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Skoura A, Billis E, Papanikolaou DT, Xergia S, Tsarbou C, Tsekoura M, Kortianou E, Maroulis I. Diastasis Recti Abdominis Rehabilitation in the Postpartum Period: A Scoping Review of Current Clinical Practice. Int Urogynecol J 2024; 35:491-520. [PMID: 38340172 PMCID: PMC11023973 DOI: 10.1007/s00192-024-05727-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/29/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Despite exercise being the standard approach to diastasis recti abdominis (DRA) rehabilitation, there is no consensus on the most effective exercise routine and adjunct modalities for reducing DRA and improving functional parameters. The present study is aimed at investigating evidence for DRA rehabilitation in postpartum women, as well as knowledge gaps and areas for future research. METHODS For this scoping review a systematic search was conducted in MEDLINE, AMED, CINAHL, Embase, ScienceDirect, Scopus, and PEDro up to November 2022. Selection criteria included studies investigating exercise therapy interventions both with and without adjunct modalities for postpartum DRA. Sample characteristics, diagnostic criteria, program design, and outcome measures were recorded. Critical appraisal of clinical trials was performed using PEDro classification. RESULTS Twenty-eight studies were included: 14 clinical trials, 3 case series, and 11 observational studies. DRA exercises that focused on deep and superficial muscles, pelvic floor muscles, respiratory maneuvers, functional exercises, or alternative interventions (yoga, suspension training, hypopressive exercise) and adjunct modalities showed promising results in reducing the inter-recti distance and related dysfunction. However, there was great variability in diagnostic criteria and methods, DRA severity, time post-birth, and exercise program design. CONCLUSIONS Reviewed studies provide valuable insights into exercise therapy, but it is important to recognize their limitations, as variability in diagnostic criteria, sample characteristics, and exercise program design hinder the generalizability of the findings. Further high-quality research is needed to strengthen the evidence in this area and provide reliable recommendations for clinical practice.
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Affiliation(s)
- Anastasia Skoura
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece.
| | - Evdokia Billis
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece
| | - Dimitra Tania Papanikolaou
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece
| | - Sofia Xergia
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece
| | - Charis Tsarbou
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece
| | - Maria Tsekoura
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece
| | - Eleni Kortianou
- Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Ioannis Maroulis
- Faculty of Medicine, School of Health Sciences, University of Patras, Rio, Patras, Greece
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Braga A, Galli L, Caccia G, Amato G, Papadia A, Torella M, Salvatore S, Scancarello C, Baruch Y, Serati M. Is Diastasis Recti Abdominis Rehabilitation after Childbirth Able to Prevent the Onset of Stress Urinary Incontinence? A Case-Control Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2182. [PMID: 38138285 PMCID: PMC10744874 DOI: 10.3390/medicina59122182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/26/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Pelvic floor muscle training (PFMT) represent the first-line approach to pelvic floor dysfunctions (PFDs). Recently, studies have shown a synergy between the pelvic floor and abdominal muscles, hypothesizing that the anatomical and functional integrity of the abdominal wall plays a role in the prevention of pelvic floor disorders. Some studies have shown a significant correlation between diastasis recti abdominis (DRA) and stress urinary incontinence (SUI). Nevertheless, the evidence reported in the literature is controversial and based on low-quality data. The aim of the study is to clarify whether DRA-specific abdominal rehabilitation is needed in women with SUI after childbirth. Materials and Methods: All consecutive women who had at least one delivery and complained of symptoms of pure SUI that were urodynamically proven were considered for the study. The group of symptomatic patients was compared with a series of consecutive women, identified during the same study period, without any symptoms of SUI. In both groups, we measured the inter-rectal distance (IRD) with an ultrasound scanner above and below the navel. Results: A total of 102 women eligible for the study group and 100 women who did not report any symptoms of SUI were enrolled. The inter-rectal distance above the umbilicus showed no significant difference between the two groups (2.12 ± 0.98 vs. 2.1 ± 0.77; p = 0.94). In contrast, the data from the sub-umbilical measurements showed a significant difference. Surprisingly, the asymptomatic group showed significantly greater (0.98 ± 0.9 vs. 1.33 ± 0.87 p-value: 0.009) IRD compared to the symptomatic group. Conclusions: The study shows that DRA is not a risk factor for SUI in women after childbirth. Therefore, specific abdominal wall rehabilitation after childbirth does not seem to be indicated.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland; (G.C.); (G.A.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (L.G.); (A.P.)
| | - Livia Galli
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (L.G.); (A.P.)
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland; (G.C.); (G.A.)
| | - Giulia Amato
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland; (G.C.); (G.A.)
| | - Andrea Papadia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (L.G.); (A.P.)
- Department of Obstetrics and Gynecology, EOC-Civico Hospital, 6900 Lugano, Switzerland
| | - Marco Torella
- Department of Gyanecology, Obstetric and Reproductive Science, Second University of Naples, 80100 Naples, Italy;
| | - Stefano Salvatore
- Department of Obstetrics and Gynecology, IRCSS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (M.S.)
| | - Yoav Baruch
- Department of Obstetrics and Gynecology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (M.S.)
