Diastasis Recti Abdominis (Postpartum)
Conditions
Keywords
Diastasis Recti Abdominis, Postpartum, Core Stability, Barre Training, Tupler Technique, Inter-Recti Distance, Pelvic Floor
Brief summary
This study will be a single blind, parallel group randomized controlled trial designed to evaluate the effectiveness of Barre-based core stability training with and without the Tupler Technique in postpartum women with Diastasis Recti Abdominis. A total of 58 eligible participants will be recruited from postpartum care units and randomly assigned in a 1:1 allocation ratio to either an experimental group receiving Barre-based core stability training combined with the Tupler Technique or a control group receiving Barre-based core stability training alone. Both interventions will be delivered under supervised conditions three times per week for 8 weeks, with each session lasting approximately 30-45 minutes. The Barre-based program focuses on controlled low impact movements aimed at improving deep core muscle activation, postural alignment, and neuromuscular coordination. The experimental group will additionally receive the Tupler Technique, which includes abdominal splinting, progressive core strengthening exercises, and neuromuscular re-education targeting approximation of the rectus abdominis muscles and improved abdominal wall function. Outcome measures include inter-recti distance, core strength, and pelvic floor function. Secondary outcomes include postural stability and functional performance. Assessments will be conducted at baseline, mid-intervention (week 4), post-intervention (week 8), and follow-up (week 12) by blinded outcome assessors to minimize bias. The purpose of this trial is to determine whether combining the Tupler Technique with Barre-based core stability training provides superior improvements in abdominal separation, core strength, pelvic floor function, and functional ability compared with Barre-based training alone in postpartum women.
Detailed description
Diastasis Recti Abdominis (DRA) is a postpartum musculoskeletal condition characterized by separation of the rectus abdominis muscles due to weakening of the linea alba, resulting in impaired core stability, reduced pelvic floor function, altered lumbopelvic mechanics, and decreased functional performance. Management is primarily conservative and involves exercise-based rehabilitation targeting abdominal wall integrity and neuromuscular control. Barre-based core stability training is a low impact exercise intervention focusing on postural alignment, controlled movement, and activation of deep core musculature, including the transversus abdominis and pelvic floor muscles. The Tupler Technique is a structured rehabilitation program for DRA that includes abdominal splinting, progressive core strengthening, and neuromuscular re-education to improve rectus abdominis approximation and abdominal wall function. This single blind, parallel group randomized controlled trial will recruit 58 postpartum women diagnosed with DRA. Participants will be randomly allocated using concealed assignment in a 1:1 ratio to either an experimental group receiving Barre-based core stability training combined with the Tupler Technique or a control group receiving Barre-based training alone. Both groups will receive supervised interventions three times per week for 8 weeks, with each session lasting 30-45 minutes. The exercise protocol emphasizes controlled activation of deep core muscles, postural control, and safe functional movement patterns. The experimental group will additionally perform abdominal splinting and structured neuromuscular re-education as part of the Tupler Technique. Outcome measures will include inter-recti distance, core strength, pelvic floor function, postural stability, and functional performance. Assessments will be conducted at baseline, week 4, week 8, and week 12 by blinded outcome assessors. Data will be analyzed to compare within group and between group changes over time, using appropriate statistical methods under an intention-to-treat approach. The study evaluates whether adding the Tupler Technique to Barre-based core stability training provides superior improvements in abdominal separation, core stability, pelvic floor function, postural control, and functional ability in postpartum women with Diastasis Recti Abdominis.
Interventions
BEHAVIORALBarre-Based Core Stability Training (BBT)
Barre-Based Core Stability Training is a low impact, structured exercise intervention designed to improve deep core muscle activation, postural alignment, and functional stability. It will include controlled movements such as pelvic tilts, glute bridges, modified planks, lower limb core-controlled exercises, and functional standing activities. The program will emphasize activation of the transversus abdominis and pelvic floor muscles through slow, controlled, and alignment focused exercises. Sessions will be conducted under supervision three times per week for 8 weeks, with each session lasting 30-45 minutes. This intervention will aim to enhance core strength, improve neuromuscular coordination, and support overall lumbopelvic stability.
BEHAVIORALTupler Technique
The Tupler Technique is a structured rehabilitation program specifically designed for the management of Diastasis Recti Abdominis. It will include abdominal splinting, progressive core strengthening exercises, and neuromuscular re-education techniques. The program will focus on activating and strengthening the transversus abdominis while promoting approximation of the rectus abdominis muscles to reduce inter-recti distance. Key components will include elevator exercises, controlled core engagement, and the use of abdominal support during functional activities to enhance abdominal wall integrity. In this study, the Tupler Technique will be delivered in combination with Barre-based training over 8 weeks with supervised sessions three times per week.
Sponsors
Lahore University of Biological and Applied Sciences
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
This will be a single blinded study in which the outcome assessors and data collectors will be blinded to group allocation to minimize assessment bias. Participants and therapists will not be blinded due to the nature of the exercise interventions.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* Women aged 18-40 years * Postpartum period between 6-12 months * Diagnosed with stage I-II Diastasis Recti Abdominis * Presence of symptoms such as abdominal weakness or back pain * Ability to follow exercise instructions
Exclusion criteria
* Stage III Diastasis Recti Abdominis * Severe hernias or significant pelvic floor dysfunction * Neurological, cardiovascular, or systemic conditions contraindicating exercise * History of abdominal surgery or trauma affecting the abdominal wall
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Inter-Recti Distance (IRD) | Baseline (Day 0), Week 4, Week 8, Week 12 | Inter-recti distance (IRD) will be measured to assess the separation of the rectus abdominis muscles in women with Diastasis Recti Abdominis. Measurements will be taken using ultrasound imaging and calipers at standardized anatomical points (above, at, and below the umbilicus). IRD will be recorded in centimeters. A reduction in IRD indicates improvement in abdominal wall integrity and core stability. |
| Core Strength | Baseline (Day 0), Week 4, Week 8, Week 12 | Core strength will be assessed using the Modified Sahrmann Test, which evaluates lumbopelvic control and activation of deep core muscles during progressive lower limb movements. Performance will be scored based on the ability to maintain neutral spine alignment without compensatory movements such as pelvic tilt or abdominal bulging. Higher scores indicate better core strength and neuromuscular control. |
| Pelvic Floor Function | Baseline (Day 0), Week 4, Week 8, Week 12 | Pelvic floor function will be assessed using the Pelvic Floor Distress Inventory (PFDI-20), a validated questionnaire measuring symptom severity related to urinary, colorectal, and prolapse distress. Scores range from 0 to 300, with higher scores indicating greater dysfunction. A reduction in score indicates improvement in pelvic floor function. |
| Postural Stability | Baseline (Day 0), Week 4, Week 8, Week 12 | Postural Stability Postural stability will be assessed using the Balance Error Scoring System (BESS). Participants perform balance tasks in double-leg, single-leg, and tandem stance on firm and foam surfaces. Errors (e.g., stepping, loss of balance, opening eyes) are counted. Lower scores indicate better postural control. |
| Functional Performance | Baseline (Day 0), Week 4, Week 8, Week 12 | Functional performance will be assessed using the Physical Functioning (PF-10) subscale of the SF-36 Health Survey. The scale evaluates limitations in activities such as walking, climbing stairs, lifting, and carrying objects. Scores range from 0 to 100, with higher scores indicating better functional ability. |
Countries
Pakistan
Contacts
CONTACTHafsa Liaquat
CONTACTDr. Sahar Fatima
PRINCIPAL_INVESTIGATORWHO
Lahore University of Biological and Applied Sciences
Outcome results
None listed