During pregnancy, women’s bodies change dramatically – and the core abdominal muscles are no exception. Diastasis Rectus Abdominis (DRA) affects 30 to 90 percent of postpartum women, yet there is little research available on the condition. 

As the fetus grows a tremendous amount of pressure is placed on the abdominal muscles causing them to stretch separate at the midline. This separation is associated with lower back pain, urinary leaking and cosmetic concerns.  A new study from Hospital for Special Surgery (HSS) will determine if core strengthening exercises can resolve this condition. 

“While exercise during and after pregnancy continues to be a hot topic, there is a strong need for scientific data on what exercises are best to decrease the abdominal separation,” said Ellen Casey, MD, physiatrist at HSS and primary investigator of the study. “This condition is sometimes viewed simply as a cosmetic issue, but the abdominal muscles are a key part of core musculature which has proven to be important for musculoskeletal and gynecological reasons. It’s time that we figure out how to heal the abdominal wall after pregnancy and give women much needed guidance in restoring their musculoskeletal health.”

The study hypothesizes that participation in a core strengthening program will decrease the inter-recti distance (IRD), increase the abdominal wall muscle strength, and reduce low back pain and urinary incontinence in postpartum women with DRA. 

This randomized controlled trial will follow 46 patients over a 24 week period. The patients will be divided evenly into two groups – Group A will participate in weekly online classes with one certified personal trainer and will also complete daily homework assignments. After 12 weeks, Group A members will exercise on their own.  The control group, B, will continue their baseline level of exercise and activity for the first 12 weeks and then participate in the same weekly online class for the final 12 weeks that Group A originally did. 

At the end of 12 and 24 weeks, each participant’s IRD and muscle contraction will be measured using musculoskeletal ultrasound. 

Additionally, the investigators will measure a variety of secondary outcomes such as abdominal wall function, lower back pain, pelvic function, stress urinary incontinence and body image.

“If we can show that core strengthening is effective, and specifically which exercises are effective, then all women could have access to postpartum rehabilitation to help avoid long-term secondary complications of DRA,” added Dr. Casey.

This study is a joint effort between HSS, Weill Cornell Medicine and Leah Keller, personal trainer and founder of Every Mother, a pre- and postnatal exercise program.