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Lee N, Bae YH, Fong SSM, Lee WH. Effects of Pilates on inter-recti distance, thickness of rectus abdominis, waist circumference and abdominal muscle endurance in primiparous women. BMC Womens Health 2023; 23:626. [PMID: 38008749 PMCID: PMC10680311 DOI: 10.1186/s12905-023-02775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 11/07/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Pilates is expected to have a positive effect on women with weakened abdominal muscles after childbirth. Pilates may have a beneficial effect on the structure and function of the abdominal muscles in pregnant women. Therefore, the objective of this study was to investigate the effects of Pilates on inter-recti distance, thickness of the rectus abdominis, waist circumference, and abdominal muscle endurance in primiparous women. METHODS Thirty-five primiparous postpartum women were assigned to either the Pilates exercise group (n = 20) or the control group (n = 15). Pilates was undertaken by the exercise group for 50 min/day, 5 days/week, for 4 weeks. The control group maintained their daily activities without any intervention. The inter-recti distance was measured at three locations along the linea alba, and the thickness of the rectus abdominis was measured using ultrasound. Abdominal muscle endurance was measured using a repeated 1-min curl-up test. Waist circumference was also measured. RESULTS The exercise group showed significant improvements from baseline in inter-recti distance, waist circumference, and abdominal muscle endurance (p < 0.05). The control group showed no significant improvement in these variables. Compared with the control group, the exercise group showed significantly improved performance in terms of inter-recti distance, waist circumference, and abdominal muscle endurance (p < 0.05). CONCLUSIONS The results of this study demonstrate that Pilates was effective in reducing inter-recti distance and waist circumference and improving abdominal muscle endurance in primiparous postpartum women. Pilates is considered an effective exercise for improving muscle structure and function in primiparous postpartum women, helping in the recovery from, and preventing, diastasis rectus abdominis.
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Affiliation(s)
- Namee Lee
- Department of Physical Therapy, Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - Young-Hyeon Bae
- Department of Healthcare and Public Health, National Rehabilitation Center, Seoul, South Korea
| | - Shirley S M Fong
- Department of Health and Physical Education, Education University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Wan-Hee Lee
- Department of Physical Therapy, Sahmyook University College of Health Science, Seoul, Republic of Korea.
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Chen B, Zhao X, Hu Y. Rehabilitations for maternal diastasis recti abdominis: An update on therapeutic directions. Heliyon 2023; 9:e20956. [PMID: 37867827 PMCID: PMC10589864 DOI: 10.1016/j.heliyon.2023.e20956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
Diastasis recti abdominis (DRA) affects a significant number of postpartum women, while its treatments are still under debate. This study aimed to systematically evaluate the effectiveness of rehabilitation training programs for postpartum DRA treatment. Four databases were systematically searched to identify eligible studies published up to February 1, 2023. We followed the PRISMA for scoping reviews guideline in this study. The characteristics and the main findings of the included studies were extracted. Sixteen studies enrolling 1129 women during the ante- and/or postnatal period were included. The common rehabilitation training for DRA included physical exercise, non-exercise physical therapy, acupuncture, and electrotherapy. The presence of DRA could be diagnosed by ultrasound, caliper, or palpation, of which ultrasound had the best reliability. Besides, these assessments could also be used for evaluating the therapeutic efficacy after the rehabilitation training programs. Several studies concluded that patients with DRA could be effectively improved by specific interventions. But a few included studies revealed rehabilitation training might be not more effective than no interventions when treating DRA. For example, some investigators did not recommend physical exercise for DRA patients due to this intervention during pregnancy kept the linea alba less stressed by maintaining abdominal tone, strength, and control, and therefore might aggravate DRA. However, it should be noted that this evidence was derived from limited studies (16/60, 27 % papers) with small samples. To some extent, women with postpartum DRA can benefit from the specific rehabilitation regimen by alleviating postpartum inter-rectus distance. Further research is still warranted to propose strategies for improving postpartum DRA.
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Affiliation(s)
- Beibei Chen
- Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou 310008, Zhejiang, China
| | - Xiumin Zhao
- Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou 310008, Zhejiang, China
| | - Yan Hu
- Department of Obstetrics and Gynecology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang, China
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Chmielewska D, Cebula M, Gnat R, Rudek-Zeprzałka M, Gruszczyńska K, Baron J, Opala-Berdzik A. Reliability of inter-recti distance measurement on ultrasound images captured by novice examiners. Physiother Theory Pract 2023:1-9. [PMID: 37695024 DOI: 10.1080/09593985.2023.2255897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND With the increased interest in inter-recti distance measurement using ultrasound imaging in physiotherapy, there is a question of measurement reliability, and the importance of the examiner's experience. PURPOSE The study aimed to investigate the reliability of inter-recti distance measurement in a DICOM viewer software by an experienced radiologist. For the measurement, the radiologist used linea alba images captured by two physiotherapists who were novice examiners. METHODS Ultrasound images were acquired by two novice examiners on repeated occasions 7 days apart (sessions A and B) in 28 nulliparous women at supraumbilical, umbilical, and infraumbilical locations along linea alba. RESULTS Excellent intra-examiner reliability of inter-recti distance measurements was shown at the supraumbilical and umbilical levels (ICC2,k = 0.941-0.983) with minimal detectable change (MDC95) ranging from 1.31 mm to 2.29 mm. Infraumbilical measurements had good to excellent reliability (ICC2,k = 0.894-0.972) with MDC95 ranging from 0.33 mm to 0.72 mm. Session A inter-examiner reliability was excellent for the mean measurements of two, three, four, and five images taken at each location (ICC2,k = 0.913-0.954) with MDC95 ranging from 0.47 mm to 2.96 mm. Session B inter-examiner reliability was excellent for the mean measurements of two, three, four, and five images taken at the supraumbilical and umbilical (ICC2,k = 0.94-0.98), MDC95 ranging from 1.38 mm to 2.58 mm and good (ICC2,k ≥ 0.81) with MDC95 ranging from 0.72 mm to 0.80 mm at the infraumbilical locations. CONCLUSION Novice examiners were able to capture good-quality ultrasound images of the linea alba that allowed for good to excellent intra- and inter-examiner reliability.
