.0009)

 

Mean DRA Exercise group Non exercise group Comparison with Rath et al(1996) Inter Recti distance in normal non pregnant
4.5cm above umbilicus 9.6 mm 38.9mm / 405% larger 8.3mm
At umbilicus 11.4 mm 59.5mm / 522% larger 21.1mm
4.5cm below umbilicus 8.2 mm 60.4mm /736% larger 9.3mm


Variable between group numbers of previous pregnancies
:

  • Exercise group – mean = 1.25 (1-2 pregnancies)
  • Non-exercise group – mean = 2.3 (1-4 pregnancies).
  • Covariate analysis of previous pregnancies was not statically significant = p=0.611

Discussion

  • Results suggest that the exercise programme was most effective at decreasing the incidence of DRA at and below umbilicus.
  • Hypothesis drawn from the results: That all exercises targeting TrA, internal & External oblique muscles strengthen the integrity of the Linea Alba and strengthen the abdominal muscles. This is due to the fact that they all cross either over or under the rectus sheath via their aponeurosis to create the Linea alba.
  • The article therefore suggests that abdominal exercises should be used to treat DRA.
  • The results of this study were compared with Rath et al (1996). The inter recti distance of the pregnant exercise group was comparable to the Rath et al (1996) study. This therefore suggests that an exercise programme engaging all abdominal complex including TrA may be able to retain normal borders of Linea Alba or prevent a diastasis.

Conclusion:

The pregnant women who did not participate in the exercise programme exhibited a statistically larger separation of the Rectus Abdominis regardless of the location of measurement and the number of previous pregnancies.

A Diastasis of Recti in pregnancy could be prevented by; doing abdominal exercises that incorporate Traverse Abdominis (hollowing of umbilicus to spine with all abdominal exercises).

Limitations of study

  • Small sample,
  • Mostly Caucasian women
  • Did not assess women’s fitness prior to the exercise programme.
  • DRA not measured prior to exercise course.

Reflection

This small study has demonstrated that pregnant women can safely complete an abdominal muscle exercise programme without increasing the width of the Linea Alba. The abdominal exercises used within this study can be compared with the majority of the exercises incorporated within the Fitback and bumps antenatal programme. FitBack and Bumps antenatal exercise programme uses upper and lower limb movements to challenge recruitment of the abdominal muscles to maintain optimal spinal position. The study highlights the importance of drawing in Transverses Abdominis with all exercises. Additionally to this I would recommend that you educate all your mums to check that their abdomen does not dome around the umbilicus when performing the exercises.

Conclusion:  

I set out to answer the question as to whether pregnant ladies with a DRA should join in with the FitBack & Bumps antenatal education and exercise programme. Chiarello et al (2005) study has 100% demonstrated that the exercise group had a reduced DRA compared to the non-exercise group. In-spite of the limitations of the study we can use this research to promote the value of exercising the abdominal muscles safely through pregnancy to reduce the incidence of DRA. The study demonstrates the importance of maintaining abdominal muscular tone during pregnancy. Also pregnant women with DRA can continue to exercise their abdominal muscles safely as long as the abdomen does not dome during the exercises within the FitBack & Bumps exercise programme.

Reference

Rath A, Attali P, Dumas JL, Goldlust D, Zhang J, Cheverl JP. (1996) The abdominal Linea Alba: an anatomo-radiologic and biomechanical study. Surg Radiolic Anat. 18: 281-288