Provider Name & Treatment Location: Charlotte Owen, BSc (Hons) MCSP; Hannah Poulton, BSc (Hons) MCSP, PhD; Mercedes Furió Valverde — Women’s Health Physiotherapy, Department of Physiotherapy, Universidad Europea, Spain; Research Group Woman & Health
Key Words: Diastasis recti abdominis; postpartum rehabilitation; TECAR therapy; electrical muscle stimulation; women’s health physiotherapy
Summary (Abstract)
This case report describes the clinical course of a 43-year-old White British woman with long-standing postpartum diastasis recti abdominis (DRA), persisting nine years after her second vaginal delivery, treated using TECAR therapy combined with high-intensity electrical muscle stimulation (Hi-EMS, Slim+ mode) alongside targeted exercise. At baseline, palpation assessment showed inter-recti distances (IRD) of up to 4 cm above and at the umbilicus. The patient received six sessions over seven weeks using a Winback BACK4 Care+ device in Slim+ mode (combined CET/RET with Hi-EMS), alongside progressive Pilates-based abdominal exercise.
Post-intervention assessment demonstrated a 0.5 cm reduction in inter-recti distance at and above the umbilicus, both at rest and during head lift, with a reduction also observed 2 cm below the umbilicus during head lift. The patient reported subjective improvements in abdominal strength, exercise confidence, and abdominal tone, with no adverse events recorded.
What is unique about this case is that the participant was nine years postpartum — a stage at which spontaneous structural recovery of DRA is unlikely — yet measurable reductions in IRD were observed over a relatively short seven-week intervention. The take-away is that combined TECAR and Hi-EMS, integrated with progressive abdominal rehabilitation, may offer measurable benefit even in chronic, long-standing DRA.
Key take-away lessons:
- Measurable reduction in inter-recti distance was achieved in a case of DRA persisting nine years postpartum, over just six sessions across seven weeks.
- Combining TECAR (CET/RET) with Hi-EMS in Slim+ mode alongside progressive Pilates-based abdominal exercise was well tolerated, with intensity progressively increased according to patient tolerance and visible abdominal activation.
- Palpation-based IRD measurement is a practical clinical outcome but has only moderate reliability; ultrasound remains the gold standard and is recommended for future studies.
Introduction
Diastasis recti abdominis (DRA) is a common physiological adaptation during pregnancy, with widening of the linea alba occurring in the majority of women by late gestation. Although spontaneous recovery often occurs postpartum, persistent DRA may be associated with reduced abdominal strength, altered trunk mechanics, and body image concerns. Exercise-based rehabilitation is widely recommended as first-line management; however, evidence exploring adjunctive electrotherapeutic modalities such as transfer of energy capacitive and resistive (TECAR) therapy and electrical muscle stimulation remains limited, though some studies suggest potential benefit when these modalities are combined with abdominal rehabilitation programs.
This case is of particular interest given the long-standing nature of the condition (nine years postpartum) and the relatively short timeframe — seven weeks — in which measurable changes were observed.
Patient Information / Diagnosis
Demographics: 43-year-old woman, White British.
Chief Complaint / Diagnosis: Persistent diastasis recti abdominis nine years following second vaginal delivery. First delivery required forceps assistance; second was unassisted. Reduced core stability, avoidance of higher-load abdominal exercise during Pilates, and dissatisfaction with abdominal appearance.
Relevant Medical History: No urinary, bowel, gynecological, or musculoskeletal impairments. Well-controlled asthma.
Past Interventions and Outcomes: No prior dedicated DRA rehabilitation reported; ongoing Pilates participation with avoidance of higher-load abdominal exercises due to symptoms.
Clinical Findings
Subjective
- Reduced core stability and abdominal strength.
- Avoidance of higher-load abdominal exercises during Pilates.
- Dissatisfaction with abdominal appearance.
Objective
Posture neutral with full and pain-free lumbar range of motion. Doming along the linea alba observed during trunk extension. Inter-recti distance (IRD) assessed via palpation at standard reference points (Table 1).
| Site of Measurement | Rest (cm) | With Head Lift (cm) |
| 5 cm above umbilicus | 4.0 | 2.5 |
| 2 cm above umbilicus | 3.0 | 2.0 |
| At umbilicus | 4.0 | 3.0 |
| 2 cm below umbilicus | 2.5 | 2.5 |
| 5 cm below umbilicus | 2.0 | 2.0 |
Detailed Treatment, Timeline, and Outcome
1. Timeline
Six sessions delivered over seven weeks, using a Winback BACK4 Care+ device (Winback, France) operating in Slim+ mode, combining capacitive and resistive energy transfer (TECAR) with high-intensity electrical muscle stimulation (Hi-EMS). Three abdominal pads were applied with the patient in a supine position.
| Session | CET (%) | RET (%) | Hi-TENS | Hi-EMS (%) | Duration |
| 1 | 50 | 50 | 25 Hz | 50 | 24 min |
| 2 | 50 | 50 | 25 Hz | 50 | 24 min |
| 3 | 50 | 50 | 25 Hz | 60 | 24 min |
| 4 | 50 | 50 | 25 Hz | 60 | 24 min |
| 5 | 50 | 50 | 25 Hz | 70 | 24 min |
| 6 | 60 | 60 | 25 Hz | 70 | 24 min |
2. Diagnostic Assessment
Diagnostic method: palpation-based assessment of inter-recti distance at five standard reference points (5 cm above umbilicus, 2 cm above umbilicus, at umbilicus, 2 cm below umbilicus, 5 cm below umbilicus), at rest and during head lift, performed by the same practitioner pre- and post-intervention.