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Affiliation(s)
- Daria Chmielewska
- Institute of Physiotherapy and Health Sciences, Electromyography and Pelvic Floor Muscles Laboratory, Department of Physical Medicine, Academy of Physical Education in Katowice, Katowice, Poland
| | - Maciej Cebula
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
- Individual Specialist Medical Practice Maciej Cebula, Katowice, Poland
| | - Rafał Gnat
- Institute of Physiotherapy and Health Sciences, Academy of Physical Education in Katowice, Katowice, Poland
| | | | - Katarzyna Gruszczyńska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Jan Baron
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Opala-Berdzik
- Institute of Physiotherapy and Health Sciences, Department of Physiotherapy in Internal Diseases, Academy of Physical Education in Katowice, Katowice, Poland
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Gluppe SB, Ellström Engh M, Bø K. Curl-up exercises improve abdominal muscle strength without worsening inter-recti distance in women with diastasis recti abdominis postpartum: a randomised controlled trial. J Physiother 2023; 69:160-167. [PMID: 37286390 DOI: 10.1016/j.jphys.2023.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/18/2023] [Indexed: 06/09/2023] Open
Abstract
QUESTION What is the effect of a 12-week, home-based, abdominal exercise program containing head lifts and abdominal curl-ups on inter-recti distance (IRD) in women with diastasis recti abdominis (DRA) 6 to 12 months postpartum? What is the effect of the program on: observed abdominal movement during a curl-up; global perceived change; rectus abdominis thickness; abdominal muscle strength and endurance; pelvic floor disorders; and low back, pelvic girdle and abdominal pain? DESIGN This was a two-arm, parallel-group, randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS Seventy primiparous or multiparous women 6 to 12 months postpartum, having a single or multiple pregnancy following any mode of delivery, with a diagnosis of DRA (IRD > 28 mm at rest or > 25 mm during a curl-up). INTERVENTION The experimental group was prescribed a 12-week standardised exercise program including head lifts, abdominal curl-ups and twisted abdominal curl-ups 5 days a week. The control group received no intervention. OUTCOME MEASURES The primary outcome measure was change in IRD measured with ultrasonography. Secondary outcomes were: observed abdominal movement during a curl-up; global perceived change; rectus abdominis thickness; abdominal muscle strength and endurance; pelvic floor disorders; and low back, pelvic girdle and abdominal pain. RESULTS The exercise program did not improve or worsen IRD (eg, MD 1 mm at rest 2 cm above the umbilicus, 95% CI -1 to 4). The program improved rectus abdominis thickness (MD 0.7 mm, 95% CI 0.1 to 1.3) and strength (MD 9 Nm, 95% CI 3 to 16) at 10 deg; its effects on other secondary outcomes were trivial or unclear. CONCLUSION An exercise program containing curl-ups for women with DRA did not worsen IRD or change the severity of pelvic floor disorders or low back, pelvic girdle or abdominal pain, but it did increase abdominal muscle strength and thickness. REGISTRATION NCT04122924.
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Affiliation(s)
- Sandra B Gluppe
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway.
| | - Marie Ellström Engh
- Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway; Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway
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Opala-Berdzik A, Rudek-Zeprzałka M, Niesporek J, Cebula M, Baron J, Gruszczyńska K, Pascoal AG, Mota P, Chmielewska D. Technical aspects of inter-recti distance measurement with ultrasonographic imaging for physiotherapy purposes: the scoping review. Insights Imaging 2023; 14:92. [PMID: 37202551 PMCID: PMC10195962 DOI: 10.1186/s13244-023-01443-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Inter-recti distance (IRD) measurement using musculoskeletal USI has been used in physiotherapy research, in particular, to investigate pregnancy-related diastasis recti abdominis (DRA) and to seek its effective treatment methods. Severe and untreated diastasis may result in the formation of umbilical or epigastric hernias. OBJECTIVE This study aimed to systematically map physiotherapy-related research articles that included descriptions of IRD measurement procedures using USI to present their similarities and differences, and formulate recommendations on the procedure. DESIGN A scoping review was conducted according to PRISMA-ScR guidelines, including 49 of 511 publications from three major databases. Publications were selected and screened by two independent reviewers whose decisions were consulted with a third reviewer. The main synthesized data items were: the examinees' body position, breathing phase, measurement sites, and DRA screening methods. The final conclusions and recommendations were the result of a consensus between seven reviewers from four research centers. RESULTS Studies used 1-5 measurement sites that were differently determined. IRD was measured at the umbilicus (n = 3), at its superior (n = 16) and/or inferior border (n = 9), and at different levels: between 2 and 12 cm above the umbilicus, or a third of the distance and halfway between the umbilicus and xiphoid (n = 37); between 2 and 4.5 cm below the umbilicus or halfway between the umbilicus and pubis (n = 27). Different approaches were used to screen subjects for DRA. CONCLUSIONS The discrepancies between the measurement procedures prevent between-study comparisons. The DRA screening method should be standardized. IRD measurement protocol standardization has been proposed. CRITICAL RELEVANCE STATEMENT This scoping review indicates that the inter-recti distance measurement procedures using ultrasound imaging differ between studies, preventing between-study comparisons. Based on the results synthesis, the measurement protocol standardization has been proposed. KEY POINTS The inter-recti distance measurement procedures using USI differ between studies. Proposed standardization concerns body position, breathing phase, measurements number per location. Determination of measurement locations considering individual linea alba length is suggested. Recommended locations: umbilical top, ½ of umbilical top-xiphoid, ¼ of umbilical top-xiphoid/pubis distances. Diastasis recti abdominis diagnostic criteria are needed for proposed measurement locations.
