Diastasis Recti During Pregnancy and Postpartum

  • Patrícia MotaEmail author
  • Augusto Gil Pascoal
  • Cristiana Vaz
  • Filipa João
  • António Veloso
  • Kari Bø
Part of the Lecture Notes in Computational Vision and Biomechanics book series (LNCVB, volume 29)


Diastasis recti abdominis (DRA) or increased inter-rectus distance (IRD) is characterized by the separation of the rectus abdominis muscles. It has its onset during pregnancy and the first weeks following childbirth. The reliability of the instruments used to assess this condition is unclear. There is scant knowledge on the prevalence and risk factors for development of the condition. There is little evidence on which exercises are most effective in reduction of DRA. The aims of our studies were to establish a reliable method for the assessment of the morphology of the abdominal wall, describe DRA prevalence, risk factors, and evaluate the acute response on the IRD induced by drawing-in and abdominal crunch exercises. The results of three methodological studies showed ultrasound imaging to be a reliable method for measuring IRD. The ultrasound transducer can be held relatively stationary in a clinical setting, to evaluate IRD. DRA is prevalent at 6 months postpartum, with a prevalence rate of 39%. The acute response on IRD produced by drawing-in exercise was a widening of the IRD in postpartum, while the abdominal crunch exercise induced an acute narrowing response of the IRD in pregnancy and in postpartum.


