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The aim of this study is to compare the combine effects of drawing in maneuver and resisted ankle dorsiflexion on pain, inter-recti distance, strength and quality of life in postpartum diastasis recti.
Randomized controlled research will assess how drawing-in maneuver and resisted ankle dorsiflexion together affect postpartum women with diastasis recti in terms of pain, inter-recti distance, abdominal strength, and quality of life. 20-40 years females from 6 weeks to 6 months to post-partum period will be included in this study and the data will be collected from Al Zahra Hospital, Ali medical center and Sharif Medical Complex. Two groups of 42 individuals will be randomly assigned to either the drawing-in maneuver alone (Group A, n = 21) or a combination of the drawing-in technique and resisted ankle dorsiflexion (Group B, n = 21). For six weeks, the intervention will be administered twice a week to both groups. Manual muscle testing for strength, caliper measurement for IRD, the SF-36 questionnaire for quality of life and the Numeric Pain Rating Scale (NPRS) for pain will all be used in baseline and post-treatment evaluations. The data will be analyzed using IBM SPSS Statistics version 25.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| DRAWING IN MANEUVER & RESISTED ANKLE DORSIFLEXION | Experimental | Drawing-In Maneuver (DIM), also known as the abdominal drawing-in maneuver, which is widely recognized as a foundational exercise for deep core activation |
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| DRAWING IN MANEUVER | Active Comparator | Resisted Ankle Dorsiflexion contributes to core muscle engagement through kinetic chain activation. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| DRAWING IN MANEUVER | Other | Each contraction will be held for 10 seconds and repeated 10 times per session. This exercise will be performed two to three times per week for six weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Numeric Pain Rating Scale | This scale examines the subjective degree of pain severity is estimated using a horizontal line on a standardized self-reporting scale. The pain level is represented by an 11-point numerical scale. There is no pain (0), mild pain (1-2-3), moderate pain (4-5-6), and severe pain (7-8-9-10). | 6th week |
| Caliper Measurement | To assess inter-recti distance at reference points (above, at, and below the umbilicus) the caliper will be used. To measure inter-recti distance 4.5 cm above and below the umbilicus (indicated with skin markings), the inside jaws of the calipers are placed between the medial edges of the right and left rectus abdominis muscles as palpated by the examiner | 6th week |
| Manual Muscle Testing (MMT) | . Manual Muscle Testing (MMT) is a widely used clinical method to evaluate the strength of individual muscles or muscle groups on a standardized 0 to 5 scale. A grade of 0 indicates no visible or palpable muscle contraction, while 1 (Trace) denotes a slight muscle flicker without any movement. A grade 2 (Poor) means the muscle can complete full range of motion only when gravity is eliminated. Grade 3 (Fair) signifies the ability to move the joint through the full range of motion against gravity, but not against any resistance. Grade 4 (Good) indicates that the muscle can perform against moderate resistance, and grade 5 (Normal) represents full strength with the ability to resist maximal manual pressure | 6th week |
| SF-36 | The SF-36 (Short Form-36 Health Survey) is a validated and reliable questionnaire used to assess health-related quality of life across eight domains, including physical functioning, bodily pain, general health, vitality, social functioning, and mental health. Each domain is scored from 0 to 100, with higher scores indicating better quality of life | 6th week |
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Inclusion Criteria:
Exclusion Criteria:
postpartum diastasis recti
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| imran amjad, PhD* | Contact | 03324390125 | imran.amjad@riphah.edu.pk | |
| imran amjad | Contact | 03324390125 | imran.amjad@riphah.edu.pk |
| Name | Affiliation | Role |
|---|---|---|
| hina gul, PhD* | Riphah International University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Al Zahra Hospital | Recruiting | Guiranwala | Punjab Province | 52250 | Pakistan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34363190 | Background | Cavalli M, Aiolfi A, Bruni PG, Manfredini L, Lombardo F, Bonfanti MT, Bona D, Campanelli G. Prevalence and risk factors for diastasis recti abdominis: a review and proposal of a new anatomical variation. Hernia. 2021 Aug;25(4):883-890. doi: 10.1007/s10029-021-02468-8. Epub 2021 Aug 6. | |
| Background | Berg-Poppe P, Hauer M, Jones C, Munger M, Wethor C. Use of exercise in the management of postpartum diastasis recti: a systematic review. The Journal of Women's & Pelvic Health Physical Therapy. 2022;46(1):35-47. | ||
| 34313855 |
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| RESISTED ANKLE DORSIFLEXION | Other | They will dorsiflex the ankle, pulling the toes toward the shin against the resistance, hold for 5-10 seconds, and then return to the starting position. Each leg will complete three sets of 10 repetitions, performed two to three times weekly |
|
| Background |
| Tung RC, Towfigh S. Diagnostic techniques for diastasis recti. Hernia. 2021 Aug;25(4):915-919. doi: 10.1007/s10029-021-02469-7. Epub 2021 Jul 27. |
| 39694630 | Background | Beamish NF, Davenport MH, Ali MU, Gervais MJ, Sjwed TN, Bains G, Sivak A, Deering RE, Ruchat SM. Impact of postpartum exercise on pelvic floor disorders and diastasis recti abdominis: a systematic review and meta-analysis. Br J Sports Med. 2025 Mar 31;59(8):562-575. doi: 10.1136/bjsports-2024-108619. |
| 34055160 | Background | Laframboise FC, Schlaff RA, Baruth M. Postpartum Exercise Intervention Targeting Diastasis Recti Abdominis. Int J Exerc Sci. 2021 Apr 1;14(3):400-409. doi: 10.70252/GARZ3559. eCollection 2021. |