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Affiliation(s)
- Agnieszka Opala-Berdzik
- Institute of Physiotherapy and Health Sciences, Department of Physiotherapy in Internal Diseases, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.
| | | | - Justyna Niesporek
- Institute of Physiotherapy and Health Sciences, Department of Physiotherapy in Internal Diseases, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Maciej Cebula
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
- Individual Specialist Medical Practice Maciej Cebula, Katowice, Poland
| | - Jan Baron
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Gruszczyńska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Augusto Gil Pascoal
- Faculty of Human Kinetics, Interdisciplinary Centre of Human Performance (CIPER), Biomechanics and Functional Morphology Laboratory (LBMF), University of Lisbon, Lisbon, Portugal
| | - Patrícia Mota
- Faculty of Human Kinetics, Interdisciplinary Centre of Human Performance (CIPER), Biomechanics and Functional Morphology Laboratory (LBMF), University of Lisbon, Lisbon, Portugal
- H&TRC - Centro de Investigação em Saúde e Tecnologia, Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL) - Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Daria Chmielewska
- Institute of Physiotherapy and Health Sciences, Electromyography and Pelvic Floor Muscles Assessment Laboratory, Department of Physical Medicine, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
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Preszler JA, McInnis KC, Baute L, Tanaka MJ. Rehabilitation of anterior knee pain in the pregnant athlete: Considerations and modifications by trimester. Phys Ther Sport 2023; 60:34-46. [PMID: 36641951 DOI: 10.1016/j.ptsp.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
BACKGROUND Anterior knee pain is a common symptom many females experience during pregnancy. There are several musculoskeletal changes that occur in anatomy and physiology throughout the course of pregnancy that impact the lower extremity kinetic chain. Pregnant athletes, recreational through competitive, who attempt to maintain a high activity level through each trimester may be at increased risk for anterior knee pain due to a greater demand for lumbopelvic and hip stabilization. CLINICAL QUESTION What are the evidence-driven rehabilitation guidelines and specific modifications needed to treat anterior knee pain in the female athlete during each trimester of pregnancy? KEY RESULTS We aim to provide an overview of rehabilitation treatment guidelines for pregnant females with anterior knee pain, presenting specific physiological changes and rationale for modifications, discussed by trimester. We recommend our program be conducted under the supervision of a physical therapist working closely with the athlete's obstetrics and sports medicine team. CLINICAL APPLICATION The number of women who are active during pregnancy is increasing. We provide an overview of the guidelines and considerations for treating women with anterior knee pain during a healthy and uneventful pregnancy.
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Affiliation(s)
- Jamie A Preszler
- Department of Sports Physical Therapy, Massachusetts General Hospital, Boston, MA, USA.
| | - Kelly C McInnis
- Division of Sports Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa Baute
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Woxnerud K, Sandblom G, Hedbeck C, Olsson A. Reference Data on the Normal Abdominal Wall Anatomy and Baseline Characteristics in Seventy-One Nulliparous Women. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:10940. [PMID: 38312400 PMCID: PMC10831656 DOI: 10.3389/jaws.2023.10940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/09/2023] [Indexed: 02/06/2024]
Abstract
Aims: The aim of this study was to describe the prepartum anatomy of the abdominal wall in a cohort of nulliparous women, for use as a reference for management of patients with postpartum abdominal wall insufficiency with or without rectus diastasis. Materials and Methods: Seventy-one women were examined with ultrasonography of the abdominal wall. The inter-recti distance (IRD), anatomical variations of the linea semilunaris, and the oblique muscles were assessed. The waistline was measured during activation and relaxation of the abdominal core. Participant characteristics were registered. Questionnaires regarding habitual physical activity (Baecke), low back pain (Oswestry), physical functioning (DRI), urinary incontinence (UDI-6 and IIQ-7), and quality-of-life (SF-36) were answered. Results: Mean age was 30.5 years (range 19-50 years) and mean BMI 23.5 kg/m2 (range 18-37). Ultrasonography showed a mean IRD of 10 mm (range 3-24) at the superior border of the umbilicus, 9 mm (4-20) 3 cm above the umbilicus, and 2 mm (-5-10) 2 cm below the umbilicus. The mean thickness of the linea alba was 3 mm (1.5-5) and mean distances between the lateral edge of the rectus muscle and the external, internal, and transverse oblique muscles were 12 mm (-10-28), 1 mm (-14-13) and 15 mm (-14-32) at umbilicus level. Responses to the DRI, UDI-6, IIQ-7 and Oswestry questionnaires showed generally lower scores than the normal population whereas Baecke and SF-36 scores were similar. Conclusion: This study provides baseline data on normal abdominal wall anatomy in a healthy nulliparous female cohort, as well as levels of activity, physical function, disability, and quality-of-life.
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Affiliation(s)
- K. Woxnerud
- Hela Kvinnans Klinik, Stockholm, Sweden
- Stockholm Hernia Center, Stockholm, Sweden
| | - G. Sandblom
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | | | - A. Olsson
- Stockholm Hernia Center, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
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Depledge J, McNair P, Ellis R. The effect of Tubigrip and a rigid belt on rectus abdominus diastasis immediately postpartum: A randomised clinical trial. Musculoskelet Sci Pract 2023; 63:102712. [PMID: 36577592 DOI: 10.1016/j.msksp.2022.102712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/22/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Rectus abdominis (RA) diastasis is a risk factor for abdominal muscle dysfunction and reduced quality of life postpartum. It is thought that supplementary abdominal supports might reduce the diastasis. However, there is limited research assessing the efficacy of abdominal supports/binding. OBJECTIVE To determine the effects of Tubigrip and a rigid abdominal belt in reducing RA diastasis in the first eight weeks postpartum. DESIGN Randomised clinical trial. METHODS 62 women undertook ultrasound imaging to measure their RA diastasis prior to and after an eight week intervention wearing either Tubigrip or a rigid abdominal belt. Data analyses involved repeated measures ANOVA and correlational methods. RESULTS The RA diastasis reduced by 46% from a mean 4.6 cm-2.5 cm over the eight week intervention period with no significant difference (p > 0.05) across groups. Women wore the Tubigrip for a significantly (p < 0.05) longer number of hours (Median: 278) compared to those in the belt group (Median: 81 h). The length of time that women wore Tubigrip or the belt was not associated with the percentage reduction in the RA diastasis (p > 0.05). There was no significant difference in the diastasis across vaginal and Caesarean section deliveries at baseline. There was a significant difference (p < 0.05) in the percent reduction of the RA diastasis across deliveries post-intervention (vaginal delivery mean: 48% vs C-section: 40%). CONCLUSION There was no difference across groups post-intervention in the RA diastasis, and it is questionable whether either support improves upon that associated with natural healing alone.
