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Christopher SM, Donnelly G, Brockwell E, Bo K, Davenport MH, De Vivo M, Dufour S, Forner L, Mills H, Moore IS, Olson A, Deering RE. Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement. Br J Sports Med 2024; 58:299-312. [PMID: 38148108 DOI: 10.1136/bjsports-2023-107489] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/28/2023]
Abstract
Female athletes have identified a lack of guidance as a barrier to successfully returning to running postpartum, and existing guidelines are vague. Our aim was to define the current practice of determining postpartum run-readiness through a consensus survey of international clinicians and exercise professionals in postpartum exercise to assist clinicians and inform sport policy changes.A three-round Delphi approach was used to gain international consensus from clinicians and exercise professionals on run-readiness postpartum. Professionals who work with postpartum runners participated in an online survey to answer open-ended questions about the following postpartum return-to-running topics: definitions (runner and postpartum), key biopsychosocial milestones that runners need to meet, recommended screening, timeline to initiate running, support items, education topics and factors that contribute to advising against running. Consensus was defined as ≥75% participant agreement.One hundred and eighteen professionals participated in round I, 107 participated in round II (response rate 90.6%) and 95 participated in round III (response rate 80.5%). Responses indicated that, following a minimum 3-week period of rest and recovery, an individualised timeline and gradual return to running progression can be considered. Screening for medical and psychological concerns, current physical capacity, and prior training history is recommended prior to a return to running.This study proposes recommendations for the initial guidance on return-to-running postpartum, framed in the context of current research and consensus from professionals. Future research is needed to strengthen and validate specific recommendations and develop guidelines for best practice when returning-to-running after childbirth.
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Affiliation(s)
- Shefali Mathur Christopher
- Department of Rehabilitation Sciences, Doctor of Physical Therapy, Tufts University, Seattle, Washington, USA
- Elon University, Elon, North Carolina, USA
| | - Gráinne Donnelly
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Kari Bo
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lorenskog, Norway
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Marlize De Vivo
- Perinatal Physical Activity Research Group, School of Psychology and Life Sciences, Section of Sport, Exercise and Rehabilitation Science, Canterbury Christ Church University, Canterbury, UK
- Active Pregnancy Foundation, None, UK
| | - Sinead Dufour
- The World of my Baby (WOMB), Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Lori Forner
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Hayley Mills
- Perinatal Physical Activity Research Group, School of Psychology and Life Sciences, Section of Sport, Exercise and Rehabilitation Science, Canterbury Christ Church University, Canterbury, UK
| | - Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Rita E Deering
- Department of Physical Therapy, Carroll University, Waukesha, Wisconsin, USA
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
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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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Theodorsen NM, Moe-Nilssen R, Bø K, Haukenes I. Effect of exercise on the inter-rectus distance in pregnant women with diastasis recti abdominis: an experimental longitudinal study. Physiotherapy 2023; 121:13-20. [PMID: 37812848 DOI: 10.1016/j.physio.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 04/18/2023] [Accepted: 08/20/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To investigate the effect of acute contraction of the pelvic floor muscles (PFM) and abdominal exercises on the inter-rectus distance (IRD) compared to resting values, and differences between gestation weeks 27 and 37, in pregnant women with diastasis recti abdominis (DRA). DESIGN Experimental longitudinal design. SETTING Physiotherapy clinic, primary health care. PARTICIPANTS Thirty-eight pregnant women with DRA ≥ 2.8 cm. INTERVENTIONS Two-dimensional ultrasound images of IRD 2 cm above and below the umbilicus were taken at rest and during PFM and abdominal exercises at gestation week 27 and 37. Repeated measures analyses of variance (ANOVAs) with post hoc tests was performed for each exercise for both locations and timepoints. MAIN OUTCOME MEASURES Change in IRD. RESULTS There was a mean increase of the IRD from rest during a PFM contraction (2 mm, 95% CI: 2, 3), drawing-in (4 mm, 95% CI: 3, 5) and a combination of these (5 mm, 95% CI: 4, 6) There was a mean decrease of the IRD from rest during the headlift (-3 mm, 95% CI: -4, -2), the curl-up (-3 mm, 95% CI: -4, -2) and the diagonal curl up (-4 mm, 95% CI: -5, -3). Effect of time from gestation week 27-37 was a mean increase of 8 mm (95% CI: 6, 9). CONCLUSION Pelvic floor and drawing-in exercise increased the IRD, whilst headlift, curl up and diagonal curl up decreased the IRD in pregnant women with DRA at gestation week 27 and 37. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Nina-Margrethe Theodorsen
- University of Bergen, Department of Global Public Health and Primary Care, PO Box 7804, 5020 Bergen, Norway.
