This randomized controlled trial aims to compare the effects of Transverse Abdominis (TrA) activation, Rectus Abdominis (RA) strengthening, and their combined approach on inter-rectus distance (IRD) and core stability in postpartum women diagnosed with diastasis rectus abdominis (DRA). Thirty-three participants will be randomly allocated into three groups and will complete a six-week exercise program at the Pakistan Society for the Rehabilitation of the Disabled (PSRD) Hospital, Lahore. The study will use real-time ultrasound and pressure biofeedback assessment to evaluate changes in IRD and core stability. It is hypothesized that TrA activation and the combined intervention will produce greater improvements compared to RA strengthening alone.
Multigravida
Delivered a singleton pregnancy via vaginal breech or instrumental delivery
Abdominal and pelvic hernias or severe musculoskeletal conditions
Patients with abdominal and pelvic surgery
Patients with disc herniation
Parallel
Transverse Abdominis activation exercises
Other interventionGroup A (TAA) will perform abdominal drawing-in maneuvers (ADIM) in crook lying, side lying, and quadruped positions. They will be instructed to gently draw the belly button inward toward the spine without moving the pelvis or rib cage, emphasizing breathing coordination and pelvic floor co-activation. In the supervised phase, participants will perform 3 sets of 10 repetitions, with each contraction held for 10-20 seconds, and a rest interval of 3 minutes between sets
Rectus Abdominis Strengthening exercises
Other interventionGroup B (RAS) will perform exercises in supine lying with knees bent, including partial curl-ups, reverse crunches, pelvic tilts, and leg raises with abdominal bracing. The command will be tighten your abdominals as if bracing for a punch, and lift without straining your neck. Each supervised session will include 3 sets of 10-15 repetitions per exercise, progressing in difficulty using added resistance if tolerated, with a 3-minute rest interval between sets
combined protocol of both transverse abdominis activation and rectus abdominis strengthening.
Other interventionGroup C (TAA+RAS) will perform a hybrid protocol integrating both TrA activation and RA strengthening exercises. Each session will begin with ADIM in crook lying, side lying, and quadruped positions, followed by RA exercises including curl-ups, pelvic tilts, and leg raises. The command will be to activate your deep core with breathing, then strengthen your outer abdominals through controlled movements. Each supervised session will consist of 3 sets of 10 repetitions for TrA exercises (10-20 seconds hold) and 3 sets of 10-15 repetitions for RA exercises, with a rest period of 3 minutes between all sets.
Inter-rectus Distance (IRD)
The Inter-rectus Distance (IRD) is the measurement of the separation between the two rectus abdominis muscles along the linea alba. It is assessed using ultrasound imaging while the participant is in a supine position with knees bent.. A high-frequency (7.5 MHz) linear probe will be placed on the abdomen while the patient lies on their back. Images will be taken at three points above, at, and below the belly button.
Core stability
core stability was assessed using the pressure biofeedback unit (PBU), a reliable and non-invasive tool designed to evaluate the activation and control of deep abdominal muscles, particularly TrA. The PBU consists of a pressure cuff connected to an analog pressure gauge and provides visual feedback on pressure changes in response to subtle lumbo pelvic movements (57). For assessment, participants were positioned in a crook lying position, and the cuff was positioned under the lumbar spine (L4-L5 region). The device was inflated to a baseline pressure of 40 mmHg, and participants will be instructed to perform the abdominal drawing-in maneuver, aiming to reduce the pressure by 6-10 mmHg without moving the pelvis or spine. They were asked to maintain this contraction for 10 seconds, and the procedure will be repeated three times, with the average score recorded for analysis.
Click on the lead sponsor to view all of their trials.
This trial is not recruiting at the moment. You can still explore other options:
