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Efficacy of Adding Fascial Manipulation to Neuromuscular Electrical Stimulation and Sling Exercise for Postpartum
Purpose:
This trial assessed whether adding fascial manipulation to neuromuscular electrical stimulation (NMES) plus sling exercise, with increased treatment time and therapist contact, improves outcomes in postpartum diastasis recti.
Methods:
In this outcome-assessor-blinded, two-arm randomized controlled trial, 96 postpartum women with diastasis recti abdominis were randomised (permuted blocks of four) to fascial manipulation plus NMES and sling exercise (60min/session) or standard NMES plus sling exercise (40min/session), three times weekly for 6 weeks. No adverse reactions were observed.
Results:
Within both groups, IRD, pelvic anterior tilt and VAS decreased and standing time and SF-36 increased (all p < 0.001). Between-group change scores favoured the intervention for pain (ΔVAS -2.51 [-3.50, -0.39] vs -0.52 [-0.97, 0.00], p < 0.001, r = -0.51) and pelvic tilt (-2.84 [-4.72, -0.74] vs -1.10 [-3.02, 0.00], p = 0.008, r = -0.31), remaining significant after false-discovery-rate correction (q < 0.05). ΔIRD (p = 0.042) and ΔGlazer (p = 0.036) were nominally significant but did not survive correction (q = 0.073). Differences in standing time, SF-36 and body fat were not significant. Exploratory responder analysis: 52.1% vs 8.3% achieved a ≥2-point VAS reduction (p < 0.001).
Conclusion:
Adding fascial manipulation to NMES plus sling exercise yields robust benefits for pain relief and pelvic tilt correction, with nominal effects on IRD and pelvic floor function; the proposed fascial mechanism remains unconfirmed.
Statement Of Significance:
Postpartum diastasis recti impairs core stability and quality of life, yet rehabilitation often neglects abdominal fascial dysfunction. In this assessor-blinded randomised trial, adding fascial manipulation to neuromuscular electrical stimulation plus sling exercise produced robust between-group benefits for pain relief (large effect; 52.1% vs 8.3% achieving a clinically meaningful reduction) and pelvic tilt correction (medium effect), with smaller, nominal effects on inter-rectus distance and pelvic floor function; balance and quality-of-life differences were not significant. Tissue-level mechanisms of fascial release remain unconfirmed.