Diastasis recti Inter-rectus distance Ultrasound Postpartum 


  1. 1.
    Boissonnault JS, Blaschak MJ (1988) Incidence of diastasis recti abdominis during the childbearing year. Phys Ther 68(7):1082–1086CrossRefGoogle Scholar
  2. 2.
    Standring S (2008) Gray’s anatomy [Internet]. Elsevier Health SciencesGoogle Scholar
  3. 3.
    Gilleard WL, Brown JM (1996) Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period. Phys Ther 76(7):750–762CrossRefGoogle Scholar
  4. 4.
    Foti T, Davids JR, Bagley A (2000) A biomechanical analysis of gait during pregnancy. J Bone Joint Surg Am 82(5):625–632CrossRefGoogle Scholar
  5. 5.
    Cunningham F, Leveno K, Bloom S, Spong CY (2009) Williams obstetrics, 23rd edn. McGraw-HillGoogle Scholar
  6. 6.
    Davies GAL, Wolfe LA, Mottola MF et al (2003) Joint SOGC/CSEP clinical practice guideline: exercise in pregnancy and the postpartum period. Can J Appl Physiol 28(3):330–341CrossRefGoogle Scholar
  7. 7.
    Gilleard W, Crosbie J, Smith R (2002) Effect of pregnancy on trunk range of motion when sitting and standing. Acta Obstet Gynecol Scand 81(11):1011–1020CrossRefGoogle Scholar
  8. 8.
    Fast A, Weiss L, Ducommun EJ et al (1990) Low-back pain in pregnancy. Abdominal muscles, sit-up performance, and back pain. Spine 15(1):28–30CrossRefGoogle Scholar
  9. 9.
    Dumas GA, Reid JG, Wolfe LA et al (1995) Exercise, posture, and back pain during pregnancy. Clin Biomech 10(2):104–109CrossRefGoogle Scholar
  10. 10.
    Rett MT, Braga MD, Bernardes NO et al (2009) Prevalence of diastasis of the rectus abdominis muscles immediately postpartum: comparison between primiparae and multiparae. Braz J Phys Ther 1 13(4):275–280.
  11. 11.
    Coldron Y, Stokes MJ, Newham DJ et al (2008) Postpartum characteristics of rectus abdominis on ultrasound imaging. Man Ther 13(2):112–121. CrossRefGoogle Scholar
  12. 12.
    Parker MA, Millar LA, Dugan SA (2010) Diastasis Rectus Abdominis and lumbo-pelvic pain and dysfunction—are they related? J Womens Health Phys Ther. 32:1Google Scholar
  13. 13.
    Bursch SG (1987) Interrater reliability of diastasis recti abdominis measurement. Phys Ther 67(7):1077–1079CrossRefGoogle Scholar
  14. 14.
    Ranney B (1990) Diastasis recti and umbilical hernia causes, recognition and repair. S D J Med 43(10):5–8Google Scholar
  15. 15.
    Rath AM, Attali P, Dumas JL et al (1996) The abdominal linea alba: an anatomo-radiologic and biomechanical study. Surg Radiol Anat 18(4):281–288CrossRefGoogle Scholar
  16. 16.
    Candido G, Lo T, Janssen PA (2005) Risk factors for diastasis of the recti abdominis. J Assoc Chart Physiother Womens Health 97:49–54Google Scholar
  17. 17.
    Spitznagle TM, Leong FC, Van Dillen LR (2007) Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J Pelvic Floor Dysfunct 18(3):321–328. CrossRefGoogle Scholar
  18. 18.
    Beer GM, Schuster A, Seifert B et al (2009) The normal width of the linea alba in nulliparous women. Clin Anat 22(6):706–711CrossRefGoogle Scholar
  19. 19.
    Akram J, Matzen SH (2014) Rectus abdominis diastasis. J Plast Surg Hand Surg 48(3):163–169. CrossRefGoogle Scholar
  20. 20.
    Chiarello CM, Falzone LA, McCaslin KE (2005) The effects of an exercise program on diastasis recti abdominis in pregnant women. J Womens Health Phys Ther 29(1):11–16CrossRefGoogle Scholar
  21. 21.
    Mota PGFD, Pascoal AGBA, Carita AIAD 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 Ther 20(1):200–205. CrossRefGoogle Scholar
  22. 22.
    Liaw L-J, Hsu M-J, Liao C-F et al (2011) The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study. J Orthop Sports Phys Ther 41(6):435–443CrossRefGoogle Scholar
  23. 23.
    Stokes IAF, Gardner-Morse MG, Henry SM (2010) Intra-abdominal pressure and abdominal wall muscular function: spinal unloading mechanism. Clin Biomech (Bristol, Avon) 25(9):859–866. CrossRefGoogle Scholar
  24. 24.
    Pascoal AG, Dionisio S, Cordeiro F et al (2014) Inter-rectus distance in postpartum women can be reduced by isometric contraction of the abdominal muscles: a preliminary case-control study. Physiotherapy 100(4):344–348. CrossRefGoogle Scholar
  25. 25.
    Mannion AF, Pulkovski N, Toma V et al (2008) Abdominal muscle size and symmetry at rest and during abdominal hollowing exercises in healthy control subjects. J Anat 213(2):173–182CrossRefGoogle Scholar
  26. 26.
    Therapeutic exercise for Lumbopelvic stabilization: a motor control approach for the treatment and prevention of low back pain. Churchill Livingstone, 2004, 1 pGoogle Scholar
  27. 27.
    Therapeutic exercise for spinal segmental stabilization in low back pain: scientific basis and clinical approach [Internet]. Churchill Livingstone, 1999.
  28. 28.
    Benjamin DR, van de Water ATM, Peiris CL (2014) Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy 100(1):1–8.
