Efficacy of adding fascial manipulation to neuromuscular electrical stimulation and sling exercise for postpartum diastasis recti: A randomized controlled trial

Purpose This trial assessed whether adding fascial manipulation to neuromuscular electrical stimulation (NMES) plus sling exercise, with increased treatment time and therapist contact, improves outcomes in postpartum diastasis recti. Methods In this outcome-assessor-blinded, two-arm randomized controlled trial, 96 postpartum women with diastasis recti abdominis were randomised (permuted blocks of four) to fascial manipulation plus NMES and sling exercise (60 min/session) or standard NMES plus sling exercise (40 min/session), three times weekly for 6 weeks. No adverse reactions were observed. Results Within both groups, IRD, pelvic anterior tilt and VAS decreased and standing time and SF-36 increased (all p < 0.001). Between-group change scores favoured the intervention for pain (ΔVAS −2.51 [−3.50, −0.39] vs −0.52 [−0.97, 0.00], p < 0.001, r = −0.51) and pelvic tilt (−2.84 [−4.72, −0.74] vs −1.10 [−3.02, 0.00], p = 0.008, r = −0.31), remaining significant after false-discovery-rate correction (q < 0.05). ΔIRD (p = 0.042) and ΔGlazer (p = 0.036) were nominally significant but did not survive correction (q = 0.073). Differences in standing time, SF-36 and body fat were not significant. Exploratory responder analysis: 52.1% vs 8.3% achieved a ≥ 2-point VAS reduction (p < 0.001). Conclusion Adding fascial manipulation to NMES plus sling exercise yields robust benefits for pain relief and pelvic tilt correction, with nominal effects on IRD and pelvic floor function; the proposed fascial mechanism remains unconfirmed. Statement of significance Postpartum diastasis recti impairs core stability and quality of life, yet rehabilitation often neglects abdominal fascial dysfunction. In this assessor-blinded randomised trial, adding fascial manipulation to neuromuscular electrical stimulation plus sling exercise produced robust between-group benefits for pain relief (large effect; 52.1% vs 8.3% achieving a clinically meaningful reduction) and pelvic tilt correction (medium effect), with smaller, nominal effects on inter-rectus distance and pelvic floor function; balance and quality-of-life differences were not significant. Tissue-level mechanisms of fascial release remain unconfirmed.