Francesca Galiano
10/08/2022 - Last update 30/12/2022

Brandi Kirk, Teresa Elliott-Burke | Year 2020

The effect of visceral manipulation on Diastasis Recti Abdominis


Diastasis recti abdominis

Type of study:

case series

Date of publication of the study’:



Purpose of the study

  • Objective: to report the utility of visceral manipulation in 3 women with diastasis recti abdominis
  • Measured outcomes: intensity of pain Visual Analogue Scale (VAS) and Female National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), disability through Oswestry Disability Index (ODI) and fear of movement through Tampa scale of kinesiophobia (TSK)


  • Number: 3
  • Description: 3 women of 33, 37 and 39 years of age, all with 2 past pregnancies and all with various intermittent problems including low back pain, abdominal pain and vulvar burning and itching. All problems that would prevent them from living normally by interfering with their socialization, care of children and housekeeping.
    At the moment of the visit, the pain intensity was equal to 2, 4 and 0 for the 3 patients, although they had previously experienced worse pain intensity, rated at 4, 8 and 5, all measured with Numeric Pain Rating Scale (NPRS). One patient reported bladder disorders (sense of incomplete emptying, nocturia and dysuria), while 2 reported bowel movement disorders (straggling to evacuate once every 4-5 days, possibly with the help of a laxative).

All patients reported having had complicated deliveries (eg, C-section for breech delivery with a significant scar, postpartum bleeding for 7 weeks, labor longer than 40 hours) and assuming various anti inflammatory drugs, steroidal and not, orally and locally.
The examinations showed a reduced lumbar range of motion (ROM), while also highlighting a muscle laxity and weakness at the pelvic and intravaginal levels, as well as several mesenteric and intestinal restrictions (an inguinal hernia in the third patient) and several postural alterations both at the lumbar and sacroiliac levels and at the systemic level (head, thorax and extremities).

During the examination all patients were positive for diastasis recti abdominis with a distance greater than 2 finger-width at least in 1 of the 3 measurement sites (ie, 3 fingers above the umbilicus, umbilicus level, and 3 fingers below). In detail:

    • 1st patient: 1,5 fingers above the umbilicus, 3 fingers at the umbilicus level and 2,5 fingers below the umbilicus
    • 2nd patient: 2 fingers above the umbilicus, 3 fingers at the umbilicus level and 1 finger below the umbilicus
    • 3rd patient: 3,5 fingers above the umbilicus, 4,5 at the umbilicus level and 2 fingers below the umbilicus. Therefore, it was decided to perform a visceral manipulation.

Interventions and evaluations

  • Evaluation of the diastasis recti abdominis at the initial assessment and after each visit
  • At least 4 sessions of primary visceral manipulation
    • 1st patient: 7 visits in 18 weeks
    • 2nd patient: 12 visits in 36 weeks
    • 3rd patient: 6 visits in 24 months
  • Visceral manipulation: treatment of the mesenteric root (upper leaf, lower leaf, and both simultaneously), intestinal loops, mesentery and intestinal motility, as taught by the Barral Institute
  • From the 4th and 5th visit other kinds of therapy have been added, like exercises to improve ROM, to promote diaphragmatic breathing, to strengthen the pelvic muscles, or articular techniques
  • Visceral manipulation performed by two physical therapist with broad knowledge and experience and specialized in pelvic conditions


The patients were discharged after 7, 12 and 6 visits respectively.

The 1st patient’s pain completely resolved and her ROM improved, with consequent complete resumption of daily activities. In addition, her diastasis recti abdominis did practically disappear (only 1 finger at the level of the umbilicus).

The 2nd patient resolved her pain problems (only some vaginal swelling persisted and some dysmenorrhea during ovulation), thus becoming able to resume socializing and moving without problems. Also, the bladder issues improved (only a subtle sense of incomplete emptying persisted), while the bowel movement disorders remained, although from once every 4-5 days she would now evacuate every day. She also saw the diastasis recti abdominis almost disappear (only 1.5 fingers at the umbilicus level). However, the pain and instability values of the pelvic floor measured by NIH-CPSI and Pelvic Floor Disability Index (PFDI-20) respectively were not lower at the time of discharge compared to the first visit.

The 3rd patient had no more pain and was therefore able to resume child care and housekeeping at her best. She reported less difficulties in the intestinal evacuation and her diastasis recti abdominis was significantly reduced (1 finger above the umbilicus, 1.5 fingers at the umbilicus level and 0.5 fingers below the umbilicus).


Visceral manipulation has been shown to be able to promote the closing of diastasis recti abdominis and the improvement of its consequential pain, while improving physical function and quality of life.
These positive effects may depend on the capacity of visceral manipulation to act on the quality of the myofascial tissue, improving its depleted state, resulting from the endurance of forces greater than those physiologically manageable during pregnancy.

In the 3rd patient the closure of the diastasis might have been due to the presence of an inguinal hernia.
A limit of the study is having evaluated the diastasis subjectively instead of through ultrasounds, which would be more accurate and, amongst other things, could be carried out in real-time to monitor the actual progress of the diastasis.
Moreover, the implementation of other kinds of therapy after the 4th visit prevents us from crediting the results exclusively to visceral manipulation.

The review of Osteopedia

By Marco Chiera

Strengths: Strengths: accurate introduction of the diastasis recti abdominis and of the potential importance of the use of a manipulative approach; detailed description of the cases (evaluation, treatment and results) using text, tables and graphs (and video for visceral manipulation techniques); good discussion of the possible etiology of diastasis recti abdominis in the face of the possible mechanical forces involved during childbirth and on the basis of the in vivo studies of surgeon Guimberteau on the fascial system; patients followed for a long period of time; good description of the limitations of the study.

Limits: like all single cases, they are not generalizable.

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