Anterior and posterior rectus abdominis sheath stiffness in relation to diastasis recti: Abdominal wall training or not?

Wingerden, Jan-Paul van; Ronchetti, Inge; Sneiders, Dimitri; Lange, Johan F.; Kleinrensink, Gert-Jan

doi:10.1016/j.jbmt.2019.10.015

Cited by 13 publications

(14 citation statements)

References 52 publications

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“…Nonetheless, the tension of the TrA muscle increased. This finding is in agreement with the results of the anatomical study by Wingerden et al [ 32 ], which demonstrated that the TrA muscle, as the deep abdominal wall muscle, played an important role in the etiology of DRA. Typical for pregnancy is the space requirement of the growing uterus, which increases intra-abdominal pressure.…”

Section: Discussionsupporting

confidence: 93%

Muscle elasticity is different in individuals with diastasis recti abdominis than healthy volunteers

Zhou

Zhu

et al. 2021

Insights Imaging

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Objective To determine the value of shear wave elastography (SWE) in assessing abdominal wall muscles, including rectus abdominis (RA), external oblique muscle (EO), internal oblique muscle, and transversus abdominis (TrA) in patients with diastasis recti abdominis (DRA) and healthy controls. Methods From October 2018 to December 2019, 36 postpartum DRA patients and 24 nulliparous healthy women were identified. Inter-rectus distance (IRD) measurements were taken by B-mode ultrasound. Shear wave speed (SWS) values were acquired by one operator at ten specific locations. Clinical and ultrasound variables, including demographics, IRD, muscle thickness, and muscle SWS, were compared between the two groups using Student’s t test or Fisher's exact test. Pearson correlation analyses were conducted for the variables of IRD, muscle thickness, and SWS in the 36 DRA patients. Results The maximum diameter of recti abdominus separation was located at the umbilicus in DRA patients (4.59 ± 1.14 cm). The SWS value was significantly lower in the RA (p = 0.003) and higher in the TrA muscle (p < 0.001) in DRA patients compared with the age-matched controls. However, SWS in both muscles (RA and TrA) showed a statistically positive correlation with IRD (p < 0.05). In addition, the SWS value in EO statistically decreased in DRA patients compared with the healthy controls (1.65 ± 0.15 vs. 1.79 ± 0.14, p = 0.001). Conclusions The application of SWE to abdominal wall muscles in DRA patients is feasible. The correlation between SWS value and IRD in RA should be interpreted with caution.

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Section: Discussionsupporting

confidence: 93%

Muscle elasticity is different in individuals with diastasis recti abdominis than healthy volunteers

Zhou

Zhu

et al. 2021

Insights Imaging

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“…Due to the heterogenous studies and varying outcomes, several management recommendations have been presented 28 . Specific core stabilizing exercises have been suggested to provide support to the abdominal canister 29 , but improvements arising from core training are, by nature, temporary and require continued training if they are to persist.…”

Section: Discussionmentioning

confidence: 99%

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

Olsson

Woxnerud²,

Kiwanuka

et al. 2023

BJS Open

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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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“…The rectus sheath wraps the rectus abdominal muscles and is divided into two layers: the anterior is formed by the healing of the aponeurosis of the external oblique muscle and the aponeurosis of the internal oblique muscle, and the posterior rectus sheaths are formed by the healing of the aponeurosis of the internal oblique muscle and the aponeurosis of the transverse abdominis. The posterior rectal sheath is functionally more related to transverse abdominis than rectus abdominal muscles, and activation of transverse abdominis plays an important role in the etiology of the DRA ( 34 , 35 ). Physical exercises adopted in this study, such as left and right-side leg rotation, are more effective in activating deep transverse abdominis, external oblique muscle, and internal oblique muscle ( 36 , 37 ), and posterior rectus fascia sheath formed by transverse abdominis tendon sheath has better efficacy in maintaining abdominal wall tension stability.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of electro-acupuncture in postpartum with diastasis recti abdominis: A randomized controlled clinical trial

Liu

Zhu

Jiang

et al. 2022

Front. Public Health

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BackgroundElectro-acupuncture (EA) has promising effects on diastasis rectus abdominis (DRA), defined as a separation of the two muscle bellies of rectus abdominis. To study, there is scant knowledge or scarce high-quality evidence.ObjectiveWe aimed to evaluate the long-term efficacy and safety of EA in treating DRA during postpartum. It was assumed that the improvement of DRA was more obvious in the EA group than in the control group.DesignRandomized, controlled, blinded trial (Clinical Trial Registration: ChiCTR2100041891).SettingHangzhou Hospital of Traditional Chinese Medicine in China.ParticipantsFemales aged 20–45 years without a past medical history of pathological rectus abdominal dissection were recruited from DRA inclusion criteria from 42 days to 1 year postpartum.Intervention110 participants were randomly assigned in a 1:1 ratio to a control group with no EA intervention (n = 55), and EA group (n = 55). The EA group received ten sessions of EA combined with physical exercise or only physical exercise over 2 weeks with a 26-week follow-up after treatment.MeasurementsOutcomes were assessed at baseline, week 2, and week 26. The primary outcome was the change of the inter recti distance (IRD) and electromyographic evaluation of the pelvic floor. Secondary outcomes included elasticity of linea alba (LA), paraumbilical subcutaneous adipose tissue (SAT) measurement, body mass index (BMI), percentage body fat (F%), dyspepsia symptoms, menstrual symptoms, quality of life (QoL), pain performance of patients with lower back pain, postnatal depression symptoms (PDS), postpartum self-image, and DRA-related symptom assessment including urine leakage, frequency, and urgency, constipation, sexual dysfunction, and chronic pelvic pain.ResultsA total of 110 maternal (55 in each group) were recruited. The mean difference in IRD from baseline to week 2 and week 26 in all states of the two groups were reduced compared with those before treatment, with statistical significance (P < 0.05). The mean of IRD at the horizontal line of the umbilicus in the end-expiratory state was smaller in the EA group than in the control group, but the difference was not statistically significant (P > 0.05) at week 2. The mean of IRD at the horizontal line of the umbilicus in head-up and flexed knee state was smaller in the EA group than in the control group, and the difference was statistically significant (P < 0.05) at week 26. Five (9.1%) and thirteen (23.64%) adverse events were reported in EA and control groups, respectively. No serious adverse events were reported.LimitationThe frequency intensity of EA parameters was selected between 4 and 6 because of individual tolerance differences.ConclusionEA is an effective approach to improve IRD, electromyographic evaluation of the pelvic floor, BMI, the elasticity of LA, paraumbilical SAT, and symptoms of DRA, with durable effects at 26 weeks after treatment.Primary funding sourceThe Construction Fund of Medical Key Disciplines of Hangzhou (Project Number: OO20200097), Hangzhou Medical and Health Science and Technology Project No. A20200483, and Zhejiang Traditional Chinese Medicine Science and Technology Plan Project (Project Number: 2021ZQ065).Clinical trial registrationhttp://www.chictr.org.cn/index.aspx, identifier: ChiCTR2100041891.

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Anterior and posterior rectus abdominis sheath stiffness in relation to diastasis recti: Abdominal wall training or not?

Cited by 13 publications

References 52 publications

Muscle elasticity is different in individuals with diastasis recti abdominis than healthy volunteers

Muscle elasticity is different in individuals with diastasis recti abdominis than healthy volunteers

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

Efficacy of electro-acupuncture in postpartum with diastasis recti abdominis: A randomized controlled clinical trial

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