  29. 29.
    Mesquita LA, Machado AV, Andrade AV (1999) Physiotherapy for reduction of diastasis of the recti abdominis muscles in the postpartum period. Revista Brasileira de Ginecologia e Obstetrícia 21(5):267–272CrossRefGoogle Scholar
  30. 30.
    Sheppard S (1996) The role of transversus abdominus in postpartum correction of gross divarication recti. Manual Ther 1(4):214–216CrossRefGoogle Scholar
  31. 31.
    Keeler J, Albrecht M, Eberhardt L et al (2012) Diastasis recti abdominis: a survey of women’s health specialists for current physical therapy clinical practice for postpartum women. J Womens Health Phys Ther 36(3):131–142CrossRefGoogle Scholar
  32. 32.
    Mota P, Pascoal AG, Carita AI, Bø K (2015) The immediate effects on inter-rectus distance of abdominal crunch and drawing-in exercises during pregnancy and the postpartum period. J Orthop Sports Phys Ther 45(10):781–788CrossRefGoogle Scholar
  33. 33.
    Noble E (1995) Essential exercises for the childbearing year: a guide to health and comfort before and after your baby is born. New Life Images, 1 pGoogle Scholar
  34. 34.
    Mantle J, Haslam J, Barton S (2004) Physiotherapy in obstetrics and gynaecology. Elsevier Health Sciences, 1 pGoogle Scholar
  35. 35.
    Boxer S, Jones S (1997) Intra-rater reliability of rectus abdominis diastasis measurement using dial calipers. Aust J Physiother 43(2):109–114CrossRefGoogle Scholar
  36. 36.
    Hsia M, Jones S (2000) Natural resolution of rectus abdominis diastasis. Two single case studies. Aust J Physiother 46(4):301–307Google Scholar
  37. 37.
    Bø K, Berghmans B, Van Kampen M et al (2015) Evidence-based physical therapy for the pelvic floor: bridging science and clinical practice. ISBN: 978-0-7020-4443-4Google Scholar
  38. 38.
    Rankin G, Stokes M, Newham DJ (2006) Abdominal muscle size and symmetry in normal subjects. Muscle Nerve 34(3):320–326. CrossRefGoogle Scholar
  39. 39.
    Hodges PW, Pengel LHM, Herbert RD et al (2003) Measurement of muscle contraction with ultrasound imaging. Muscle Nerve W 27(6):682–692. CrossRefGoogle Scholar
  40. 40.
    Mendes Dde A, Nahas FX, Veiga DF et al (2007) Ultrasonography for measuring rectus abdominis muscles diastasis. Acta Cir Bras 22(3):182–186CrossRefGoogle Scholar
  41. 41.
    Hides JA, Miokovic T, Belavý DL et al (2007) Ultrasound imaging assessment of abdominal muscle function during drawing-in of the abdominal wall: an intrarater reliability study. J Orthop Sports Phys Ther 37(8):480–486CrossRefGoogle Scholar
  42. 42.
    Whittaker JL, Warner MB, Stokes MJ (2009) Induced transducer orientation during ultrasound imaging: effects on abdominal muscle thickness and bladder position. Ultrasound Med Biol 35(11):1803–1811. CrossRefGoogle Scholar
  43. 43.
    Whittaker JL, Warner MB, Stokes MJ (2010) Ultrasound imaging transducer motion during clinical maneuvers: respiration, active straight leg raise test and abdominal drawing in. Ultrasound Med Biol 36(8):1288–1297. CrossRefGoogle Scholar
  44. 44.
    Klimstra M, Dowling J, Durkin JL et al (2007) The effect of ultrasound probe orientation on muscle architecture measurement. J Electromyogr Kinesiol 17(4):504–514. CrossRefGoogle Scholar
  45. 45.
    Kwah LK, Pinto RZ, Diong J et al (2013) Reliability and validity of ultrasound measurements of muscle fascicle length and pennation in humans: a systematic review. J Appl Physiol 114(6):761–769. CrossRefGoogle Scholar
  46. 46.
    Bénard MR, Becher JG, Harlaar J et al (2009) Anatomical information is needed in ultrasound imaging of muscle to avoid potentially substantial errors in measurement of muscle geometry. Muscle Nerve 39(5):652–665. CrossRefGoogle Scholar
  47. 47.
    Noorkoiv M, Stavnsbo A, Aagaard P et al (2010) In vivo assessment of muscle fascicle length by extended field-of-view ultrasonography. J Appl Physiol 109(6):1974–1979. CrossRefGoogle Scholar
  48. 48.
    Aggeloussis N, Giannakou E, Albracht K et al (2010) Reproducibility of fascicle length and pennation angle of gastrocnemius medialis in human gait in vivo. Gait Posture 31(1):73–77. CrossRefGoogle Scholar
  49. 49.
    Mota P, Pascoal AG, Sancho F et al (2012) Test-retest and intrarater reliability of 2-dimensional ultrasound measurements of distance between rectus abdominis in women. J Orthop Sports Phys Ther 42(11):940–946. CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Patrícia Mota
    • 1
    • 2
    Email author
  • Augusto Gil Pascoal
    • 1
  • Cristiana Vaz
    • 1
  • Filipa João
    • 1
  • António Veloso
    • 1
  • Kari Bø
    • 3
  1. 1.Fac. Motricidade Humana, CIPER, LBMFUniv LisboaLisbonPortugal
  2. 2.ESTeSL, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de LisboaLisbonPortugal
  3. 3.Department of Sports MedicineNorwegian School of Sports SciencesOsloNorway

Personalised recommendations