| | - Rolf Moe-Nilssen
- University of Bergen, Department of Global Public Health and Primary Care, PO Box 7804, 5020 Bergen, Norway
| | - Kari Bø
- Norwegian School of Sport Sciences, Department of Sports Medicine, Postboks 4014 Ullevål stadion, 0806 Oslo, Norway
| | - Inger Haukenes
- University of Bergen, Department of Global Public Health and Primary Care, PO Box 7804, 5020 Bergen, Norway
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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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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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Arranz-Martín B, Navarro-Brazález B, Sánchez-Sánchez B, Torres-Lacomba M. Author Response to Mota et al. Phys Ther 2023; 103:7055847. [PMID: 37116463 DOI: 10.1093/ptj/pzad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/30/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Beatriz Arranz-Martín
- Physiotherapy in Women's Health Research Group (FPSM), Department of Physiotherapy, Universidad de Alcalá, Carretera Madrid - Barcelona, Alcalá de Henares, Madrid, Spain
| | - Beatriz Navarro-Brazález
- Physiotherapy in Women's Health Research Group (FPSM), Department of Physiotherapy, Universidad de Alcalá, Carretera Madrid - Barcelona, Alcalá de Henares, Madrid, Spain
| | - Beatriz Sánchez-Sánchez
- Physiotherapy in Women's Health Research Group (FPSM), Department of Physiotherapy, Universidad de Alcalá, Carretera Madrid - Barcelona, Alcalá de Henares, Madrid, Spain
| | - Maria Torres-Lacomba
- Physiotherapy in Women's Health Research Group (FPSM), Department of Physiotherapy, Universidad de Alcalá, Carretera Madrid - Barcelona, Alcalá de Henares, Madrid, Spain
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Benjamin DR, Frawley HC, Shields N, Peiris CL, van de Water ATM, Bruder AM, Taylor NF. Conservative interventions may have little effect on reducing diastasis of the rectus abdominis in postnatal women - A systematic review and meta-analysis. Physiotherapy 2023; 119:54-71. [PMID: 36934466 DOI: 10.1016/j.physio.2023.02.002] [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: 12/03/2021] [Revised: 11/23/2022] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Diastasis of the rectus abdominis muscle (DRAM) commonly occurs in pregnancy and postnatally. Physiotherapists routinely guide women in its management, although the effectiveness of these treatments is unknown. OBJECTIVES To determine the effectiveness of conservative interventions to reduce the presence and width of DRAM in pregnant and postnatal women. DATA SOURCES EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro searched until August 2021. STUDY SELECTION/ELIGIBILITY Randomised control trials examining any conservative interventions to manage DRAM during the ante- and postnatal periods were included. STUDY APPRAISAL AND SYNTHESIS METHODS Methodological quality was assessed using the Cochrane Risk of Bias 2 tool. Meta-analyses were performed using a random effects model to calculate mean differences (MD) and odds ratios (OR). A GRADE approach determined the certainty of evidence for each meta-analysis. RESULTS Sixteen trials with 698 women during the postnatal period were included. No trials evaluated interventions during the antenatal period. All interventions included some form of abdominal exercise. Other interventions included abdominal binding, kinesiotape and electrical stimulation. There was moderate certainty evidence from six trials (n = 161) that abdominal exercise led to a small reduction in inter-recti distance (MD -0.43 cm, 95% CI -0.82 to -0.05) in postnatal women compared to usual care. LIMITATIONS Three of the 16 trials had a low risk of bias. CONCLUSION AND IMPLICATIONS Conservative interventions do not lead to clinically significant reductions in inter-recti distance in women postnatally but abdominal exercises may have other physical and psychosocial benefits in the management of DRAM. Systematic Review Registration Number PROSPERO (CRD42020172529).
