Comparing the effects of suspension and isometric-isotonic training on postural stability, lumbopelvic control, and proprioception in women with diastasis recti abdominis: a randomized, single-blinded, controlled trial
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.
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.
“…Moreover, since the exercise effect is not solely determined by inter-recti distance but also by overall perspective such as symptom reduction or improved appearance In addition, all kinds of exercises are carried out by the subjects, but each person's cognition to the exercise method is inconsistent, and the exercise effect will be different, which will also affect the scienti c data obtained. Currently, there is a signi cant amount of research papers discussing the types of exercise that are helpful for the DRA rehabilitation [11,17,[20][21][22][23][24], as well as Narrowing inter-recti distance to judge the effect of its exercise [2,[16][17]. However, limited research has explored the causes of DRA from the perspective of biomechanics, including why abdominal muscle contraction leads to a decrease in the inter-recti distance.…”
Background The main treatment for diastasis recti abdominis (DRA) is physical therapy. Most existing research focuses on the types of intervention to take, the effects of exercise, and the evaluation methods of these effects. So far, there are no recognized exercise programs. Perhaps researchers have overlooked the changes in trunk mechanics caused by pregnancy, as well as the relationship between biomechanics and exercises for DRA. This study aims to explore the mechanisms of rehabilitation exercise for DRA from a biomechanical perspective.
Methods PubMed, EMBASE, CNKI, and Web of Science databases were consulted using the terms 'Diastasis rectus abdominis, Abdominis Muscle,' 'Biomechanics,' 'Linea alba,' 'Physical therapy,' 'transversus abdominis,' and 'trunk stabilization.' All English and Chinese-written published articles were included until Oct, 2023.
Results The transverse abdominis muscle (TrA) is located deep within the abdominal wall and is attached to the fascia (aponeurosis) at both the front and back ends. During the Abdominal Drawing-In Maneuver, the muscles contract centrally. They shorten and thicken, resulting in reduced abdominal volume, increased abdominal pressure, and improved trunk stability. It also causes the displacement of the aponeurosis on both sides, resulting in centripetal force. The transverse fiber constitutes the main structure of the dorsal rectus sheath and the posterior layer of the linea alba. According to measurements obtained through shear wave elastic ultrasonic imaging and other equipment, the transverse stress is high and the compliance is low. Its biomechanical characteristics facilitate the transverse transfer of force generated by the TrA to the linea alba, and the force on both sides ends in the linae alba, which increases the tension. In patients with DRA, the linea alba undergoes significant deformation, and its stiffness decreases.
Conclusions The deformation of the linea alba is the main feature of DRA. TrA is the only muscle in the abdominal region that can increase the tension of the linea alba and improve the stability of the trunk by increasing internal abdominal pressure. Therefore, exercising TrA is the best treatment for the rehabilitation of DRA from mechanisms.
“…Therefore, the objective of this study was to assess the impact of trunk stabilisation versus activation exercises on pain and disability in postpartum lumbo-pelvic pain. [18][19][20][21]…”
The purpose of this study was to determine and compare the effects of trunk stabilisation and activation exercises on pain and disability in postpartum lumbo-pelvic pain. It was a randomised clinical trial (ClinicalTrials.gov: NCT05490810). Twenty-eight females with lumbo-pelvic pain were randomly allocated to two groups with 14 patients in each group. Group A was treated with trunk stabilisation exercises and Group B was treated with trunk activation exercises, three times a week for eight weeks. Numeric pain rating scale was used to measure the intensity of pain. Disability was assessed through Oswestry disability index (ODI). Both the groups were evaluated before and at the end of the last treatment session. Data was analysed by SPSS 21. There was a significant difference between trunk stabilisation versus activation exercises on pain and disability in postpartum lumbo-pelvic pain with p value <0.05 in Group A patients.
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