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Affiliation(s)
- Jill Depledge
- Community Rehabilitation Team, Auckland District Health Board, Auckland, New Zealand.
| | - Peter McNair
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Richard Ellis
- Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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11
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Ramírez-Jiménez M, Alburquerque-Sendín F, Garrido-Castro JL, Rodrigues-de-Souza D. Effects of hypopressive exercises on post-partum abdominal diastasis, trunk circumference, and mechanical properties of abdominopelvic tissues: a case series. Physiother Theory Pract 2023; 39:49-60. [PMID: 34779692 DOI: 10.1080/09593985.2021.2004630] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Abdominal diastasis (AD) is highly prevalent at post-partum. Although several conservative approaches have been proposed, an effective and protocolized treatment is lacking for this condition. OBJECTIVE To identify modifications of inter-rectus abdominis distance (IRAD), trunk circumferences and mechanical properties of the AD, transversus abdominis and the pelvic floor (PF) muscles, after the application of hypopressive exercises (HE) and at a two-month follow-up in postpartum AD. METHODS Twelve volunteers with post-partum AD followed a four-week (three times a week) tailored program of HE. The main outcome was the IRAD, assessed at four specific supraumbilical points (3, 6, 9, and 12 cm). Abdominal circumference and respiratory expansion were measured at three different locations (axillar, xiphoid, and umbilical), and the mechanical properties of abdomino-pelvic tissues were also assessed using tonometry (MyotonPRO). Four evaluations were performed for all outcomes: at baseline, post-intervention, at a 1-month follow-up, and at a 2-month follow-up. RESULTS The IRAD of participants was reduced (p < .05), furthermore, some participants displayed no AD after the intervention period. In addition, the abdominal circumference increased, mainly at follow-up, whereas the thoracic respiratory expansion decreased a median of 2 cm. The tension and stiffness of the LA decreased, when assessed at 3 and 6 cm supraumbilical. Finally, the tension and elasticity of TA/IO and of the PF, and also the elasticity of the PF decreased after the intervention period. No complaints were identified in relation to the HE program or assessments. CONCLUSION A program of HE showed positive results for the reduction of post-partum AD. Different study designs should be performed to better explain the effects of HE for AD.
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Affiliation(s)
- Miriam Ramírez-Jiménez
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Francisco Alburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
| | - Juan Luis Garrido-Castro
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Department of Computer Science and Numerical Analysis, Rabanales Campus, University of Córdoba, Córdoba, Spain
| | - Daiana Rodrigues-de-Souza
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
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12
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Automatic Assessment of Abdominal Exercises for the Treatment of Diastasis Recti Abdominis Using Electromyography and Machine Learning. Symmetry (Basel) 2022. [DOI: 10.3390/sym14081654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Diastasis Recti Abdominis (DRA) is a medical condition in which the two sides of the rectus abdominis muscle are separated by at least 2.7 cm. This happens when the collagen sheath that exists between the rectus muscles stretches beyond a certain limit. The recti muscles generally separate and move apart in pregnant women due to the development of fetus in the womb. In some cases, this intramuscular gap will not be closed on its own, leading to DRA. The primary treatment procedures of DRA involve different therapeutic exercises to reduce the inter-recti distance. However, it is tedious for the physiotherapists to constantly monitor the patients and ensure that the exercises are being done correctly. The objective of this research is to analyze the correctness of such performed exercises using electromyogram (EMG) signals and machine learning. To the best of our knowledge, this is the first work reporting the objective evaluation of rehabilitation exercises for DRA. Experimental studies indicate that the surface EMG signals were effective in classifying the correctly and incorrectly performed movements. An extensive analysis was carried out with different machine learning models for classification. It was inferred that the RUSBoosted Ensembled classifier was effective in differentiating these movements with an accuracy of 92.3%.
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13
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Djivoh Y, De Jaeger D. Acute effect of Sit-up versus Curl-up on the interrecti distance: A cross-sectional study in parous women. Prog Urol 2022; 32:776-783. [DOI: 10.1016/j.purol.2022.07.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022]
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14
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Li Q, Lei S, Liu Y, Liu Q, Chen Y, Lin X, Zhang X. Effectiveness of Yoga on the Interrectus Distance in Early Postpartum Women: A High-Frequency Ultrasound Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8908095. [PMID: 35647191 PMCID: PMC9142290 DOI: 10.1155/2022/8908095] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/13/2022] [Accepted: 04/23/2022] [Indexed: 11/17/2022]
Abstract
To investigate the effects of ultrasonic evaluation of a progressive yoga exercise program on reducing the inter-recti distance (IRD) among women in the early postpartum period. Postpartum women (n = 116), free of obstetric complications and in recovery following vaginal delivery between weeks 1 and 12, were recruited. Participants were randomly assigned to the control and yoga exercise group in the pre- and post-intervention design. The control group received no treatment, while the yoga exercise group participated in a guided 12-week progressive yoga exercise program started at postpartum week 1. The IRD was examined using high-frequency ultrasound at postpartum weeks 6 and 12. The results showed that the supraumbilical, umbilical, and subumbilical IRD were significantly decreased in the yoga exercise group after the 12-week progressive yoga exercise intervention compared with the first (week 6) and second (week 12) measurements. The differences in IRD at supraumbilical, umbilical, and subumbilical intervals between weeks 6 and 12 significantly increased in the yoga exercise group. Progressive yoga exercises are effective program that reduce IRD among women in the early postpartum period through ultrasound evaluation. In conclusion, women should advocate combined yoga exercise in the early postpartum days following a supervised program.