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Affiliation(s)
- Deenika R Benjamin
- Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia.
| | - Helena C Frawley
- Melbourne School of Health Sciences, The University of Melbourne, Victoria, Australia; Allied Health Research, Royal Women's Hospital, Australia; Allied Health Research, Mercy Hospital for Women, Australia.
| | - Nora Shields
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Victoria 3086, Australia.
| | - Casey L Peiris
- Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia.
| | - Alexander T M van de Water
- Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia.
| | - Andrea M Bruder
- Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia.
| | - Nicholas F Taylor
- Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia; Allied Health Clinical Research Office, Eastern Health 5 Arnold Street, Box Hill 3128, Australia.
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Olsson A, Woxnerud K, Kiwanuka O, Sandblom G, Stackelberg O. The TOR concept (training, operation, and rehabilitation) applied to a cohort of postpartum women with training-resistant symptomatic rectus diastasis: evaluation 1 year after surgery. BJS Open 2023; 7:7025466. [PMID: 36734959 PMCID: PMC9897176 DOI: 10.1093/bjsopen/zrac162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/13/2022] [Accepted: 11/07/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Rectus diastasis is a common sequela of pregnancy and is associated with functional disabilities such as back pain, abdominal core instability, abdominal muscle weakness, urinary incontinence, and psychological issues such as a negative body image. The aim of this study was to evaluate the effect of the TOR concept (training, operation, and rehabilitation), a novel concept for treating abdominal wall insufficiency combined with rectus diastasis, after pregnancy. TOR consists of preoperative evaluation of symptoms and custom-designed abdominal core training, tailored rectus diastasis repair, and individual progressive postoperative rehabilitation. METHODS A consecutive series of women diagnosed with rectus diastasis and core dysfunction resistant to training, underwent plication of the linea alba between 2018 and 2020. After surgery, all patients participated in an individually designed rehabilitation programme over a 4-month interval. Physical function was recorded before surgery and 1 year after surgery using the disability rating index questionnaire. Symptoms associated with core instability were recorded before and 1 year after surgery. Quality of life was assessed using the SF-36. The abdominal wall anatomy was assessed with ultrasound before and 1 year after surgery. RESULTS Seventy-one women were included and all attended 1-year follow-up. Response rate was 81.7 per cent (58) for the disability rating index, and 59.2 per cent (42) for SF-36. Self-reported physical function (disability rating index) improved in 54 of 58 patients (93.1 per cent), with a median score reduction of 91.3 per cent. Core instability symptoms decreased significantly. All SF-36 subscales improved significantly compared with preoperative scores, reaching levels similar to or higher than the normative Swedish female population. No recurrence of rectus diastasis was seen at the 1-year follow-up. CONCLUSIONS Surgical reconstruction within the TOR concept resulted in significant improvements in physical function and quality of life as well as a significant decrease in symptoms of core instability.
