Combined Effects of Hypopressive Exercises and Abdominal Bracing on Diastasis Recti Outcomes

Combined Effects of Hypopressive Exercises and Abdominal Bracing on Interrecti Distance, Lumbopelvic Pain, and Abdominal Muscle Strength in Diastasis Recti

Diastasis Recti Abdominis (DRA) is the separation of the rectus abdominis muscles along the linea alba, commonly seen after childbirth due to the mechanical and hormonal changes that occur during pregnancy. DRA can negatively affect posture, trunk stability, and breathing patterns, and may result in persistent lumbopelvic pain and weakened core muscles if not properly managed. Although hypopressive exercises and abdominal bracing have individually demonstrated positive effects in reducing inter-recti distance and improving core function, limited research exists regarding their combined effects. This randomized clinical trial aims to evaluate the combined impact of hypopressive exercises and abdominal bracing on inter-recti distance, lumbopelvic pain, and abdominal muscle strength in postpartum women with DRA. The study will include 34 postpartum women recruited from Jinnah Hospital, Lahore, who will be randomly assigned into two groups. Group A will receive both hypopressive exercises and abdominal bracing, while Group B will receive only hypopressive exercises along with standard postpartum physiotherapy. Outcome measures will include pain intensity, lumbopelvic disability, abdominal muscle strength, and inter-recti distance, with data analyzed using SPSS version 25.

Study Overview

• Status: Recruiting
• Conditions: Diastasis Recti
• Intervention / Treatment: Other: Hypopressive exercise and Abdominal Bracing; Other: Hypopressive Exercise

Detailed Description

Diastasis Recti Abdominis (DRA) is the separation of rectus abdominis muscles along the linea alba, which is common after childbirth due to the mechanical and hormonal changes that occur during pregnancy. DRA can affect posture, trunk stability, and breathing patterns, and may lead to persistent lumbopelvic pain and a weakened core if not managed properly. Although hypopressive exercises and abdominal bracing have individually shown promising results in reducing interrecti distance and improving core function, limited research is available on their combined effects. This study aims to evaluate the combined impact of hypopressive exercises and abdominal bracing on inter-recti distance, lumbopelvic pain, and abdominal muscle strength in postpartum women with DRA.

This study will be a randomized clinical trial. The study will be conducted at Jinnah Hospital, Lahore, over 10 months, involving a total of 34 postpartum women selected through non-probability convenience sampling. Participants will be randomly assigned to two groups: Group A will receive a combination of hypopressive exercises and abdominal bracing, and Group B will receive only hypopressive exercises. The hypopressive protocol includes diaphragmatic breathing cycles followed by rib cage expansion and a 10-second apnea, while the abdominal brace will be worn during waking hours for six weeks, except during bathing and exercising. Both groups will also receive standard postpartum physiotherapy. Outcome measures include the Numerical Pain Rating Scale (NPRS) to evaluate pain intensity, the Pelvic Girdle Questionnaire (PGQ) to assess lumbopelvic disability, Manual Muscle Testing (MMT) for abdominal muscle recti distance. Data will be analyzed using SPSS version 25, and with p-value of <0.05 will be considered statistically significant.

• Study Type: Interventional
• Enrollment (Estimated): 34
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Imran Amjad, PHD*; Phone Number: 03324390125; Email: imran.amjad@riphah.edu.pk
• Study Contact Backup: Name: Imran Amjad, PHD*; Phone Number: 0515481826; Email: imran.amjad@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • Recruiting
      • Jinnah Hospital
      • Contact: Ghulam Fatima, PhD*; Phone Number: 03034073057; Email: ghulam.fatima@riphah.edu.pk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age group of 23 to 30 years

  • Inter recti distance > 2 to 5 cm
  • A women who had undergone a vaginal delivery at least 8 weeks before the first measurement
  • A postpartum female with the presence of diastasis rectus abdominis
  • BMI under or equal to 29kg/m2

Exclusion Criteria:

• Pregnant females (29)