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Affiliation(s)
- Qunfeng Li
- Guangdong Polytechnic of Science and Technology, Zhuhai, 510640 Guangdong, China
| | - Siman Lei
- Faculty of Education, University of Macau, Taipa, 999078 Macao SAR, China
| | - Yanhong Liu
- Zhuhai Women and Children's Hospital, Zhuhai, 519001 Guangdong, China
| | - Qiongzhu Liu
- Zhuhai Women and Children's Hospital, Zhuhai, 519001 Guangdong, China
| | - Ying Chen
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630 Guangdong, China
| | - Xin Lin
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630 Guangdong, China
| | - Xinling Zhang
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630 Guangdong, China
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15
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Critchley CJC. Physical Therapy Is an Important Component of Postpartum Care in the Fourth Trimester. Phys Ther 2022; 102:6536908. [PMID: 35225339 DOI: 10.1093/ptj/pzac021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/26/2021] [Accepted: 01/07/2022] [Indexed: 01/23/2023]
Abstract
ABSTRACT The objectives of this Perspective paper are to educate physical therapists on their important role in assessing and treating common pregnancy- and delivery-related health conditions and to advocate for their routine inclusion in postpartum care during the fourth trimester. Pelvic floor dysfunction (PFD) and diastasis recti abdominis (DRA) are 2 examples of musculoskeletal disorders associated with pregnancy and childbirth that can have negative physical, social, and psychological consequences. This paper reviews evidence from 2010 through 2021 to discuss the efficacy of physical therapist intervention in the fourth trimester for PFD and DRA. The role of physical therapy in the United States is compared with its role in other developed nations, with the intent of illustrating the potential importance of physical therapy in postpartum care. Evidence shows physical therapy is an effective, low-risk, therapeutic approach for PFD and DRA; however, physical therapists in the United States currently have a peripheral role in providing postpartum care. Lack of awareness, social stigma, and policy barriers prevent women from receiving physical therapist care. Recommendations are made regarding ways in which physical therapists can increase their involvement in the fourth trimester within their community, stimulate policy change, and promote improved postpartum care practices. IMPACT This Perspective highlights the valuable role of physical therapist assessment and treatment during the postpartum period for some common musculoskeletal conditions associated with pregnancy and delivery.
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16
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Hu J, Gu J, Yu Z, Yang X, Fan J, You L, Hua Q, Zhao Y, Yan Y, Bai W, Xu Z, You L, Chen C. Efficacy of Standardized Rehabilitation in the Treatment of Diastasis Rectus Abdominis in Postpartum Women. Int J Gen Med 2021; 14:10373-10383. [PMID: 35002294 PMCID: PMC8721020 DOI: 10.2147/ijgm.s348135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Jing Hu
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Juanfen Gu
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Zhiyan Yu
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Xianxu Yang
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Jian Fan
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Lingying You
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Qinyan Hua
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Yuting Zhao
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Yuerong Yan
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Weiwei Bai
- Department of Ultrasound, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Zipeng Xu
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
| | - Lina You
- Department of Postpartum Rehabilitation Center, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
- Correspondence: Lina You; Chaobo Chen Tel +86 13812052853; +86 13585000831 Email ;
| | - Chaobo Chen
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, Jiangsu, People’s Republic of China
- Department of Immunology, Ophthalmology and ORL, Complutense University School of Medicine, Madrid, 28040, Spain
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Differences in Inter-Rectus Distance and Abdominopelvic Function between Nulliparous, Primiparous and Multiparous Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312396. [PMID: 34886122 PMCID: PMC8656862 DOI: 10.3390/ijerph182312396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 01/25/2023]
Abstract
Widening of the inter-rectus distance (IRD) is highly prevalent among postpartum women and can lead to dysfunction of abdominopelvic muscles. The aim of this study was to evaluate the differences in IRD and abdominopelvic function between nulliparous, primiparous and multiparous women. A cross-sectional study was conducted on 75 women (25 nulliparous, 25 primiparous and 25 multiparous at 6 months postpartum). The participants underwent ultrasound assessment under three conditions (at rest, abdominal draw-in maneuver (ADIM) and curl-up) at two locations (2 cm above and 2 cm below the umbilicus). Furthermore, abdominopelvic muscle function was determined by prone, supine and side bridge tests. In all conditions and locations, the IRD were significantly higher (p < 0.05) in the primiparous and multiparous women than in the nulliparous. The multiparous women presented greater (p > 0.05) IRD at rest and during ADIM compared to the primiparous women. Regarding abdominopelvic muscle function, differences were only significant (p < 0.05) between the nulliparous with primiparous women in prone and supine conditions. These findings suggest that parity influences IRD: women at 6 months postpartum present greater IRD compared to nulliparous women; multiparous women present greater IRD at rest and during the activation of deep abdominal muscles than primiparous women; and primiparous women exhibit worse abdominopelvic muscle function than nulliparous women.
