Investigating the effect of three contrasting interventions on recovery of abdominal muscle separation after childbirth

INTERVENTION: Participants will be enrolled in the study prior to two weeks post‐natal. The first baseline data (outcome measure) collection timepoint will take place at two weeks postnatal. Participants will be re‐assessed at eight weeks post‐natal and those that have persistent diastasis of the rectus abdominis muscle allocated to one of three groups for intervention (of 12 weeks duration): 1. Advice only 2. Abdominal support ‐ these participants will be required to wear an abdominal support for 10‐12 hours/day for 12 weeks. The abdominal support is an easily removable elasticised garment worn in a double layer extending from the pubic symphysis to the xiphoid process of the sternum. Instructions for wear and fitting will be provided by an experienced Women's Health Physiotherapist. Participants will be asked to complete a diary to monitor adherence to the intervention. 3. Abdominal exercise‐ these participants will be required to see a Physiotherapist for 7 sessions over 12 weeks for exercise prescription and progression and be asked to perform these exercises at home 5 times per week for 20 minutes. Exercises will commence with static activation of the transverses abdominis muscle in crook‐lying, side‐lying and 4‐point‐kneel position. These will be progressed to including arm and/or leg movements and further progressed to involve movement of the Thorax on the lumbar spine i.e. curl‐up, Russian twist. Exercises are of a low‐moderate intensity and will be performed until fatigue. This will be assessed via monitoring of posture, breathing and correct muscle activation patterns. Participants will be asked to complete an exercise diary to monitor adherence to the intervention. Outcome measures will be reassessed at the end of the intervention i.e. at 20 weeks post‐natal, CONDITION: Diastasis of the Rectus Abdominis Muscle; ; Diastasis of the Rectus Abdominis Muscle Musculoskeletal ‐ Other muscular and skeletal disorders PRIMARY OUTCOME: The primary outcome measure is the Linea alba distortion index.; Real‐time Ultrasound Imaging will be used to image the abdominal muscle inter‐rectii distance and the linea alba distortion index subsequently measured from this image. [12 weeks following commencement of intervention i.e. 20 weeks following baseline data measurement] SECONDARY OUTCOME: International Physical Activity Questionnaire[At 3 months post completion of the intervention i.e. 20 weeks following baseline data measurement] Pelvic Girdle Pain Questionnaire[At 3 months post completion of the intervention i.e. 20 weeks following baseline data measurement.] Roland Morris Questionnaire for low back pain[At 3 months post completion of the intervention i.e. 20 weeks following baseline data measurement] Body Quality of Life Questionnaire for Body Image[At 3 months post completion of the intervention i.e. 20 weeks following baseline data measurement] Exercise Diary[At 3 months post completion of the intervention i.e. 20 weeks following baseline data measurement] Inter‐rectii distance. This will be measured using real‐time Ultrasound imaging. ; ; ; [At 3 months post completion fo the intervention i.e. 20 weeks following baseline data measurement] Pelvic Floor Distress Inventory[At 3 months post completion of the intervention i.e. 20 weeks following baseline data measurement] INCLUSION CRITERIA: • aged > 18 years; • <2 weeks postnatal at time of enrolment into study; • Primiparous (first pregnancy or first pregnancy beyond 20 weeks’ gestation); • Willing/able to travel to follow up appointments at site of data collection