Combined Effects of Hypopressive Exercises and Abdominal Bracing on Diastasis Recti Outcomes

Official title

Combined Effects of Hypopressive Exercises and Abdominal Bracing on Interrecti Distance, Lumbopelvic Pain, and Abdominal Muscle Strength in Diastasis Recti

Overview

Diastasis Recti Abdominis (DRA) is the separation of the rectus abdominis muscles along the linea alba, commonly seen after childbirth due to the mechanical and hormonal changes that occur during pregnancy. DRA can negatively affect posture, trunk stability, and breathing patterns, and may result in persistent lumbopelvic pain and weakened core muscles if not properly managed. Although hypopressive exercises and abdominal bracing have individually demonstrated positive effects in reducing inter-recti distance and improving core function, limited research exists regarding their combined effects. This randomized clinical trial aims to evaluate the combined impact of hypopressive exercises and abdominal bracing on inter-recti distance, lumbopelvic pain, and abdominal muscle strength in postpartum women with DRA. The study will include 34 postpartum women recruited from Jinnah Hospital, Lahore, who will be randomly assigned into two groups. Group A will receive both hypopressive exercises and abdominal bracing, while Group B will receive only hypopressive exercises along with standard postpartum physiotherapy. Outcome measures will include pain intensity, lumbopelvic disability, abdominal muscle strength, and inter-recti distance, with data analyzed using SPSS version 25.

Detailed description

Diastasis Recti Abdominis (DRA) is the separation of rectus abdominis muscles along the linea alba, which is common after childbirth due to the mechanical and hormonal changes that occur during pregnancy. DRA can affect posture, trunk stability, and breathing patterns, and may lead to persistent lumbopelvic pain and a weakened core if not managed properly. Although hypopressive exercises and abdominal bracing have individually shown promising results in reducing interrecti distance and improving core function, limited research is available on their combined effects. This study aims to evaluate the combined impact of hypopressive exercises and abdominal bracing on inter-recti distance, lumbopelvic pain, and abdominal muscle strength in postpartum women with DRA.

This study will be a randomized clinical trial. The study will be conducted at Jinnah Hospital, Lahore, over 10 months, involving a total of 34 postpartum women selected through non-probability convenience sampling. Participants will be randomly assigned to two groups: Group A will receive a combination of hypopressive exercises and abdominal bracing, and Group B will receive only hypopressive exercises. The hypopressive protocol includes diaphragmatic breathing cycles followed by rib cage expansion and a 10-second apnea, while the abdominal brace will be worn during waking hours for six weeks, except during bathing and exercising. Both groups will also receive standard postpartum physiotherapy. Outcome measures include the Numerical Pain Rating Scale (NPRS) to evaluate pain intensity, the Pelvic Girdle Questionnaire (PGQ) to assess lumbopelvic disability, Manual Muscle Testing (MMT) for abdominal muscle recti distance. Data will be analyzed using SPSS version 25, and with p-value of \<0.05 will be considered statistically significant.

Interventions

• Other Hypopressive exercise and Abdominal Bracing
  The hypopressive exercise protocol included maintaining spinal elongation, a neutral pelvis, knee flexion, and scapular muscle activation. Participants performed diaphragmatic breathing followed by full expiration and a 10-second apnea with rib cage expansion, causing inward abdominal contraction without inhalation. Exercises were performed in lying, sitting, standing, kneeling, and four-point kneeling positions. Each exercise was repeated three times with 30-second rest intervals. The intervent
• Other Hypopressive Exercise
  Each exercise was performed during the expiratory phase and required the contraction of the pelvic floor muscles. Participants were instructed to perform between 1 to 3 sets of 10 repetitions per exercise, holding each contraction for 5 seconds followed by 10 seconds of relaxation. The number of sets and the difficult level were progressively adjusted over time. This treatment protocol will be performed over a time period of 6 weeks

Primary outcome measures

• Numerical Pain Rating Scale (NPRS) [Time frame: 6 weeks]
• Pelvic Girdle Questionnaire (PGQ) [Time frame: 6 weeks]
• Manual muscle testing (MMT) [Time frame: 6 weeks]
• Tape measure and Finger-Width Method [Time frame: 6 weeks]

Eligibility criteria

Inclusion criteria

• Age group of 23 to 30 years

• Inter recti distance > 2 to 5 cm
• A women who had undergone a vaginal delivery at least 8 weeks before the first measurement
• A postpartum female with the presence of diastasis rectus abdominis
• BMI under or equal to 29kg/m2

Exclusion criteria

• Pregnant females (29)

• Subjects who underwent any recent abdominal surgeries
• Patient diagnosed with a Fibroid uterus
• Patient diagnosed with abdominal hernia
• Cesarean section (C-section)
• Chronic medical conditions such as diabetes, uncontrolled hypertension, cardiovascular disease, or thyroid disorders.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Other

Study locations

Pakistan · 1 center

• Jinnah Hospital — Lahore

Publications

• Hsia M, Jones S. Natural resolution of rectus abdominis diastasis. Two single case studies. Aust J Physiother. 2000;46(4):301-307. doi: 10.1016/s0004-9514(14)60291-9. PMID 11676815
• Mota P, Gil Pascoal A, Bo K. Diastasis recti abdominis in pregnancy and postpartum period. Risk factors, functional implications and resolution. Current women's health reviews. 2015;11(1):59-67
• Michalska A, Rokita W, Wolder D, Pogorzelska J, Kaczmarczyk K. Diastasis recti abdominis - a review of treatment methods. Ginekol Pol. 2018;89(2):97-101. doi: 10.5603/GP.a2018.0016. PMID 29512814
• Thabet AA, Alshehri MA. Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial. J Musculoskelet Neuronal Interact. 2019 Mar 1;19(1):62-68. PMID 30839304

Identifiers

NCT: NCT07642141 · REC/RCR & AHS/25/0525

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