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18
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Olsson A, Kiwanuka O, Sandblom G, Stackelberg O. Evaluation of functional outcomes following rectus diastasis repair-an up-to-date literature review. Hernia 2021; 25:905-914. [PMID: 34302558 PMCID: PMC8370918 DOI: 10.1007/s10029-021-02462-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Over the last decade rectus diastasis has gained attention as a condition that may benefit from surgery. Numerous surgical techniques have been presented but scientifically proper studies reporting functional outcome are few and evidence is incomplete. The aim of this up-to-date review is to analyse the outcomes of rectus diastasis repair in recently published papers, focusing on functional changes following surgery. METHOD A comprehensive search in PubMed and Web of Science was performed. Suitable papers were selected using titles and abstracts with terms suggesting surgical treatment of rectus diastasis. All abstracts were scrutinised, and irrelevant studies excluded in four stages. Reports providing original data, including outcome assessment following surgery, were included. RESULT Ten papers with a total of 780 patients were found to fulfil the search criteria. Study design, surgical procedure, follow-up time, functional outcome and assessment instruments were compiled. All included studies reported improvements in a variety of functional aspects regardless of surgical method. The outcomes assessed include core stability, back pain, abdominal pain, posture, urinary incontinence, abdominal muscle strength and quality of life. CONCLUSION The results of this review show that surgical repair of rectus diastasis is a safe and effective treatment that improves functional disability. However, the absence of standardized instruments for assessing outcome makes it impossible to compare studies. Since indications for surgery are relative and related to core function, valid instruments for assessing indication and outcome are needed to ensure benefit of the procedure.
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Affiliation(s)
- A Olsson
- Department of Clinical Science and Education, Södersjukhuset, and Department of Surgery, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 11883, Stockholm, Sweden.
| | - O Kiwanuka
- Department of Clinical Science and Education, Södersjukhuset, and Department of Surgery, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 11883, Stockholm, Sweden
| | - G Sandblom
- Department of Clinical Science and Education, Södersjukhuset, and Department of Surgery, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 11883, Stockholm, Sweden
| | - O Stackelberg
- Department of Clinical Science and Education, Södersjukhuset, and Department of Surgery, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 11883, Stockholm, Sweden.,Institute of Environmental Medicine, Unit of Cardiovascular and Nutritional Epidemiology, Karolinska Institute, Stockholm, Sweden
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19
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Gluppe S, Engh ME, Bø K. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis. Braz J Phys Ther 2021; 25:664-675. [PMID: 34391661 PMCID: PMC8721086 DOI: 10.1016/j.bjpt.2021.06.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 05/28/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
Background Diastasis recti abdominis (DRA) affects a significant number of women in the postpartum period. Objective To systematically review whether abdominal and pelvic floor muscle (PFM) exercise programs are effective in the treatment of DRA postpartum. Methods Electronic search was conducted from inception to March 2020. Randomized controlled trials (RCT) or pilot RCTs that compared abdominal training, PFM training, or a combination of both in at least one arm of the trial were included. The primary outcome was presence of DRA (numbers/percentage) or inter-recti distance (IRD) change. GRADE was used to rate the overall quality of evidence. Pooled effect sizes were expressed as mean difference (MD) with 95% confidence intervals (CI). Results Seven RCTs totaling 381 women were included. Two studies comparing transversus abdominis (TrA) training with minimal intervention provided data to be included in a meta-analysis. The results provided very low level quality evidence that TrA training reduced IRD (MD = -0.63 cm, 95% confidence interval: -1.25, -0.01, I2 = 0%). Two studies included curl-up exercises as part of their intervention. Level of evidence based on single trials of high risk of bias show very low evidence that curl-up training is more effective than minimal intervention for treating DRA. Similarly, analyses based on single trials provided low to very low quality evidence that PFM training is not more effective than minimal intervention for treating DRA. Conclusion There is currently very low-quality scientific evidence to recommend specific exercise programs in the treatment of DRA postpartum. Trials investigating abdominal and PFM exercises on DRA have mostly been performed on women with mild DRA. The abdominal and PFM exercise programs identified were heterogenous in terms of type of exercises and training dose. We found low quality evidence that TrA and curl-up training are more effective than minimal intervention for treating DRA. There is low to very low evidence that PFM training is not more effective than minimal intervention.
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Affiliation(s)
- Sandra Gluppe
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway.
| | - Marie Ellström Engh
- Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway; Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
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20
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Cuña-Carrera ID, Alonso-Calvete A, González-González Y, Soto-González M. Changes in abdominal muscles architecture induced by different types of breathing. ISOKINET EXERC SCI 2021. [DOI: 10.3233/ies-210159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The underlying morphology and behavior of abdominal muscles during breathing are still lacking in knowledge in healthy population. OBJECTIVE: To analyze the effects of three different types of breathing on the architectural characteristics of abdominal muscles. METHODS: Ninety-eight healthy subjects were measured to assess the effects of breathing on the abdominal muscles, subjects performed three different types of breathing and the muscular thickness was measured with ultrasound imaging, analyzing also the differences between sexes. RESULTS: During the three different types of breathing and in comparison with the resting state, an increase of the thickness has been reported in the transversus abdominis (p< 0.001; effect size = 2.44, very large) and internal oblique (p< 0.001; effect size = 1.04, moderate) in both sexes, but with a higher increase in men. External oblique and rectus abdominis increased their thickness through breathing only while the lips were with pursed (p< 0.05) with trivial effect sizes and only differences between sexes were found in rectus abdominis. CONCLUSIONS: All breathings activated the deepest abdominal muscles, but the most superficial were only activated with lips pursed. Moreover, men appeared to activate more the deepest abdominal muscles but also the rectus abdominis. Findings in this study support the use of different types of breathing depending on the muscle to be activated or the sex, helping health care professionals to address their interventions on the abdominal muscles with a more focused approach.
