Bridging the Gap Between Evidence and Practice: A Survey-Based Review of Physical Therapy Management for Diastasis Recti with Emphasis on Transverse Abdominis (TRA) Exercise in the Postpartum Period

Introduction: Diastasis Recti Abdominis (DRA) is a common musculoskeletal condition affecting postpartum women, characterized by the separation of the rectus abdominis muscles. Despite its prevalence, there is a lack of standardized clinical guidelines for its evaluation and treatment, particularly regarding the role of transverse abdominis (TrA)-focused exercises in postpartum rehabilitation.
Objective: This review aims to evaluate current clinical practices in the assessment and management of DRA among physical therapists, with a specific focus on the integration and effectiveness of TrA-targeted interventions in postpartum care.
Methods: A systematic literature search was conducted across PubMed, EMBASE, and Web of Science databases up to 2021. The search included English-language studies on DRA that reported clinical outcomes related to exercise therapy, with or without adjunct modalities. Case series, observational studies, and clinical trials were included; abstracts, non-English articles, and unavailable full texts were excluded. A total of 28 studies met inclusion criteria. Data were extracted on study design, sample characteristics, DRA assessment methods, intervention protocols, and functional outcomes. Critical appraisal of clinical trials was conducted using the PEDro scale.
Results: The included studies comprised 14 clinical trials, 3 case series, and 11 observational studies. TrA-focused exercises—particularly those involving abdominal drawing-in maneuvers (ADIM)—were commonly used across interventions and associated with reduced inter-recti distance (IRD) and improved trunk stability. However, wide variation was found in diagnostic definitions, program designs, and outcome measures. A randomized controlled trial showed that a deep core stabilization program significantly decreased IRD and enhanced quality of life. Survey data indicated that while most physical therapists are aware of and routinely assess DRA postpartum, treatment approaches differ significantly due to the absence of standardized guidelines.
Conclusion: Targeted activation of the TrA shows promise in managing DRA and supporting postpartum recovery, but inconsistent evaluation methods and treatment strategies hinder clinical consensus. The findings highlight the urgent need for standardized protocols, enhanced clinician education, and further high-quality research to validate and unify evidence-based practices. Future studies should evaluate long-term functional outcomes of TrA-based interventions and assess the impact of adjunct modalities such as abdominal binding and electrotherapy.

Inter-recti distance, abdominal drawing-in maneuvers

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