Effectiveness of Curl-Up Task as Abdominal Exercise for Persistent Diastasis Recti Abdominis in Parous Women With Ehlers–Danlos Syndrome: A Randomized Controlled Trial

Purpose: Women with hypermobility-type Ehlers–Danlos syndrome often have impaired core strength, aggravated by diastasis recti abdominis. The purpose of this study was to determine if a 3- or 6-month exercise program improves inter-rectus distance (IRD) and abdominal strength in women with Ehlers–Danlos syndrome. Methods: Adult parous women were randomized to exercise (EX) or control (CON). Testing at baseline, 12, and 24 weeks included: IRD at rest and with curl-up at the umbilicus with digital calipers, and abdominal strength with manual muscle testing. EX performed strengthening, breathing, and postural exercises 3×/wk. CON was not provided with exercise. IRD was analyzed with repeated measures analysis of variance (ANOVA) and strength via nonparametric analyses. Results: Participants (EX = 11, CON = 13) were similar at baseline. When comparing the 2 groups, umbilical IRD at rest and with curl-up improved from baseline to 12 ( P ≤ .001) and 24 weeks ( P < .001) only in EX. IRD at rest and with curl-up improved in EX compared with CON at both 12 ( P = .003 and P < .001, respectively) and 24 weeks ( P ≤ .001). Strength improved in EX from baseline to 12 ( P = .021) and 24 weeks ( P = .006), and between EX and CON at 24 weeks ( P = .038). Discussion: While IRD improved at both 12 and 24 weeks, meaningful strength changes require 24 weeks. This program challenges the conventional treatment of persistent diastasis recti abdominis by incorporating curl-up exercise and emphasizing the importance of utilizing linea alba tension and transversus abdominis activation.