The relationship between transversus abdominis and rehabilitation exercises for diastasis recti abdominis: A scoping review.

BACKGROUND

Physiotherapy is the primary management approach for diastasis recti abdominis (DRA). Most published research has focused on intervention types, exercise effects, and their evaluation, with relatively little work on how to design exercise programmes that are grounded in biomechanical mechanisms. One reason for this gap may be that changes in trunk mechanics associated with pregnancy have been overlooked. This scoping review explores the biomechanical basis for rehabilitation exercises for DRA, with a particular focus on the transversus abdominis (TrA).

METHODS

We searched PubMed, EMBASE, Web of Science, and CNKI for English- and Chinese-language publications up to February 2025. Search terms included "diastasis recti abdominis," "abdominal muscles," "biomechanics," "linea alba," "physical therapy/physiotherapy," "transversus abdominis," AND "trunk stabilization," combined with Boolean operators. All human studies relevant to the biomechanical mechanisms of DRA rehabilitation were eligible, regardless of study design.

RESULTS

During contraction, the TrA thickens, shortens, and slides laterally, decreasing abdominal cavity volume and increasing intra-abdominal pressure, thereby enhancing trunk stability. Forces generated by the TrA are transmitted via the transversus aponeurosis and the dorsal rectus sheath to the linea alba, increasing linea alba tension. The posterior layer of the linea alba and the dorsal rectus sheath are dominated by transverse fibres, which exhibit high transverse stress and low compliance. Altered trunk biomechanics and linea alba deformation are characteristic features of DRA.

CONCLUSION

TrA contraction improves trunk stability and augments linea alba tension. Accordingly, exercises that preferentially activate and strengthen the TrA represent a logical, mechanism-based treatment for DRA rehabilitation.

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