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Affiliation(s)
- A Olsson
- Correspondence to: Anders Olsson, PhD, Department of Clinical Science and Education and Department of Surgery, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden (e-mail: )
| | - K Woxnerud
- Stockholm Hernia Center, Stockholm, Sweden,Women's Health Department, Hela Kvinnans Klinik, Stockholm, Sweden
| | - O Kiwanuka
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - G Sandblom
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - O Stackelberg
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden,Department of Surgery, Södersjukhuset, Stockholm, Sweden,Unit of Nutritional Epidemiology, Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden
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Diggles A. The "Mother Load" and Return to Sport: A Case Report of Returning to Professional Netball Following Cesarean Section. Int J Sports Phys Ther 2023; 18:228-239. [PMID: 36793569 PMCID: PMC9897013 DOI: 10.26603/001c.65894] [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: 03/21/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023] Open
Abstract
Background Increasing numbers of elite female athletes are competing in professional sport, and many wish to become pregnant and return to competitive sport after childbirth. Athletes have a higher risk of pelvic floor dysfunction (PFD) than non-athletes (54% versus 7%) and there is also an increased prevalence in post-partum women compared to nulliparous women (35% versus 2.8-7.9%). Additionally, PFD has been shown to influence athletic performance. High quality evidence for elite athletes is lacking, and there are no exercise guidelines specifically for these women to prepare or effectively guide their safe return to sport (RTS). The purpose of this case report is to detail the management of an elite athlete who presented following cesarean section (CS) with the goal of RTS within 16 weeks. Case Description A 27-year-old primiparous Caucasian professional netballer presented at four weeks post- caesarean section (CS) for RTS screening and assessment of pelvic floor muscle (PFM) function. Assessment included readiness and fear of movement screening, dynamic pelvic floor muscle function, structural integrity of the CS wound, levator hiatal dimensions, bladder neck descent, and early global neuromuscular screening. Measures were collected at four weeks, eight weeks, and six months post-partum. The post-partum athlete demonstrated alterations in pelvic floor muscle function, reduced lower limb power and psychological readiness. A functionally staged dynamic and sport specific pelvic floor muscle training program was implemented and adapted to the patient for her early post-partum timeline. Results Rehabilitation strategies were effective in achieving the primary outcome of RTS at 16 weeks post-partum with no adverse events reported at 6 months follow-up. Discussion This case highlights the need for a holistic and individualised RTS management approach that includes women's and pelvic health risk factors in a professional athlete. Level of Evidence 5.
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Vesting S, Gutke A, Fagevik Olsén M, Praetorius Björk M, Rembeck G, Larsson MEH. Can Clinical Postpartum Muscle Assessment Help Predict the Severity of Postpartum Pelvic Girdle Pain? A Prospective Cohort Study. Phys Ther 2022; 103:pzac152. [PMID: 36326139 PMCID: PMC10071582 DOI: 10.1093/ptj/pzac152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/02/2022] [Accepted: 09/07/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate whether the clinical assessment of pelvic floor muscles and the diastasis recti abdominis could predict the severity of pelvic girdle pain during the first year postpartum. METHODS Between 2018 and 2020, 504 women were recruited to this prospective longitudinal cohort study. At 2 to 3 months postpartum, their pelvic floor muscles and diastasis recti abdominis were assessed using vaginal palpation, observation, and caliper measurement. The participants completed the Pelvic Girdle Questionnaire (PGQ) at 2 to 3, 6, 9, and 12 months postpartum. Mixed-effect models were used to determine how the results of pelvic floor muscle and diastasis recti abdominis assessments predicted the PGQ score. A sub-analysis for middle to high PGQ scores was conducted. RESULTS Maximal voluntary pelvic floor muscle contractions ≥3 (Modified Oxford Scale, scored from 0 to 5) predicted a decreased PGQ score (β = -3.13 [95% CI = -5.77 to -0.48]) at 2 to 3 months postpartum, with a higher prediction of a middle to high PGQ score (β = -6.39). Diastasis recti abdominis width did not have any significant correlation with the PGQ score. A sub-analysis showed that a diastasis recti abdominis width ≥35 mm predicted an increased PGQ score (β = 5.38 [95% CI = 1.21 to 9.55]) in women with pelvic girdle pain. CONCLUSION The distinction between weak and strong maximal voluntary pelvic floor muscle contractions is an important clinical assessment in women with postpartum pelvic girdle pain. The exact diastasis recti abdominis width, measured in millimeters, showed no clinical relevance. However, a diastasis recti abdominis width ≥35 mm was associated with a higher PGQ score, and further research about this cutoff point in relation to pain is needed. IMPACT This study highlights the importance of clinical assessment of pelvic floor muscles in patients with postpartum pelvic girdle pain. A better understanding of the role of this muscle group will enable more effective physical therapist treatment of pelvic girdle pain.
