R E V I S T A O N L I N E D E P E S Q U I S A

CUIDADO É FUNDAMENTAL UNIVERSIDADE FEDERAL DO ESTADO DO RIO DE JANEIRO . ESCOLA DE ENFERMAGEM ALFREDO PINTO

R E V I S T A O N L I N E D E P E S Q U I S A

CUIDADO É FUNDAMENTAL
RESEARCH DOI: 10.9789/2175-5361.rpcfo.v13.9555

UNIVERSIDADE FEDERAL DO ESTADO DO RIO DE JANEIRO . ESCOLA DE ENFERMAGEM ALFREDO PINTO

PHYSIOTHERAPY IN THE REDUCTION OF DIASTASIS OF THE

RECTI ABDOMINIS IN INMEDIATE POSPARTUM
Atuação fisioterapêutica na redução da diástase abdominal no puerpério
imediato
Fisioterapia para reducir la diástasis abdominal en el posparto inmediato
Gracielle Pampolim1, Bruna Ribeiro dos Santos2, Isabelle Gadiolli Verzola3, Alessandra Miranda Ferres4,
Geiceane Bruna Rodrigues da Silva5, Sara Silva Sarmento6.

How to cite this article:

Pompolim G, Santos BR, Verzola IG, Ferres AM, Silva GBR, Sarmento SS. Physiotherapy in the reduction
of diastasis of the recti abdominis in inmediate pospartum. 2021 jan/dez; 13:856-860. DOI: http://dx.doi.
org/0.9789/2175-5361.rpcfo.v13.9555.

ABSTRACT
Objective: to verify if the physiotherapeutic intervention in the immediate puerperium contributes to the
reduction of the diastasis. Methods: randomized intervention study of two groups of 25 mothers recruited
at a maternity hospital in Vitória-ES. Both were submitted to diastasis evaluation and measurement using a
caliper, and in the treatment group, in addition to the evaluation, a physical therapy protocol was applied at
06 and 18 hours after delivery. Data were analyzed by Wilcoxon, Mann-Whitney and paired t-tests. Results:
there was a decrease in the abdominal diastasis between the first and last evaluation in both groups and the
variables studied, however, the analysis between groups identified a sharper decline in the treatment group
(p <0.001). Conclusion: the findings of this study show that the physiotherapeutic care in the immediate
puerperium is able to positively influence the reduction of the abdominal diastasis, providing a faster recovery
to the puerperal women.
DESCRIPTORS: Postpartum period; Diastasis, muscle; Rectus abdominis; Physical therapy; Postnatal care.

RESUMO
Objetivo: verificar se a intervenção fisioterapêutica no puerpério imediato contribui para a redução da diástase. Métodos: estudo de
intervenção com randomização de dois grupos de 25 puérperas recrutadas em uma maternidade de Vitória-ES. Ambos foram submetidos

1 Physiotherapist, 3Master in Public Policy and Local Development, Professor at School of Science, Santa Casa de Misericordia –
EMESCAM, Vitoria – Espirito Santo – Brazil
2 Physiotherapist, graduated from School of Science, Santa Casa de Misericordia – EMESCAM, Vitoria – Espirito Santo – Brazil.
3 Undergraduate student from the Physiotherapy Course of School of Science, Santa Casa de Misericordia – EMESCAM, Vitoria –
Espirito Santo – Brazil.
4 Undergraduate student from the Physiotherapy Course of School of Science, Santa Casa de Misericordia – EMESCAM, Vitoria –
Espirito Santo – Brazil..
5 Physiotherapist, graduated from School of Science, Santa Casa de Misericordia – EMESCAM, Vitoria – Espirito Santo – Brazil.
6 Physiotherapist, graduated from School of Science, Santa Casa de Misericordia – EMESCAM, Vitoria – Espirito Santo – Brazil.

DOI: 10.9789/2175-5361.rpcfo.v13.9555 | Pompolim G, Santos BR, Verzola IG et al. | Physiotherapy in the reduction of diastasis...

