PREGNANCY-

INDUCED PATHOLOGY
• The combined influence of hormones,
weight gain, and postural changes of
pregnancy contributes to a variety of
impairments that can be addressed
with physical therapy.
 COMMON MUSCULOSKELETAL
PATHOLOGIES
Diastasis Recti Abdominis

Postural back pain

Symphysis pubis dysfunction

Sacroiliac/ pelvic girdle pain

Nerve compression syndrome

Urogenital dysfunction (Bladder dysfucntion, Pelvic organ prolapse)

Varicose veins

Joint laxity
Diastasis Recti
 (DIASTASIS RECTI ABDOMINIS)
DRA
• Diastasis recti is separation of the rectus
abdominis muscles in the midline at the
linea alba.

• Any separation larger than 2 cm or two

fingerwidth is considered significant.
 INCIDENCE
• Not exclusive to child bearing age
• According to studies incidence can range
• 0 in non pregnant and first trimester
• 27% in second trimester
• 66% in third trimester
• 36% of the women between 5 weeks and 3 months
postpartum
 INCIDENCE

• Diastasis recti may occur in pregnancy as a result of

hormonal effects on the connective tissue and the
biomechanical changes of pregnancy; it may also
develop during labor, especially with excessive
breath-holding. It causes no discomfort.
 INCIDENCE

• It can occur above, below, or at the level of the

umbilicus but appears to be less common below
the umbilicus.
• It appears to be less common in women with good
abdominal tone before pregnancy.
• Routine assessment for this condition is
highly recommended and can easily
be done in conjunction with
abdominal strength testing.
 SIGNIFICANCE
• The condition of diastasis recti may produce
musculoskeletal complaints, such as low
back pain, possibly as a result of decreased
ability of the abdominal musculature to
stabilize the pelvis and lumbar spine.
 FUNCTIONAL LIMITATIONS
• Functional limitations can also occur, such
as inability to perform independent supine
to sitting transitions because of extreme loss
of the mechanical alignment and function
of the rectus muscle.
 DECREASED FETAL
PROTECTION
• In severe separations, the remaining midline
layers of abdominal wall tissue are skin,
fascia, subcutaneous fat, and peritoneum.
The lack of muscular support provides less
protection for the fetus.
 POTENTIAL FOR
HERNIATION
• Severe cases of diastasis recti may progress
to herniation of the abdominal viscera
through the separation at the linea alba.
• This degree of separation requires surgical
repair.
Examination
• Test all pregnant patients for the presence
of diastasis recti before performing any
abdominal exercises. This test should be
repeated throughout the pregnancy and
appropriate modifications made to existing
exercises.
 SELF EXAMINATION
• Instruct patients to perform a self-test on or
after the third postpartum day for optimal
accuracy.

• Until 3 days after delivery, the abdominal

musculature has inadequate tone for valid
test results.
 EXAMINATION FOR
DIASTASIS RECTI
• Patient position:
Hook lying
Procedure:

Have the patient slowly raise her head and shoulders

off the floor, reaching her hands toward the knees,
until the spines of the scapulae leave the floor.
Place the fingers of one hand horizontally across the
midline of the abdomen at the umbilicus
• If a separation exists, the fingers will sink into the gap
between the rectus muscles

• Number of fingers that can be placed between the

muscle bellies is then documented.

• A diastasis recti can also present as a longitudinal

bulge along the midline. Because this condition can
occur above, below, or at the level of the
umbilicus, test for it at all three areas.
SELF ASSESSMENT OF
DIASTASIS RECTI

Place two fingers in the midline

and raise the head
Intervention
 INTERVENTION FOR
DIASTASIS RECTI
• Teach the patient to perform the corrective
exercise for diastasis recti exclusive of other
abdominal exercise until the separation is
decreased to 2 cm or less.
 INTERVENTION FOR
DIASTASIS RECTI
• due to the angle of attachment of the
obliques into the linea alba, there is a
possibility that trunk rotation exercises will
perpetuate the separation
 FOCUS ON EVIDENCE
• Garshasbi and Faghih Zadeh30 studied more than 200
primigravid women (pregnant for the first time) in a
prospective randomized study of the effect of exercise
on the intensity of low back pain during pregnancy.
• The exercise group experienced significant decrease in
intensity of low back pain by the end of the study, while
intensity was increased in the control group
CORRECTIVE EXERCISE
FOR DRA
 CORRECTIVE EXERCISE
FOR DRA
Lie on your back, knees bent.
Cross your hands at your waist and guide your recti muscles
toward the midline to stabilize them.

Take in a deep breath.

As you slowly exhale, perform a pelvic muscle contraction
and raise your head off the bed (keep your shoulders on
the bed).
• While you lift, gently pull your underlying muscles
together with your hands. If your tummy is too
large, wrap a sheet or large towel around your
body, and grasp the ends with opposite hands.
Apply same pull.
• Slowly return to the starting position as you
breathe in
• Try to do 10 in a row, at least three times aday.
• Do not perform a standard curl-up (raising your shoulders off
the bed) until your center seam does not bulge or hollow and
you feel only 2 finger widths or less separation between the recti
muscles.
WHAT TO AVOID IF YOU HAVE A
DIASTASIS
Avoid heavy lifting and other activities that put pressure on
your abdominals

Some exercises; such as crunches, pushups, sit-ups, etc.; can cause a

diastasis to become much worse.

Avoid high intensity exercises

http://www.active.com/Assets/Running/360/crunch-360.jpg
• Be proactive. Diastasis can be avoided if the
necessary measures are taken pre and perry
pregnancy (seeing a pelvic floor physio, training
with a certified trainer, belly wrapping, etc).
• Practice core strengthening exercises that will help
to rebuild the tension in the linea alba and
ultimately restore the core
 REFERENCES
• 1. Physiotherapy in Obstetrics and Gynecology By: Jill
Mantle, Jeanette Haslam, Sue Barton, 2nd edition.
• 2. Textbook of Physiotherapy for Obstetric and
Gynecological Conditions (Paperback) By (author) G.B.
Madhur.
THANK YOU