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Affiliation(s)
- Sabine Vesting
- Närhälsan Gibraltar Rehabilitation, Gothenburg, Sweden
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annelie Gutke
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Physical Therapy and Occupational Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marcus Praetorius Björk
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
- Department of Research, Education and Innovation, Region Västra Götaland, South Älvsborg Hospital, Borås, Sweden
| | - Gun Rembeck
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Borås, Sweden
- Region Västra Götaland, Regional Health, Borås Youth Guidance Center, Borås, Sweden
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria E H Larsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
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Bixo L, Sandblom G, Österberg J, Stackelberg O, Bewö K, Olsson A. Association Between Inter-Recti Distance and Impaired Abdominal Core Function in Post-Partum Women With Diastasis Recti Abdominis. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2022; 1:10909. [PMID: 38314149 PMCID: PMC10831648 DOI: 10.3389/jaws.2022.10909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/14/2022] [Indexed: 02/06/2024]
Abstract
Background and Aim: The definition and management of Diastasis Recti Abdominis (DRA) is under debate. This study aimed to understand the correlation between the post-partum inter-recti distance (IRD) and functional impairments associated with core instability, with the hypothesis that IRD could serve as a proxy for core instability symptoms and constitute a tool in decision-making for DRA treatment. Material and Methods: A cohort of post-partum women with abdominal core instability symptoms combined with DRA were studied. The size of IRD was measured with ultrasonography and cross-sectionally analysed against functional impairments registered with the self-report Disability Rating Index (DRI), which grades the ability to perform 12 different daily activities. Results: A total of 224 women were included in the study. In univariable analysis, IRD was associated with impairment of the activities running (p = 0.007), heavy work (p = 0.036) and exercise/sports (p = 0.047), but not with dressing, walking, sitting for long periods, standing bent over a sink, carrying a suitcase, making a bed, light manual labour or heavy lifting. No significant correlations were seen in the multivariable analysis when adjustments were made for BMI and parity. Conclusion: IRD and post-partum functional impairments had no significant correlation in multivariable analysis. The post-partum core instability condition is complex and probably associated with more factors than solely the IRD. The IRD alone does not seem to be a sufficient proxy for decision-making regarding optimal treatment. A more complete instrument to assess the post-partum abdominal core is warranted.
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Affiliation(s)
- L. Bixo
- Department of Surgery, Mora Hospital, Mora, Sweden
| | - G. Sandblom
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - J. Österberg
- Department of Surgery, Mora Hospital, Mora, Sweden
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - O. Stackelberg
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - K. Bewö
- Department of Surgery, Mora Hospital, Mora, Sweden
| | - A. Olsson
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Stockholm Hernia Center, Stockholm, Sweden
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12
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Denizoglu Kulli H, Gurses HN. Relationship between inter-recti distance, abdominal muscle endurance, pelvic floor functions, respiratory muscle strength, and postural control in women with diastasis recti abdominis. Eur J Obstet Gynecol Reprod Biol 2022; 279:40-44. [DOI: 10.1016/j.ejogrb.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/11/2022] [Accepted: 10/01/2022] [Indexed: 11/28/2022]
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13
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Weis CA, Pohlman K, Barrett J, Clinton S, da Silva-Oolup S, Draper C, Lee J, Kumar R, O'Beirne M, Stuber K, Hawk C. Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process. J Manipulative Physiol Ther 2022; 45:469-489. [PMID: 34836673 DOI: 10.1016/j.jmpt.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 01/01/2021] [Accepted: 03/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this project was to develop a best-practices document on chiropractic care for pregnant and postpartum patients with low back pain (LBP), pelvic girdle pain (PGP), or a combination. METHODS A modified Delphi consensus process was conducted. A multidisciplinary steering committee of 11 health care professionals developed 71 seed statements based on their clinical experience and relevant literature. A total of 78 panelists from 7 countries were asked to rate the recommendations (70 chiropractors and representatives from 4 other health professions). Consensus was reached when at least 80% of the panelists deemed the statement to be appropriate along with a median response of at least 7 on a 9-point scale. RESULTS Consensus was reached on 71 statements after 3 rounds of distribution. Statements included informed consent and risks, multidisciplinary care, key components regarding LBP during pregnancy, PGP during pregnancy and combined pain during pregnancy, as well as key components regarding postpartum LBP, PGP, and combined pain. Examination, diagnostic imaging, interventions, and lifestyle factors statements are included. CONCLUSION An expert panel convened to develop the first best-practice consensus document on chiropractic care for pregnant and postpartum patients with LBP or PGP. The document consists of 71 statements on chiropractic care for pregnant and postpartum patients with LBP and PGP.
