Background: Pregnancy is the most common cause of a diastasis recti abdominis (DRA), usually occurring during the third trimester. An abnormally wide interrecti distance (IRD) from a DRA can persist up to 1 year postpartum or longer. Although some women can fully recover function with an abnormally widened IRD, in others impaired muscle contractility of the abdominals decreases trunk stability and strength during load transfer activities of daily living. Diastasis recti abdominis has also been correlated with support-related pelvic floor impairments persisting years after delivery. There is a paucity of research describing conservative interventions for DRA, and no existing clinical protocols for best practice patterns at present to guide the physical therapist. This case report describes physical therapy intervention for a postpartum patient with a large DRA.
Study Design: Case study with review of the literature.
Case Description: This report describes physical therapy intervention for a 32-year-old gravida 2, para 2 (G2P2) woman referred at 7 weeks postpartum with a DRA measuring 11.5 cm IRD at the umbilicus and extending more than 9 cm vertically along the linea alba.
Outcome: The patient attended 18 sessions from evaluation to discharge over a 4-month period. Interrecti distance was reduced to 2.0 cm at the widest point of separation. She regained functional strength and achieved all goals for load transfer activities: standing, walking, lifting and carrying her child, and light jogging.
Discussion: The patient in this case report demonstrated successful reduction of IRD of a large DRA and restoration of functional strength with physical therapy intervention. Physical therapists play an important role in identifying and treating patients with significant DRAs. However, guidelines are currently not available in the literature identifying how large of a diastasis can be conservatively treated with exercise. Interventions should include patient education on precautions with DRA, therapeutic progressive exercise with abdominal muscle retraining, and recommendations for support garments or self-bracing of recti muscles during trunk flexion.