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ISSN 2175-5361 DOI: 10.9789/2175-5361.rpcfo.v13.9555
Pompolim G, Santos BR, Verzola IG et al. Physiotherapy in the reduction of diastasis...

à avaliação e mensuração da diástase através de um paquímetro, e The Recti Abdominis Diastasis (RAD) is prevalent in
no grupo de tratamento além da avaliação foi aplicado um protocolo women with multiple births, pregnant women with twins
de tratamento fisioterápico às 06 e 18 horas após o parto. Os dados and is also linked to weight gain during pregnancy.6 The
foram analisados através dos testes de Wilcoxon, Mann-Whitney e separation of this musculature varies vertically, with 70%
teste t pareado. Resultados: houve diminuição da diástase abdominal of the population spacing between 2 cm and 3 cm in the
entre a primeira e a última avaliação em ambos os grupos, no entanto, infra-umbilical region, and the supra-umbilical region with
a análise entre grupos identificou uma redução mais acentuada no
an average spacing greater than 3.0 cm.7
grupo de tratamento (p<0,001). Conclusão: os achados deste estudo
The onset of RAD is often noticed in the third trimester
mostram que o atendimento fisioterápico no puerpério imediato é
of pregnancy and in the immediate postpartum period, and
capaz de influenciar positivamente na redução da diástase abdominal,
may spontaneously regress within eight weeks after delivery,
proporcionando às puérperas uma recuperação mais rápida.
however, in some cases it may remain for much longer, which
DESCRITORES: Período pós-parto; Diástase muscular; Reto do abdome;
could lead to increased risk in develop low back pain and
Fisioterapia; Cuidado pós-natal.
pelvic instability.6
In this context, physiotherapeutic intervention is an
RESUMEN important ally and focuses on the treatment of previous
Objetivo: verificar si la intervención de fisioterapia en el changes experienced during pregnancy, on improving body
período posparto inmediato contribuye a la reducción de awareness and re-education of the pelvic floor and abdominal
la diástasis. Métodos: estudio de intervención aleatorizado muscles, as well as the recovery of immediate postpartum,
de dos grupos de 25 madres reclutadas en un hospital justifying the realization of the present research, which aims to
de maternidad en Vitória-ES. Ambos fueron sometidos ascertain the contribution of physiotherapeutic intervention in
the immediate postpartum regarding the reduction of diastasis
a evaluación y medición de la diástasis utilizando un
of the rectus abdominis muscle.
calibrador, y en el grupo de tratamiento, además de la
evaluación, se aplicó un protocolo de fisioterapia a las 06
y 18 horas después del parto. Los datos fueron analizados METHODS
por Wilcoxon, Mann-Whitney y pruebas t pareadas. This is an intervention study with randomization, carried
Resultados: hubo una disminución en la diástasis abdominal out with a sample of 50 puerperal women from Maternity
entre la primera y la última evaluación en ambos grupos y Hospital Pró-Matre of Vitória, Espírito Santo-Brazil, from
las variables estudiadas, sin embargo, el análisis entre los December 2016 to February 2017. Women in the immediate
grupos identificó una reducción más marcada en el grupo postpartum period were included in this study (6 hours after
de tratamiento (p <0.001). Conclusión: los resultados de delivery), aged 18 years old and older, who were attending the
este estudio muestran que la atención de fisioterapia en el obstetrics clinic during the research period and who agreed
período posparto inmediato puede influir positivamente to sign the Free and Informed Consent Form. Postpartum
en la reducción de la diástasis abdominal, proporcionando women should have up to 4 children and have a diastasis
a las mujeres puerperales una recuperación más rápida. greater than 3 centimeters from the rectus abdominis muscles.
Postpartum women who underwent the cesarean section or
DESCRIPTORES: Periodo posparto; Diástasis muscular;
who did not know how to answer the questionnaires correctly
Recto del abdomen; Fisioterapia; Atención posnatal.
were excluded from the study, in addition to the mothers
who had any pathologies associated with pregnancy such as:
INTRODUCTION polyhydramnios, fetal macrosomia, hypertensive disease of
The muscles responsible for the safety and stability of gestation - DHEG and gestational diabetes.
the spine are the muscles: internal oblique, external oblique, The sample was randomized in two groups according
transverse abdomen and rectus abdominis.1 These muscles to the order of arrival at the obstetrics clinic: control
act synchronously with the lumbar multifidus, diaphragm group and treatment group, both with 25 mothers. Then,
and pelvic floor muscles, in order to support all pelvic and an evaluation form prepared by the student researchers was
abdominal organs and protect the lumbar spine from internal applied, contemplating the socioeconomic, demographic
and external overloads.1-3 and clinical data in order to characterize the profile of the
Throughout the pregnancy period, there are significant sample and their knowledge about the presence of diastasis.
anatomical and physiological changes in the pregnant woman’s After the application of the form, a physical examination
body, which culminate in changes in all systems of the was performed to measure the RAD using a single Nove54
human body, including increased cardiac output, respiratory, caliper, providing accuracy and reliability to the assessment
endocrine and skeletal changes. Among the most common throughout the research.
skeletal changes are exacerbated lumbar lordosis, increased To check for the presence of abdominal diastasis during
articular mobility in the sacroiliac region and articular spinal the physical examination, the puerperal woman was asked
flaccidity.4 In addition, with the development of the uterus to position herself in the supine position with knees and hips
during pregnancy, it is possible to observe an intense extension flexed, feet resting on the bed and arms along the body so that
of the abdominal muscles up to 20 cm.5 two markings were made, one 03 cm above and another 03
cm below the umbilical scar, and then anterior flexion of the