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Affiliation(s)
- Carol Ann Weis
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
| | | | | | - Susan Clinton
- Embody Physiotherapy & Wellness (Private Practice), Andrews University, Sewickley, Pennsylvania
| | - Sophia da Silva-Oolup
- Undergraduate Department, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Crystal Draper
- Undergraduate Department, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Joyce Lee
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Rupali Kumar
- Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas Texas
| | - Maeve O'Beirne
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Kent Stuber
- Canadian Memorial Chiropractic College, Calgary, AB, Canada
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Arranz-Martín B, Navarro-Brazález B, Sánchez-Sánchez B, McLean L, Carazo-Díaz C, Torres-Lacomba M. The Impact of Hypopressive Abdominal Exercise on Linea Alba Morphology in Women Who Are Postpartum: A Short-Term Cross-Sectional Study. Phys Ther 2022; 102:6652576. [PMID: 35908286 DOI: 10.1093/ptj/pzac086] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 02/13/2022] [Accepted: 05/06/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the acute effect of an abdominal hypopressive exercise (AHE) on linea alba morphology among women who are primiparous and to compare this effect with that of other common abdominal exercise modalities. METHODS A cross-sectional study of 46 women 3 months after first delivery was conducted. B-mode ultrasound imaging of the interrectus distance (IRD) and linea alba distortion was performed 2 cm below (I-point) and above (S-point) the umbilicus and at the mid-point between the umbilicus and xiphoid process (X-point). Images were recorded at rest and during an AHE performed in a supine position, a semi curl-up (SCU), an abdominal drawing-in maneuver (ADIM), and a SCU performed after an initial ADIM (ADIM+SCU). RESULTS The SCU exercise narrowed the IRD at the X- and S-points. Compared with SCU, AHE and ADIM widened the IRD at the S- and X-points. No significant differences were found when comparing the IRD at rest, during AHE and during ADIM, but AHE tended to narrow I-point IRD more than ADIM but to widen S-point IRD more than ADIM+SCU. No participant showed linea alba distortion during the AHE or ADIM. When compared, SCU increased the occurrence of distortion with respect to AHE and ADIM. The isolated hypopressive posture did not change the IRD or linea alba distortion. CONCLUSION Among women who were postpartum, AHE seemed to narrow IRD below the umbilicus compared with ADIM without either of these 2 modalities generating linea alba distortion, as SCU or ADIM+SCU does. Thus, although no significant differences were found when comparing the IRD at rest and during AHE, the AHE could improve the tensile response of the linea alba without increasing the IRD. IMPACT This is believed to be the first study to describe linea alba changes during AHE in women who are postpartum. AHE and ADIM seem to show different effects on infraumbilical IRD. The lack of distortion suggests that linea alba may undergo tensile loading at all levels.