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Affiliation(s)
- Iria Da Cuña-Carrera
- Departamento de Bioloxía Funcional e Ciencias da Saúde, Facultade de Fisioterapia, Universidade Vigo, Campus A Xunqueira, Pontevedra, Spain
| | - Alejandra Alonso-Calvete
- Departamento de Bioloxía Funcional e Ciencias da Saúde, Facultade de Fisioterapia, Universidade Vigo, Campus A Xunqueira, Pontevedra, Spain
- REMOSS Research Group, Facultade de Ciencias da Educación e do Deporte, Universidade de Vigo, Campus A Xunqueira, Pontevedra, Spain
| | - Yoana González-González
- Departamento de Bioloxía Funcional e Ciencias da Saúde, Facultade de Fisioterapia, Universidade Vigo, Campus A Xunqueira, Pontevedra, Spain
| | - Mercedes Soto-González
- Departamento de Bioloxía Funcional e Ciencias da Saúde, Facultade de Fisioterapia, Universidade Vigo, Campus A Xunqueira, Pontevedra, Spain
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21
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Depledge J, McNair P, Ellis R. Exercises, Tubigrip and taping: can they reduce rectus abdominis diastasis measured three weeks post-partum? Musculoskelet Sci Pract 2021; 53:102381. [PMID: 33910111 DOI: 10.1016/j.msksp.2021.102381] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 04/11/2021] [Accepted: 04/14/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rectus abdominis diastasis is regarded as a risk factor for abdominal muscle dysfunction and reduced quality of life postpartum. It is thought that specific exercises and additional physical support might reduce the diastasis, with a need to establish efficacy in doing so. OBJECTIVES Determine the effect of four abdominal exercises as well as Tubigrip or taping in reducing rectus abdominis diastases three weeks postpartum. DESIGN Cross-sectional repeated measures comparison. METHODS 32 women undertook a single session of ultrasound imaging. Ultrasound measurements of inter-rectus distance were taken at rest and during: 1) crook lying abdominal "drawing in" exercise; 2) crook lying trunk curl-up; 3) early Sahrmann level leg raise; 4) McGill side lying plank. The curl-up and abdominal "drawing in" exercises were assessed under two further conditions: a) wearing Tubigrip, b) taping across the diastasis. Data analyses involved repeated measures ANOVA. RESULTS At rest the mean inter-rectus distance above and below the umbilicus was 3.5 cm (SD:1.1) and 2.6 cm (SD:1.2) respectively. A significant decrease (19%, p < 0.05) was observed at both measurement points during the curl-up exercise. No other exercises elicited a significant difference compared to resting. At rest, wearing Tubigrip reduced the inter-rectus distance (7%, p < 0.05). During exercise, there was no additional change in the inter-rectus distance (p > 0.05) with supports. CONCLUSION The curl-up exercise was most effective in reducing inter-rectus distance. As no exercises invoked an increase in the rectus diastasis, they could not be regarded as potentially detrimental. Tubigrip and taping did not add to the effects of these exercises.
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Affiliation(s)
- Jill Depledge
- Community Rehabilitation Team, Auckland District Health Board, Auckland, New Zealand.
| | - Peter McNair
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Richard Ellis
- Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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22
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ACOG Committee Opinion No. 804: Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstet Gynecol 2021; 137:376. [PMID: 33481514 DOI: 10.1097/aog.0000000000004267] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gluppe S, Ellström Engh M, Kari B. Women with diastasis recti abdominis might have weaker abdominal muscles and more abdominal pain, but no higher prevalence of pelvic floor disorders, low back and pelvic girdle pain than women without diastasis recti abdominis. Physiotherapy 2021; 111:57-65. [PMID: 33691943 DOI: 10.1016/j.physio.2021.01.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate whether women with diastasis recti abdominis (DRA) have weaker abdominal muscles and higher prevalence of pelvic floor disorders (PFD), low back, pelvic girdle and abdominal pain than women without DRA. DESIGN Cross sectional study of women with and without DRA. SETTING University study. PARTICIPANTS Seventy-two parity and age matched women with and without DRA. MAIN OUTCOME MEASURES Maximal abdominal muscle strength and endurance were assessed with a dynamometer and with a curl-up test. Women reported whether they experienced PFD, low back pain, pelvic girdle pain or abdominal pain. Those experiencing PFD or pain completed the Pelvic Floor Distress Inventory-short form 20 (PFDI-20), the Oswestry Disability Index (ODI), the Pelvic Girdle Questionnaire (PGQ) or questions about abdominal pain, respectively. RESULTS Maximal abdominal strength standing with 30° hip flexion was significantly lower in women with DRA (mean difference -12.9Nm, 95%CI: -24.4 to -1.5; P=0.028), but adjusted analyses showed no significant difference (mean difference -11.9Nm, 95%CI: -26.5 to 2.6; P=0.106). Adjusted analyses showed significant higher prevalence of abdominal pain in women with DRA (OR: 0.02, 95%CI: 0.00 to 0.61, P=0.026). There was no difference between the groups in PFD, low back and pelvic girdle pain. CONCLUSION Women with DRA tend to have weaker abdominal muscles and higher prevalence of abdominal pain, but no higher prevalence of PFD, low back or pelvic girdle pain than women without DRA.
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Affiliation(s)
- Sandra Gluppe
- Department of Sports Medicine, Norwegian School of Sports Sciences, Sognsveien 220, 0806 Oslo, Norway.
| | - Marie Ellström Engh
- Department of Obstetrics and Gynaecology, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Bø Kari
- Department of Sports Medicine, Norwegian School of Sports Sciences, Sognsveien 220, 0806 Oslo, Norway; Department of Obstetrics and Gynaecology, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
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Chen H, D’Onofrio G, Hameed F. Role of Exercise Treatment of Low Back Pain in Pregnancy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00292-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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