Non operative management of postpartum Diastasis Recti: a systematic review and metanalysis of randomized controlled trials

Rectus Abdominis Diastasis (RAD) is a prevalent postpartum condition, yet consensus regarding the efficacy of conservative management remains limited. This meta-analysis evaluates the effectiveness of structured exercise programs in reducing Inter-Recti Distance (IRD) and improving functional outcomes in postpartum women compared to no-treatment or standard care. A systematic search was conducted for Randomized Controlled Trials (RCTs) published before August 2025. The primary outcome was IRD reduction; the secondary outcome was physical disability assessed via the Oswestry Disability Index (ODI). Methodological quality and certainty of evidence were evaluated using Revised Cochrane Risk-of-Bias (RoB 2) and GRADE criteria. Nine RCTs (450 participants) were included for IRD analysis, demonstrating a significant reduction in the exercise group (MD: -8.05 mm; 95% CI: -10.43, -5.68; p < 0.05). Subgroup analyses showed that interventions initiated < 3 months postpartum achieved greater reduction (MD: -10.2 mm; 95% CI: -14.94, -5.46) than delayed starts. Crucially, while no significant difference was found between specific types of training (p = 0.32), a consistent advantage was observed for structured exercise over no intervention or standard care. Regarding functional outcomes, meta-analysis of 3 comparisons from 2 RCTs (n = 115) using the ODI score showed no significant difference between groups (MD: 0.82 higher score; 95% CI: -2.75, 4.38; p = 0.75; I20%). Structured exercise programs significantly reduce IRD in women with RAD. However, this anatomical improvement does not translate into superior functional recovery, as measured by the ODI score, within the observed periods. Further standardized research is warranted to establish optimal clinical protocols and the need for RAD-specific functional scales in future research.