After childbirth, is rectus abdominis training more effective than transversus abdominis training in reducing the gap between abdominal muscles in people with diastasis of the rectus abdominis muscles (DRAM)?

Participants will be randomised into one of two treatment groups within 72 hours of giving birth. The experimental treatment/Rectus abdomins (RA) group will be asked to complete between 1-10 x 1 second crunch (head lift) with dosage prescribed depending on patient’s technique. Exercise will be completed and assessed in crook lie and exercise prescription based on number able to complete with good technique and prior to the onset of doming of linea alba as assessed by a senior physiotherapist. Dosage for both groups will be 1-2 x a day, at least 5 days of the week with a tick-box exercise diary provided for data on compliance. Verbal and written education will be provided at the time of exercise prescription about some exercise being better than none, and to continue even if not meeting prescribed dosages. Participants will also be taught about being able to make the exercises “Mother-baby friendly” to better fit them into their routine by encouraging baby to be completing tummy time on her chest during completion. The participants will be provided with a written home exercise program designed specifically for this study with the same information. They will then be asked to come in for re-assessment and progression (if appropriate) at 6 and 12 weeks postpartum. Progression will include re-assessment of exercise technique and prescription of a new dosage between 1-20 repetitions of the prescribed exercise as appropriate at the week 6 review. Re-assessment will involve the standardised assessment position from baseline measures (flat supine lie with extended legs) using ultrasound to measure 2cm above/below and at the level of the umbilicus. This is the measurement technique which will also be used at baseline on the ward. Progression will not occur at the 12 week appointment as this will be the conclusion of the participant's program. Follow up appointments will have the option of being held at the hospital or as a home-based appointment and will be expected to be approximately 15 minutes in duration. All participants will receive a modified version of the hospital's standard physiotherapy postpartum education material which will be edited to remove the current advice regarding DRAM to avoid confusion. A seperate education sheet including details of the prescribed exercise will be provided. All education and prescription will be completed face to face by a senior physiotherapist. Participants will be encouraged to return their exercise diary at each follow up appointment to monitor compliance.