COMPARISON OF ABDOMINAL EXERCISES AND NEUROMUSCULAR ELECTRICAL STIMULATION ON DIASTASIS RECTI ABDOMINIS MUSCLE IN POSTNATAL FEMALES WITH CAESAREAN SECTION.

The separation of the two rectus abdominis muscles along the linea alba is termed diastasis of recti abdominis muscles (DRAM). DRAM is a common health problem in people that are both pregnant and postpartum. With a 100% frequency at gestational week 35, it is extremely frequent during pregnancy. Control and function of the trunk are greatly influenced by the musculature of the abdomen. The existence, extent, and duration of DRAM have been connected to low back and pelvic discomfort however the relationship is not conclusive. It has been proven to weaken abdominal muscles and impair their functioning in lumbo-pelvic stability. Additionally, DRAM has been linked to pelvic floor dysfunction. The mechanical control and function of the abdomen can be compromised by diastasis recti, which compromises the abdominal muscles. This study examined the impact of abdominal exercises and neuromuscular electrical stimulation on the DRAM in postnatal females who underwent Caesarean section. A total of 208 individuals, aged between 20 and 34, who had recti diastasis measuring more than 2.5 cm, underwent screening. They were split into two groups at random. Group B only received abdominal exercises, whereas Group A received NMES in addition to their activities. For a period of 12 weeks, the intervention was given to both groups three times a week. Changes have been recorded before and after the intervention. The pressure biofeedback unit, measuring tape, and vernier caliper were employed to evaluate the outcome measures of inter-recti distance, abdominal muscle strength, and waist-hip ratio, respectively. In every outcome, both groups had a highly significant (p<0.05) improvement. Furthermore, after 12 weeks, group A had improved in all measures with highly significant (p<0.05) intergroup comparisons. In comparison to MNES alone, NMES can have a more significant effect on reducing DRAM in postpartum women when paired with abdominal Exercise.

Acupuncture for postpartum diastasis recti abdominis and its effects on abdominal circumference, separation distance of rectus abdominis. / é’ˆåˆºæ²»ç–—äº§åŽè ¹ç›´è‚Œåˆ†ç¦»æ‚£è€ çš„ç–—æ•ˆåŠå¯¹è ¹å›´ã€è ¹ç›´è‚Œåˆ†ç¦»é—´è·çš„å½±å“.

OBJECTIVES: To observe the therapeutic efficacy of acupuncture and its effects on abdominal circumference, separation distance of rectus abdominis and quality of life in patients with postpartum diastasis recti abdominis on the basis of diastasis recti abdominis exercise. METHODS: A total of 87 postpartum women with diastasis recti abdominis were randomly divided into an observation group (44 cases) and a control group (43 cases) . The control group was treated with conventional diastasis recti abdominis rehabilitation exercise, including abdominal breathing training and supine leg lifting training, 3 times a day for 2 weeks. On the basis of the treatment in the control group, the observation group was treated with acupuncture at Zhongwan(CV 12), Qihai(CV 6)and bilateral Shenshu(BL 23), Daimai(GB 26), Daheng(SP 15), Zusanli (ST 36), etc., 30 min each time, once a day for 2 weeks. Before and after treatment, the separation distance of rectus abdominis, low back pain visual analogue scale (VAS) score, abdominal circumference and 36-item short form health survey questionnaire (SF-36) score in the two groups were compared, and the clinical effect was evaluated. RESULTS: After treatment, the separation distance of rectus abdominis, low back pain VAS scores, abdominal circumference of the two groups were lower than those before treatment(P<0.05), and the physiological function, physiological role, pain, mental health, emotional role, social function, energy, general health scores and total scores of SF-36 were higher than those before treatment(P<0.05); the separation distance of rectus abdominis, low back pain VAS score, abdominal circumference of the observation group were lower than those in the control group(P<0.05), the sub-item scores and total score of SF-36 of the observation group were higher than those in the control group(P<0.05).The effective rate of the observation group was 95.5% (42/44), which was higher than 79.1% (34/43) in the control group(P<0.05). CONCLUSIONS: Acupuncture combined with diastasis recti abdominis exercise can effectively relieve the low back pain of postpartum diastasis recti abdominis patients, promote the recovery of recti abdominis function, and improve the quality of life. The clinical effect is superior to diastasis recti abdominis exercise alone.

Comparison of the efficiency of core stabilization exercises and abdominal corset in the treatment of postpartum diastasis recti abdominis.

