Many women experience an increase in the inter-recti abdominal muscle distance due to stretching and thinning of the linea alba during and also after pregnancy[1]. In particular, the presence of a diastasis recti abdominis (DRA), defined as an impairment characterized by a midline separation of the rectus abdominis muscle along the linea alba [2].A widening of >2cm, 25mm², or 2 fingers width at one or more assessment points (at the level of the umbilicus or 4.5cm above or below the umbilicus) is considered significant[1, 3]. In a descriptive study by Boissonnault and Blaschak, the incidence ranged from 0% in non-pregnant and 1^st trimester women, 27% in 2^nd trimester and 66% in 3^rd trimester. 36% of women between 5 week and 3 months postpartum had observed continue to displacement of separation of diastasis recti. DRA is not exclusive to childbearing women but is seen frequently in this population[3]. The linea alba is a meshwork of connective tissue in which the tendinous insertions of the external oblique, internal oblique, and transverse abdominis muscle intermingle, providing structure and stability to the abdominal wall and trunk. A DRA can indicate connective tissue alterations of the linea alba, an increase in muscle length with consequent altered line of muscle pull, damage of the fixation of the rectus muscles in their sheaths, or a disruption of the entire musculofascial abdominal wall. The anisotropic, directionally dependent behavior of linea alba, in conjunction with craniocaudal differences in the width and thickness of the linea alba, necessitates IRD measurements both above and below the umbilicus to document the DRA width [4]. DRA occurs due to hormonal elastic changes of the connective tissue, mechanical stresses placed on the abdominal wall by the growing fetus, and displacement of the abdominal organs[4]. During pregnancy increased level of relaxin, progesterone and estrogen hormones causes softening of connective tissues and weakening of the linea alba[3]. Other risk factors of diastasis recti include age, women over the age of 35 years, high birth weight of child, multiple birth pregnancy, caesarean section, and excessive abdominal exercises after the first trimester of pregnancy, massive weight loss occurring spontaneously or after bariatric surgery, previous or repeated abdominal surgery, menopausal women, and those using hormone replacement therapy[2, 3]. Women with diastasis recti usually perceive no pain at rest, whereas discomfort, pain, corset instability and bulging of the abdominal wall are symptoms appearing during physical activities[3]. DRA is relatively common and can have negative consequences. The abdominal wall plays important functions in posture, trunk, and pelvic stability, respiration, trunk movement, and support of the abdominal viscera. An increase in the inter-recti distance puts these functions in jeopardy, and can weaken abdominal muscles and influence their functions. This may result in altered trunk mechanics, impaired pelvic stability and changed posture, which may leave the lumbar spine and pelvis more vulnerable to injury[1]. The pelvic floor and abdominal muscles function synergistically, each muscle group enhances the effectiveness of the other during contraction. As a result of this synergistic relationship, a decrease in abdominal muscle function associated with DRA could affect the performance of the pelvic floor musculature[2]. Abdominal exercises if taught in the postpartum period are postulated to help restore the anatomical width of the linea alba[5]. Exercises to strengthen core muscles include the crunch exercise, and the plank exercise. The plank exercise is a posture designed to use body weight to resist gravity; it can be performed on various surfaces, in variable positions, with devices, and impacts multiple joints[6]. Abdominal hollowing and bracing prior to performing abdominal curls facilitates activation of the transversus abdominis and internal oblique’s throughout the abdominal curling activity[7]. DRA is measured by placing palpating fingers between the medial borders of the right and left rectus abdominis muscles, parallel to the linea alba. DRA size is determined by indicating the number of fingers that fit between the 2 muscle bellies at locations above, below, and at the umbilicus while the individual performs a partial curl-up. Clinically, this palpation technique is easy to perform but has not demonstrated adequate reliability and validity. A modification of this palpation technique using nylon dial or digital calipers to measure the IRD has been shown to be reliable in pregnant and postpartum women[4]. Despite DRA being a common and significant clinical problem there is still insufficient research about protocols concerning the influence of diastasis of the rectus abdominis [1]. The purpose of this study was to determine the added effects of a modified dynamic core stability plank exercise program on DRA closure and pelvic floor disability.

Digital nylon caliper, Pen, Measuring tape, Pelvic floor disability index, Towel, Plinth.

The study conducted was an experimental study using purposive sampling. The study was carried out at Bhausaheb Sardesai Talegaon Rural Hospital on 16 subjects for a duration of 6 weeks. The subjects were selected according to the inclusion and exclusion criteria. Inclusion criteria: 3 months and above post-partum [8], Age 18 years and above [8], Presence of diastasis recti greater than 25mm [3], Post-menopausal women [2]. Exclusion criteria: Subjects with any heart condition, respiratory condition, pelvic surgery, neurological diseases, traumatic bowel or bladder, prior history of physical therapy for pelvic floor issues & depression [8].