  • Subjects who underwent any recent abdominal surgeries
  • Patient diagnosed with a Fibroid uterus
  • Patient diagnosed with abdominal hernia
  • Cesarean section (C-section)
  • Chronic medical conditions such as diabetes, uncontrolled hypertension, cardiovascular disease, or thyroid disorders.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group A: Hypopressive Exercise and Abdominal Bracing; The hypopressive exercise protocol included maintaining spinal elongation, a neutral pelvis, knee flexion, and scapular muscle activation. Participants performed diaphragmatic breathing followed by full expiration and a 10-second apnea with rib cage expansion, causing inward abdominal contraction without inhalation. Exercises were performed in lying, sitting, standing, kneeling, and four-point kneeling positions. Each exercise was repeated three times with 30-second rest intervals. The intervention lasted 6 weeks with 12 sessions. Participants in Group A also used an ITA-Med postnatal abdominal binder made of breathable elastic material. The binder covered the area from the pubis to the lower ribs and was worn during waking hours for 6 weeks, except during sleep and bathing. It was applied while lying down and adjusted for a snug but comfortable fit. Participants were instructed to avoid excessive tightness and monitor the skin for irritation.	Other: Hypopressive exercise and Abdominal Bracing; The hypopressive exercise protocol included maintaining spinal elongation, a neutral pelvis, knee flexion, and scapular muscle activation. Participants performed diaphragmatic breathing followed by full expiration and a 10-second apnea with rib cage expansion, causing inward abdominal contraction without inhalation. Exercises were performed in lying, sitting, standing, kneeling, and four-point kneeling positions. Each exercise was repeated three times with 30-second rest intervals. The intervention lasted 6 weeks with 12 sessions. Participants in Group A also used an ITA-Med postnatal abdominal binder made of breathable elastic material. The binder covered the area from the pubis to the lower ribs and was worn during waking hours for 6 weeks, except during sleep and bathing. It was applied while lying down and adjusted for a snug but comfortable fit. Participants were instructed to avoid excessive tightness and monitor the skin for irritation.
Active Comparator: Group B: Hypopressive Exercise only; Each exercise was performed during the expiratory phase and required the contraction of the pelvic floor muscles. Participants were instructed to perform between 1 to 3 sets of 10 repetitions per exercise, holding each contraction for 5 seconds followed by 10 seconds of relaxation. The number of sets and the difficult level were progressively adjusted over time.	Other: Hypopressive Exercise; Each exercise was performed during the expiratory phase and required the contraction of the pelvic floor muscles. Participants were instructed to perform between 1 to 3 sets of 10 repetitions per exercise, holding each contraction for 5 seconds followed by 10 seconds of relaxation. The number of sets and the difficult level were progressively adjusted over time. This treatment protocol will be performed over a time period of 6 weeks

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numerical Pain Rating Scale (NPRS)	It is a standardized self-reporting scale consisting of a horizontal line used to estimate the subjective level of pain intensity. It is a 11 point numerical scale, corresponding to the degree of pain. 0= no pain, 1-2-3 = mild pain, 4-5-6 = moderate pain, 7-8-9-10 = severe pain. The patients will be asked to select from that 11 points numerical continuum the number that corresponds to their perceived pain intensity. NPRS is considered a valid and reliable scale for measures of pain intensity. NPRS has shown high test-retest (r=0.96 and 0.95 ) reliability.	6 weeks
Pelvic Girdle Questionnaire (PGQ)	It is a straightforward tool with 25 items, 20 of which measure activity restrictions (the activity subscale) and 5 of which measure symptoms (the symptom subscale). Every item is worth four points and is graded on a Likert scale with a range of 0 to 3. The PGQ has a maximum possible score of 75, which includes 15 for the symptom subscale and 60 for the activity subscale. Three points are deducted from the maximum possible score for an item that has no response or a response of "not applicable." The final figures are displayed as a percentage, with 0 denoting no disability and 100 denoting severe disability. A worse result is indicated by a higher score. PGQ is considered a valid and reliable scale for measuring disability. PGQ has shown test-retest reliability ( 0.93 (activity), .91 (symptom).	6 weeks
Manual muscle testing (MMT)	Manual muscle testing (MMT) is a widely used clinical method for assessing muscle strength by applying manual resistance to specific muscles or muscle groups and grading the response on a standardized 0-5 scale. It is considered a valid and reliable tool, particularly effective in detecting moderate to severe muscle weakness. Studies report high inter-rater reliability (ICC = 0.85-0.98) and good intra-rater consistency when performed by trained clinicians, especially for muscle grades 3 and above.	6 weeks
Tape measure and Finger-Width Method	The finger-width method and tape measure are commonly used clinical tools to assess diastasis recti postpartum. The finger-width method shows good intra-rater reliability (Kappa > 0.7) but only moderate inter-rater reliability (Kappa ≈ 0.53) and limited validity compared to ultrasound. In contrast, the tape measure method demonstrates excellent intra- and inter-rater reliability (ICC = 0.80-1.00) and strong validity, with high correlation to ultrasound (r = 0.82-0.98). While ultrasound remains the 14 gold standard, the tape measure is a more accurate and reliable clinical alternative than the finger-width method.	6 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Muzzammil Akhtar, Riphah International University

Publications and helpful links

General Publications

• Michalska A, Rokita W, Wolder D, Pogorzelska J, Kaczmarczyk K. Diastasis recti abdominis - a review of treatment methods. Ginekol Pol. 2018;89(2):97-101. doi: 10.5603/GP.a2018.0016.
• Thabet AA, Alshehri MA. Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial. J Musculoskelet Neuronal Interact. 2019 Mar 1;19(1):62-68.
• Hsia M, Jones S. Natural resolution of rectus abdominis diastasis. Two single case studies. Aust J Physiother. 2000;46(4):301-307. doi: 10.1016/s0004-9514(14)60291-9.
• Mota P, Gil Pascoal A, Bo K. Diastasis recti abdominis in pregnancy and postpartum period. Risk factors, functional implications and resolution. Current women's health reviews. 2015;11(1):59-67

Study record dates

Study Major Dates

• Study Start (Actual): April 2, 2025
• Primary Completion (Estimated): July 2, 2026
• Study Completion (Estimated): August 15, 2026

Study Registration Dates

• First Submitted: June 8, 2026
• First Submitted That Met QC Criteria: June 8, 2026
• First Posted (Actual): June 11, 2026

Study Record Updates

• Last Update Posted (Actual): June 11, 2026
• Last Update Submitted That Met QC Criteria: June 8, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Lumbopelvic pain; Hypopresive Exercise; Abdominal Bracing
• Other Study ID Numbers: REC/RCR & AHS/25/0525

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No