title: The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study.
abstract: METHODS
  A prospective longitudinal study.
  
  
  BACKGROUND
  Diastasis recti abdominis (DRA) is defined as an increase in the inter-recti distance (IRD), or width of the linea alba. It is a common occurrence in women postpartum. Little information exists on the short- and long-term recovery of IRD and the relationship between changes in IRD and the functional performance of the abdominal muscles.
  
  
  OBJECTIVE
  To investigate the natural recovery of IRD and abdominal muscle strength and endurance in women between 7 weeks and 6 months postpartum, and to examine the relationship between IRD and abdominal muscle function.
  
  
  METHODS
  Forty postpartum (25-37 years of age) and 20 age-matched, nulliparous females participated. IRD was measured at 4 locations (upper and lower margin of the umbilical ring, and 2.5 cm above and below the umbilical ring) with a 7.5-MHz linear ultrasound transducer. Trunk flexion and rotation strength and endurance were measured with manual muscle testing and curl-ups. Evaluation was conducted at 4 to 8 weeks and 6 to 8 months after childbirth in postpartum women, and only once for the nulliparous female controls.
  
  
  RESULTS
  During follow-up, the IRD at 2.5 cm above the umbilical ring and at the upper margin of the umbilical ring decreased (P = .013 and P = .002, respectively). The strength and static endurance of the abdominal muscles improved over time (P<.05). A negative correlation between IRD and abdominal muscle function at 7 weeks and 6 months postpartum was found (r = 0.34 to 0.51; P<.05, except for trunk flexion strength at 6 months postpartum [P = .064]). In addition, IRD changes between 7 weeks and 6 months postpartum were correlated with improvement in trunk flexion strength (Spearman rho = 0.38, P = .040). At 6 months after childbirth, postpartum women had greater mean ? SD IRDs at all 4 locations (from cranial to caudal: 1.80 ± 0.72, 2.13 ± 0.65, 1.81 ± 0.62, and 1.16 ± 0.58 cm) than those of nulliparous females (0.85 ± 0.26, 0.99 ± 0.31, 0.65 ± 0.23, and 0.43 ± 0.17 cm) (all P<.001). All abdominal strength and endurance measurements were less than those of nulliparous females (all P<.001).
  
  
  CONCLUSIONS
  The IRD and abdominal muscle function of postpartum women improved but had not returned to normal values at 6 months after childbirth. Future research is essential to explore the need for intervention and, if needed, the effectiveness of specific intervention to reduce the size of IRD in postpartum women.
authors.affiliation: Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan.
authors.forename: Lih-Jiun
authors.initials: LJ
authors.lastname: Liaw
authors.forename: Miao-Ju
authors.initials: MJ
authors.lastname: Hsu
authors.forename: Chien-Fen
authors.initials: CF
authors.lastname: Liao
authors.forename: Mei-Fang
authors.initials: MF
authors.lastname: Liu
authors.forename: Ar-Tyan
authors.initials: AT
authors.lastname: Hsu
mesh_terms: D000009:Abdominal Muscles / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000502:physiology*; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053580:Muscle Strength / Q000502:physiology; D009929:Organ Size; D010807:Physical Endurance / Q000502:physiology; D049590:Postpartum Period / Q000502:physiology*; D011446:Prospective Studies; D014463:Ultrasonography