Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review

Physiotherapy. 2019 Mar;105(1):24-34. doi: 10.1016/ Epub 2018 Jul 24.


Background: Diastasis of the rectus abdominis muscle (DRAM) is common during and after pregnancy.

Objectives: To determine the association between: the presence of DRAM and low back pain, lumbo-pelvic pain, incontinence, pelvic organ prolapse, abdominal muscle performance or health-related quality of life; and between DRAM width and severity of these outcomes.

Data sources: Six electronic databases (EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro).

Study selection: Included studies of all designs with adults with DRAM that assessed low back pain, lumbo-pelvic pain incontinence, pelvic organ prolapse, abdominal performance or health-related quality of life.

Study appraisal & synthesis methods: Methodological quality was assessed using the Effective Public Health Practice Project tool. A narrative summary was completed for DRAM presence and presence of the various musculoskeletal dysfunctions, and DRAM width and the severity of these dysfunctions.

Results: Twelve studies involving 2242 participants were included. There was no significant association between the presence of DRAM and lumbo-pelvic pain or incontinence. There was a small association between the presence of DRAM and pelvic organ prolapse. DRAM width may be associated with health-related quality of life, abdominal muscle strength and severity of low back pain.

Limitations: Quality of studies was weak. There was variability in the methods used to assess DRAM.

Conclusion: There is weak evidence that DRAM presence may be associated with pelvic organ prolapse, and DRAM severity with impaired health-related quality of life, impaired abdominal muscle strength and low back pain severity. Systematic Review Registration Number: PROSPERO CRD42017058089.

Keywords: Abdominal muscles; Diastasis; Low back pain; Pelvic organ prolapse; Pelvic pain; Rectus abdominis; Urinary incontinence.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Abdominal Muscles / physiopathology
  • Diastasis, Muscle / epidemiology*
  • Humans
  • Low Back Pain / epidemiology*
  • Muscle Strength / physiology
  • Pelvic Organ Prolapse / epidemiology*
  • Quality of Life*
  • Rectus Abdominis / physiopathology*
  • Urinary Incontinence / epidemiology*