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ISSN 2175-5361 DOI: 10.9789/2175-5361.rpcfo.v13.9555
Pompolim G, Santos BR, Verzola IG et al. Physiotherapy in the reduction of diastasis...

trunk was requested until the lower angle of the scapula was RESULTS AND DISCUSSION
out of bed. Soon afterwards, palpation was performed between
The sample of this study was composed of 50 women, with
the limits of the medial edges of the muscles and the caliper
an average age of 22.6 ± 3.28 years old, 48 (96%) declared
was placed for accurate measurement in the supraumbilical
themselves brown, 22 (44%) reported being “homemakers”, 48
and infraumbilical regions.
(96%) were primiparous, 50 (100%) underwent prenatal care
In the control group, two evaluations were performed: the
and none of them had knowledge about abdominal diastasis
first, 06 hours after delivery and the second, 18 hours after
(data not shown in the table). No statistical differences were
delivery. The treatment group underwent physical therapy in
found between the groups studied.
the period of 06 hours and 18 hours postpartum individually.
As observed in Table 1, there was a decrease in abdominal
Therefore, there was an interval of 12 hours between the
diastasis between the first and the last assessment (6h and 18h,
1st and 2nd evaluation in the control group and between
respectively), in both groups in isolation and in both variables
the 1st and 2nd attendance for the treatment group. This
analyzed. However, in the analysis between the groups (Table
interval offered the postpartum woman a break between one
2), it was found that in the treatment group, the decrease in
physiotherapeutic intervention and another, as well as the
supra-umbilical abdominal diastasis was more pronounced,
time for the organism to adapt naturally and physiologically.
this difference being statistically significant (p < 0.001).
Interventions were performed between the hours of 7:00 am
and 9:00 am in the morning, and between 7:00 pm and 9:00 Table 1 - Comparison of the measurement of abdominal
pm due to the time of rest and so that the evaluations were diastasis (6 hours and 18 hours after delivery) in the supre-
not carried out during the night. umbilical and infraumbilical regions in the control and
Treatment protocol: In the first appointment, the puerperal treatment groups.