OBJECTIVE: To examine the feasibility of three physiotherapy interventions for the treatment of diastasis recti abdominis (DRA): core stabilization exercises, abdominal corset and a combination of exercise and abdominal corset. STUDY DESIGN: Forty-five women 6 to 12 weeks postpartum who were diagnosed with DRA by a gynecologist/obstetrician were recruited for the study. The women were randomly divided into three groups: core stabilization exercises (1st group), the combination of exercise and abdominal corset (2nd group) and abdominal corset (3rd group). The treatment session for each group continued for 8 weeks. Outcome measurements were pain evaluation, inter-rectus distance (IRD) measured using ultrasound, trunk flexion strength and endurance, balance with open eyes/closed with a balance board, and Oswestry Disability Index (ODI). RESULTS: Statistically significant difference was observed in all outcome measures except the balance eyes closed results in the first group (p < 0.05). There was a statistically significant difference in all outcome measures in the second group (p < 0.05). Also, there was a statistically significant difference in visual analog scale, trunk flexor endurance, IRD results, balance with open eyes and ODI results in the third group (p < 0.05). When the values pre and post-treatment between the groups were examined, a statistically significant change was observed in trunk flexion strength, trunk flexor endurance, and balance with open eyes/closed parameters (p < 0.05). CONCLUSIONS: Physiotherapy interventions as core stabilization exercises and the abdominal corset can positively impact IRD, trunk flexion muscle strength and endurance, balance and disability in DRA management. The combination of exercise and corset was found more effective in the postpartum process.

Effect of Electrical Stimulation Followed by Exercises in Postnatal Diastasis Recti Abdominis via MMP2 Gene Expression.

Since abdominal muscle training is one of the most important ways to treat rectal diastasis, it is necessary to design and provide appropriate exercises to treat this problem. One of the complementary methods to achieve higher intensity training is the use of electrical muscle stimulation along with voluntary activity, which causes maximum recall in muscle units. Therefore, in the current study, the effect of electrical stimulation followed by exercises was evaluated in postnatal diastasis recti abdominis via MMP2 gene expression. For this purpose, we studied on thirty-two women who had rectal diastasis for six months and were referred to a physiotherapy clinic by a gynecologist. They were divided into the control group (n=16) and the intervention group (n=16). The distance between the two blocks of the rectus abdominis muscle and the thickness of the abdominal muscles at rest was determined by ultrasound. In the intervention group, electrical stimulation and strengthening exercises of oblique muscles were performed for six weeks. The control group did not perform any specific exercises. After six weeks, another ultrasound was performed. The expression of the MMP2 gene was measured by the real-time PCR method. Comparison of the distance between the two blocks of rectus abdominis muscle (above the umbilicus and below the umbilicus) before and after six weeks showed that in the experimental group after intervention in both areas had a significant decrease (above the umbilicus = 0.001 and below the umbilicus P = 0.03), while this distance in the control group did not decrease significantly (p >0.05). Also, in the upper part of the umbilicus, the distance between the two rectus abdominis muscle blocks in two groups after the intervention showed a significant difference (p = 0.04). Evaluation of MMP2 gene expression showed that there was no significant difference between the two groups before the intervention (p >0.05). However, after the intervention, the expression of this gene decreased significantly in the intervention group (p = 0.007). In general, the present study results showed that electrical stimulation of abdominal muscles with strengthening exercises of internal and external oblique muscles could reduce rectal diastasis and increase the thickness of these muscles in people with rectal diastasis.

Immediate Effect of Abdominal and Pelvic Floor Muscle Exercises on Interrecti Distance in Women With Diastasis Recti Abdominis Who Were Parous.

OBJECTIVE: There is a lack of consensus on which abdominal or pelvic floor muscle (PFM) exercises to recommend for the treatment of diastasis recti abdominis (DRA). The objective of this study was to investigate the immediate effect of abdominal and PFM exercises on interrecti distance (IRD) in women with DRA who are parous. METHODS: In this cross-sectional study, 38 women who were parous, with a mean age of 36.2 years (SD = 5.2), diagnosed with DRA participated. IRD was assessed with 2-dimensional real-time ultrasonography during rest and during 8 randomly ordered different exercises. A paired t test was used to compare the IRD at rest with the IRD recorded during each exercise as well as the differences between exercises. Means with 95% CI are reported. RESULTS: Head lift and twisted curl-up exercises significantly decreased the IRD both above and below the umbilicus. Above the umbilicus, the mean IRD difference from rest during head lift was 10 mm (95% CI = 7 to 13.2), whereas during twisted curl-up it was 9.4 mm (95% CI = 6.3 to 12.5). Below the umbilicus, the corresponding values were 6.1 mm (95% CI = 3.2 to 8.9) and 3.5 mm (95% CI = 0.5 to 6.4), respectively, but PFM contraction, maximal in-drawing, and PFM contraction + maximal in-drawing increased the IRD (mean difference = -2.8 mm [95% CI = -5.2 to 0.5], -4.7 mm [95% CI = -7.2 to -2.1], and - 5.0 mm [95% CI = -7.9 to -2.1], respectively). CONCLUSIONS: Head lift and twisted curl-up exercises decreased the IRD both above and below the umbilicus, whereas maximal in-drawing and PFM contraction exercises only increased the IRD below the umbilicus. A randomized controlled trial is needed to investigate whether head lift and twisted curl-up exercises are effective in permanently narrowing the IRD. IMPACT: To date there is scant scientific knowledge of which exercises to recommend in the treatment of DRA. In-drawing and PFM contraction leads to an acute increase in IRD, while head lift and twisted curl-up leads to an acute decrease in IRD in postpartum women. There is a need for high-quality randomized controlled trials to investigate if there is a long-term reduction in IRD by doing these exercises over time. The acute IRD increase and decrease during the different exercises is also present in a sample of women with larger separations.