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Affiliation(s)
- Beatriz Arranz-Martín
- Physiotherapy in Women's Health Research Group (FPSM), Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Beatriz Navarro-Brazález
- Physiotherapy in Women's Health Research Group (FPSM), Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Beatriz Sánchez-Sánchez
- Physiotherapy in Women's Health Research Group (FPSM), Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Linda McLean
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Carmen Carazo-Díaz
- Applied Statistical Methods in Medical Research Group, Catholic University of Murcia (UCAM), Murcia, Spain
| | - María Torres-Lacomba
- Physiotherapy in Women's Health Research Group (FPSM), Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
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15
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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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16
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Eriksson Crommert M, Petrov Fieril K, Gustavsson C. Women's experiences of living with increased inter-recti distance after childbirth: an interview study. BMC WOMENS HEALTH 2020; 20:260. [PMID: 33228602 PMCID: PMC7684710 DOI: 10.1186/s12905-020-01123-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 11/08/2020] [Indexed: 11/10/2022]
Abstract
Background Although an increased inter-recti distance, also known as diastasis recti, is common after pregnancy, evidence-based knowledge about the condition is relatively limited. In particular, little is known about the consequences as perceived by the women. The objective of the present study was to describe how postpartum women with increased inter-recti distance experience the condition as well as the contacts they have had with healthcare providers regarding their symptoms. Methods A purposeful sampling approach was used to recruit 19 participants from an existing study cohort of 144 women. All participants had an inter-recti distance of at least two finger widths and at least one child, with the youngest child between the ages of 1 and 6 years. Individual interviews based on a semi-structured interview guide were performed and subsequently analysed using qualitative content analysis. Results Four categories emerged from the interviews: the body’s function and ability has changed; the body does not look like it used to; uncomprehending attitudes and treatment in their surroundings; and trying to acquire an understanding of and strategies to cope with the diastasis. The findings reveal that women with increased inter-recti distance might experience fear of movement and engage in avoidance behaviour. In combination with feelings of physical instability in the midsection of their bodies and body dissatisfaction, many of the women restrict their everyday lives and physical activities. Conclusions The findings indicate that increased inter-recti distance is a complex phenomenon that affects the women in a multitude of ways, highlighting the importance of considering the condition for each individual in her own context from a biopsychosocial perspective.
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Affiliation(s)
- Martin Eriksson Crommert
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University/Örebro University Hospital, S-building, 701 85, Örebro, Sweden.
| | - Karolina Petrov Fieril
- Centre for Clinical Research, County Council of Värmland, Hus 73, Plan 3, 651 85, Karlstad, Sweden
| | - Catharina Gustavsson
- Centre for Clinical Research Dalarna, Uppsala University, Nissers Väg 3, 791 82, Falun, Sweden.,School of Education, Health and Social Studies, Dalarna University, 791 88, Falun, Sweden.,Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Box 564, BMC, 751 22, Uppsala, Sweden
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Kirk B, Elliott-Burke T. The effect of visceral manipulation on Diastasis Recti Abdominis (DRA): A case series. J Bodyw Mov Ther 2020; 26:471-480. [PMID: 33992284 DOI: 10.1016/j.jbmt.2020.06.007] [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: 04/07/2019] [Revised: 03/18/2020] [Accepted: 06/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Diastasis recti abdominis (DRA) is a condition that affects many postpartum and older women, often due to pregnancy-related issues and heavy lifting. Published research on nonsurgical DRA treatment has primarily focused on exercise to correct or prevent this dysfunction. A survey of women's health physical therapists identified that visceral manipulation and other interventions are utilized to treat DRA. No literature exists to identify the specifics of visceral manipulation or its effect on DRA. STUDY DESIGN This case series is a retrospective chart review of three female patients with DRA who received visceral manipulation. CASE DESCRIPTION The ages of the patients were 33, 37, 39 years old and all were positive for DRA based on inter-rectus distance (IRD) described as greater than two finger-width measurements at one of three measurement sites. Patients presented with chief complaints of low back pain, abdominal pain, and vulvar burning and itching. All women were gravida two and para two. Each patient received at least four treatments of visceral manipulation (VM). OUTCOMES VM decreased the IRD, decreased numeric pain rating scores, and improved functional activities in three women with DRA. Improvements were also seen in bladder and bowel symptoms. DISCUSSION Four treatments of visceral manipulation appear to be effective in decreasing DRA measurements in three women. DRA measurements improved to two finger-widths or less above, at, and below the umbilicus. The changes remained stable for six to sixteen months.
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Affiliation(s)
- Brandi Kirk
- Kirk Center for Healthy Living, Faculty The Barral Institute 16618 W 159th Street, Suite 402, Lockport, IL, 60441, USA
| | - Teresa Elliott-Burke
- Physical Therapy Institute, Midwestern University Multispecialty Clinic, 3450 Lacey Road, Downers Grove, IL, 60515, USA.
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18
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Wise SL, Binkley JL, Binkley HM. Pregnancy and Postpartum Training: Coaching Considerations. Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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