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.

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.

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.

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.

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).

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.