[Impact of the diastasis of the rectus abdominis muscles on the pelvic-perineal symptoms: Review of the literature]. / Impact du diastasis des muscles droits de l'abdomen sur les symptômes pelvi-périnéaux : revue de la littérature.

INTRODUCTION: The diastasis of the rectus abdominis muscles is common during pregnancy and post-partum. OBJECTIVE: To determine the prevalence of this pathology, methods of diagnosis, association with pelvic-perineal disorders and therapies that may be proposed. METHODS: Review of Pubmed, Medline, Embase and Cochrane literature using the following words and MeSH: diastasis, diastasis and pregnancy, diastasis of the rectus abdominis muscle, increase of the inter-recti distance. RESULTS: Among the 124 articles found, 61 were selected. Ultrasound seems to be the exam of choice both in terms of feasibility and reproducibility for the diagnosis of this pathology (intra-class correlation coefficients (ICC) high 0.81 to 0.94). The risk factors identified vary from one study to another: heavy load bearing (OR=2.18 (95 % CI 1.05 to 4.52) P=0.04), weight gain. Studies are discordant regarding the association between diastasis and low back pain (RR=1.39 (95 % CI 0.91-2.14), P=0.17), urinary incontinence (RR=0.86 (95 % CI 0.55-1.33) P>0.65) and prolapse (OR=2.25 (95 % CI 1.51-3.37) P<0.001), but the diastasis seems to play a role in the alteration of the quality of life for these patients. CONCLUSION: Knowledge about risk factors, consequences of diastasis and management is still limited today. It is therefore necessary to establish prospective studies on larger numbers in order to improve knowledge on the diastasis of the rectus abdominis muscles.

Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial.

OBJECTIVES: This study was aimed at discovering the efficacy the deep core stability exercise program has on the closure of diastasis recti and on the overall improvement in the quality of life for postpartum women. METHODS: The study group consisted of forty women with diastasis recti, aged between 23 and 33 who were randomly divided into two groups. The 20 women in the first group underwent a deep core stability-strengthening program plus traditional abdominal exercises program, 3 times a week, for a total duration of 8 weeks. The other 20 women, forming the second group, only underwent the traditional abdominal exercises program, 3 times a week for 8 weeks. Following this procedure, the inter-recti separation was measured using digital nylon calipers while the quality of life was measured by Physical Functioning Scale (PF10) for all the participants. RESULTS: As a result of the use of the deep core stability exercise program, inter-recti separation had a high statistically relevant decrease, (P<0.0001), showing a highly statistically relevant improvement with regard to the quality of life in the study groups (p<0.0001). CONCLUSIONS: The deep core stability exercise program is effective in treating diastasis recti and improving postpartum women's quality of life.

Movement System Impairment-Guided Approach to the Physical Therapist Treatment of a Patient With Postpartum Pelvic Organ Prolapse and Mixed Urinary Incontinence: Case Report.

Background and Purpose: Women with postpartum pelvic organ prolapse (POP) and urinary incontinence are often treated by physical therapists specializing in women's health. Movement system impairments often coexist in this patient population. The purpose of this case report is to describe the physical therapist treatment of a woman with postpartum POP complicated by additional pelvic symptoms. Case Description: A 31-year-old woman presented with postpartum POP, diastasis recti, urinary incontinence, and constipation. Movement system impairments were consistent with a physical therapist diagnosis of femoral adduction-medial rotation syndrome exacerbated by levator ani muscle weakness and incoordination and impaired intra-abdominal pressure regulation. Interventions, based on a movement system guided approach, included postural correction; pelvic-floor, abdominal, and hip muscle strengthening; functional training to correct identified movement faults; and patient education. Outcomes: Movement system impairment outcomes included: correction of femoral adduction-medial rotation and knee hyperextension during standing at rest, ambulation, and exercise; increased hip muscle strength; and effective regulation of intra-abdominal pressure (resolution of breath holding with the Valsalva maneuver) during all transitional movements and therapeutic exercise. The patient also demonstrated reductions in POP, urinary, and colorectal symptom severity that exceeded the minimal clinically important difference. Additionally, she demonstrated a reduction in diastasis rectus distance. Discussion: A movement system impairment-guided approach led the physical therapist to consider impairments outside the pelvic floor that could have contributed to the patient's pelvic symptoms. Using this approach, the patient achieved resolution of musculoskeletal and movement impairments and reductions in POP, urinary and colorectal symptoms, and symptom-related distress.