Diagnosis: persistent postpartum diastasis recti abdominis, nine years duration, with doming along the linea alba on trunk extension and IRD up to 4 cm at rest. No competing diagnoses considered; lumbar spine and pelvic floor screening unremarkable.
Prognostic characteristics: chronicity (nine years postpartum) generally predicts low likelihood of spontaneous further recovery, making any measurable change over a short intervention period clinically notable.
Therapeutic Intervention
1. Type of Intervention
Combined TECAR therapy (CET and RET) with high-intensity electrical muscle stimulation (Hi-EMS) in Slim+ mode, delivered via a Winback BACK4 Care+ device, alongside progressive Pilates-based abdominal exercise targeting all layers of the abdominal musculature.
2. Protocol Steps
- Three abdominal pads applied with the patient in supine position.
- Six sessions over seven weeks; settings per session as detailed in the timeline table (CET/RET 50–60%, Hi-TENS 25 Hz throughout, Hi-EMS progressed from 50% to 70%, session duration 24 minutes).
- Hi-EMS intensity progressively increased according to patient tolerance and visible abdominal muscle activation.
- Exercise advice and progression provided concurrently, incorporating Pilates-based exercises targeting all layers of the abdominal musculature.
3. Changes in Therapeutic Intervention
CET/RET intensity was increased from 50% to 60% and Hi-EMS intensity was progressively increased from 50% to 70% across the six sessions, titrated to patient tolerance and visible abdominal muscle activation. No adverse events were reported at any stage.
Treatment Protocol and Follow-Ups
Session Frequency: Six sessions over seven weeks.
Techniques used in follow-up sessions: Winback BACK4 Care+ in Slim+ mode (combined CET/RET with Hi-EMS, Hi-TENS at 25 Hz), with progressive intensity, alongside Pilates-based abdominal exercise.
Clinician- and patient-assessed outcomes: Palpation-based inter-recti distance at five reference points, at rest and during head lift; patient-reported abdominal strength, exercise confidence, and abdominal tone.
Important follow-up diagnostic and other test results: Post-intervention IRD measurements (Table 3, see Results); photographic comparison for illustrative purposes (not an objective measurement tool).
Intervention adherence and tolerability: All six sessions completed; Hi-EMS intensity progressed according to tolerance with no reported adverse events.
Adverse and unanticipated events: None reported.
Results after Treatment Completed
Post-intervention IRD measurements were performed by the same practitioner using identical palpation techniques (Table 3).
| Site of Measurement | Rest (cm) | With Head Lift (cm) |
| 5 cm above umbilicus | 3.5 | 2.0 |
| 2 cm above umbilicus | 2.5 | 1.5 |
| At umbilicus | 3.5 | 2.5 |
| 2 cm below umbilicus | 2.5 | 2.0 |
| 5 cm below umbilicus | 2.0 | 2.0 |
Post-intervention measurements demonstrated a reduction in inter-recti distance at and above the umbilicus (0.5 cm reduction at rest at 5 cm above umbilicus, 2 cm above umbilicus, and at the umbilicus; 0.5 cm reduction during head lift at the same sites). A reduction was also observed 2 cm below the umbilicus during head lift (2.5 cm to 2.0 cm). No change was observed 5 cm below the umbilicus. The patient continued her usual physical activity program with advised exercise progression, and reported subjective improvement in abdominal strength, increased confidence during Pilates exercises, and improved abdominal tone. Photographic comparison (before and after six sessions) was included for illustrative purposes only and does not represent an objective measurement tool.
Discussion
Evidence regarding the use of TECAR therapy combined with high-intensity electrical muscle stimulation for persistent postpartum DRA remains limited. Previous studies suggest that TECAR therapy may enhance outcomes when combined with abdominal exercise programs, and electrical muscle stimulation has separately demonstrated benefits in postpartum rehabilitation settings. The present case contributes additional clinical observation of measurable IRD reduction following six sessions of combined TECAR and Hi-EMS integrated with progressive rehabilitation.
Ultrasound imaging is considered the gold standard for IRD measurement; palpation demonstrates only moderate reliability and cannot be considered a fully valid substitute, representing a limitation of this case report. The participant was nine years postpartum, a stage at which spontaneous structural changes are unlikely — the measurable improvement observed over a relatively short seven-week period is therefore clinically noteworthy and may suggest potential value of this combined approach in chronic cases.
Additional limitations include the single-participant design, short follow-up duration, and the concurrent use of exercise progression, which prevents attribution of outcomes solely to the device-based intervention. Future research should include larger sample sizes, ultrasound-based measurement, longer follow-up periods, and validated patient-reported outcome measures.
Take-away: in this single case, the combined use of TECAR therapy with high-intensity electrical muscle stimulation alongside targeted exercise was associated with a measurable reduction in inter-recti distance and improved self-reported functional outcomes — notably in a case of DRA persisting for nine years, with measurable changes achieved over just seven weeks. Due to the nature of a single case report, causality cannot be established, and further controlled studies are required to determine efficacy and generalisability.
Patient Perspective
Not applicable / not reported (n/a in source documentation).
Informed Consent
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of the originating journal.