woman performed 10 repetitions of each exercise and in

Abdominal Control Group (n = 25)
the second appointment, 20 repetitions of each exercise,
Diastasis 6h 18h ∆ p
as described: For the first exercise, the puerperal woman
was instructed to adopt the initial supine position, with Supra Umbilical 34.5±2.8 33.9±2.8 -0.6±0.4 < 0.001a
knees and hips flexed, foot supported on the bed and
Infra Umbilical 19.8±5.7 19.0±5.9 -0.8±0.7 0.015b
with the help of a pillow between the knees, and then the hip
adduction movement was requested, associated with isometric Treatment Group (n = 25)
contraction of the pelvic floor. 6h 18h ∆ p
In the second exercise, the isometric contraction of the
Supra Umbilical 36.0±2.7 34.6±2.8 -1.4±0.4 < 0.001a
abdominal muscles was performed, mainly the transversus
abdominis, with manual feedback from the researcher in Infra Umbilical 22.3±3.4 21.5±3.4 -0.8±0.3 < 0.001b
the lower abdomen. And to finish the exercises, the isotonic ∆ difference between measures; a Paired t Test; b Wilcoxon Test.
contraction of the oblique abdominal muscles was requested,
through the anterior flexion movement combined with Table 2 - Comparison of the differences in abdominal
rotation of the trunk, so that the lower edge of the scapula diastasis measurements (6 hours and 18 hours after delivery)
was removed from contact with the bed. To facilitate the in the supre-umbilical and infraumbilical regions between
performance of this exercise, the hands were crossed under the control and treatment groups.
the occipital region with shoulder abduction and elbow flexion.
Control Treatment
The descriptive analysis of the collected data was Abdominal Group Group
performed using frequency tables and data summary Diastasis
(n = 25) (n = 25)
measures such as mean, median and standard deviation.
For the inferences analysis, the normality of the sample ∆ ∆ p (∆)
distribution was verified through the Shapiro-Wilk test Supra Umbilical -0.6 ±0.4 -1.4±0.4 < 0.001c
and once the sample distribution was identified, the paired
Infra Umbilical -0.8±0.7 -0.8±0.3 0.55c
t-test was used to analyze the intra-groups Supra Umbilical
variable; Test Wilcoxon for the analysis of intra-groups Infra ∆ difference between measures; c Mann-Whitney Test.
Umbilical variable and the Mann-Whitney test for the analysis
During the gestational period, the Recti Abdominis
of differences between the groups. The analysis was conducted
Diastasis is very common, which is not necessarily normal.
using the SPSS software (IBM 22). Significance level of
Although studies have shown that multiparity can predispose a
p < 0.05 was adopted for all analyzes.
greater separation of muscle fibers from the rectus abdominis
This study was approved by the Research Ethics Committee
during pregnancy, it was observed that most puerperal women
of the School of Sciences of Santa Casa de Misericórdia de
were primiparous and all had diastasis.8
Vitória on December 13, 2016, registered under number
In addition, a higher incidence of supraumbilical
1.865.043. At all times in the study, the guidelines of resolution
abdominal diastasis was evidenced in this study. In
466/12 were respected.
agreement with this, it was found in a study that 36% of the

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population had diastasis at the supraumbical level, due to the known, favoring a healthier postpartum and consequently an
disposition of the fetus, and 11% infraumbilical diastasis, as a improvement in the quality of life. In addition to highlighting
result of the connection of the abdominal muscles in the shape the importance of including this theme in health education
of the letter V.9 processes performed during prenatal care.
It is noted in the present study that the performance of
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Received in: 20/10/2019

Required revisions: 05/11/2019
Approved in: 09/12/2019
Published in: 01/07/2021

Corresponding author
Gracielle pampolim
Address: Avenida Nossa Senhora da Penha, 2190
Vitória/ ES, Brazil
Zip code: 29.045-402
Email address: [email protected]

Disclaimer: The authors claim to

have no conflict of interest.

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