Rehabilitation of Diastasis Dysfunction

In a case report published within the past year by physical therapist Karen Litos, a detailed and thorough case study describes the therapeutic progression and outcomes for a woman with significant functional limitation due to a separation of her diastasis recti muscles. The patient in the case is described as a 32-year-old G2P2 African-American woman referred to PT at 7 weeks postpartum. Delivery occurred vaginally with epidural, no perineal tearing, and pushing time of less than an hour. Primary concerns of the patient included burning or sharp abdominal pain when lifting, standing, and walking. Uterine contractions that naturally occurred during breastfeeding also worsened the abdominal pain and caused the patient to discontinue breastfeeding. The patient furthermore reported sensations that her insides felt like they would fall out, and abdominal muscle weakness and fatigue with activity.

Although many other significant details related to history, examination and evaluation were included in the case report, I will focus on the signs, interventions, and outcomes recorded in the paper. Diastasis was measured using finger width assessment and a tape measure. (Although ultrasound is more accurate and valid, palpation of diastasis has been demonstrated to have good intra-rater reliability as used in this study. Measures for interrecti distance (IRD) at time of evaluation were 11.5 cm at the umbilicus, 8 cm above the umbilicus, and 5 cm below the umbilicus. The patient also reported pain on the visual analog scale (VAS) of 3-8/10.

Interventions in rehabilitation included, but were not limited to: instruction in wearing an abdominal binder, appropriate abdominal and trunk strengthening (promotion of efficient load transfer and avoidance of exercises that may worsen separation), biomechanics training with functional tasks such as transfers, self-bracing of abdominals, avoiding Valsalva, postural alignment and symmetrical weight-bearing strategies. Plan of care was developed as 2-3x/week for 2-3 weeks, the patient was seen for 18 visits over a four month period. Therapeutic exercise was progressed to include general hip and trunk muscle strengthening towards a goal of stability during movement. Cardiovascular training progressed to light treadmill jogging and use of an elliptical.

After 18 visits, functional goals were all met and included picking up her baby, holding her baby for 30 minutes, standing or walking for at least an hour. VAS pain score progressed to 0 on the 0-10 scale. The diastasis was measured at discharge to be 2 cm at the umbilicus, 1 cm above the umbilicus, and 0 cm below the umbilicus. This case report is first an excellent example of a detailed case example. Second, while the separation dramatically improved, most importantly, the patient’s function improved and her goals were met. This case is a wonderful example of how sharing details of a patient’s rehabilitation efforts can be useful for other rehabilitation therapists to consider when developing a plan of care.

If you are interested in discussing more about postpartum care, check out the first in our peripartum series, “Care of the Pregnant Patient” taking place next in Boston in May with Institute co-founder Holly Herman.