Comparative Efficacy of Abdominal Exercises and Abdominal Binding on Diastasis Recti Abdominis Reduction in Postpartum Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background And Purpose: Diastasis Recti Abdominis (DRA) is a separation of the rectus abdominis muscles which often results from pregnancy. This meta-analysis aims to identify the most effective non-surgical treatment to reduce post-partum DRA.

Methods: A comprehensive search was performed on electronic databases including PubMed, Cochrane, and Embase databases for RCTs involving abdominal or pelvic muscle exercises, and abdominal binding for DRA Reduction. Primary outcomes included inter-recti distance (IRD) Resolution, Oswestry Disability Index (ODI) score, and Pelvic Floor Disability Index (PFDI) score. ROB 2.0 tool was used for the risk of bias assessment of RCTs. Meta-analysis was performed using Review Manager version 5.4. Sensitivity analysis was conducted to determine the influence of studies on the overall results. Meta regression was performed using R version 4.4 to identify the sources of heterogeneity.

Results: Thirteen RCTs were included in the analysis. Abdominal exercise significantly reduced IRD below the umbilicus compared with abdominal binding (Mean difference [MD] = -0.31, 95% CI: -0.53 to -0.10, p = 0.004) but was ineffective for IRD resolution ≥ 2 cm above the umbilicus (MD = 0.22, 95% CI: -1.43 to 1.88, p = 0.79). Compared with no intervention, abdominal exercise significantly reduced IRD below the umbilicus (MD = -0.31, 95% CI: -0.53 to -0.10, p = 0.004) but was ineffective in IRD resolution ≥ 2 cm above the umbilicus (MD = 0.11, 95% CI: -0.38 to 0.59, p = 0.67). No significant reduction was found in the ODI score (MD = -5.57, 95% CI: -19.31 to 8.17, p = 0.43) and PFDI score (MD = -12.99, 95% CI: -43.49 to 17.51, p = 0.04).

Discussion: Abdominal exercises reduce IRD below the umbilicus more effectively than binding and no intervention, but their effectiveness above the umbilicus is unclear. ODI and PFDI showed no significant improvement. Further research with standardized criteria and diverse population is needed to clarify the efficacy of these treatments for diastasis recti.