Abstract:Background:
Diastasis rectus abdominis (DRA) is characterized by a widening between the rectus abdominis muscles and thinning of the linea alba. It is common during pregnancy and may contribute to postpartum low back pain (LBP) and stress urinary incontinence (SUI). Core strengthening is thought to improve DRA, but there is no widely accepted exercise program.
Objectives:
To assess changes in interrectus distance (IRD) and participant-reported outcomes … Show more
“…The yoga exercise program combined with dynamic exercise; the entire muscle group of the rectus abdominis can be practiced effectively. The findings of this study are consistent with Leopold et al [26] in which to cooperate with breathing and core strengthening by exercise program among 43 postpartum women in a control trial study significantly decreased IRD. However, the program [27] has taken more frequently in eight weeks 24 sessions (3 times weekly, for a total of 24 sessions), which differed compared with fewer sessions carried out in this study, and the progressive yoga exercise protocol might cause to reduce IRD actively in decreasing the distance above and below the umbilicus in exercise group.…”
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.
“…The yoga exercise program combined with dynamic exercise; the entire muscle group of the rectus abdominis can be practiced effectively. The findings of this study are consistent with Leopold et al [26] in which to cooperate with breathing and core strengthening by exercise program among 43 postpartum women in a control trial study significantly decreased IRD. However, the program [27] has taken more frequently in eight weeks 24 sessions (3 times weekly, for a total of 24 sessions), which differed compared with fewer sessions carried out in this study, and the progressive yoga exercise protocol might cause to reduce IRD actively in decreasing the distance above and below the umbilicus in exercise group.…”
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.
“…The reviewed studies had varying sample sizes (3–129) and used different cut-off points for DRA diagnosis, such as 2.0 cm [ 29 – 32 ], 2.2 cm [ 12 ], or 2.5 cm [ 33 – 37 ] above the umbilicus during rest, and 1.5–3.0 cm above the umbilicus during a head-lift or curl-up [ 38 – 40 ]. Three studies proposed cut-offs of two finger-widths at the umbilicus [ 21 ] or anywhere in the midline [ 23 , 41 ] during a head-lift and subsequently assessed with ultrasound, whereas 12 studies did not use any cut-off points [ 22 , 37 , 42 – 51 ].…”
Section: Resultsmentioning
confidence: 99%
“…Although most samples had ultrasound-measured [ 12 , 21 – 23 , 30 – 34 , 36 , 37 , 41 , 43 , 46 – 51 ] or caliper-measured [ 29 , 35 , 38 – 40 , 42 – 45 , 52 ] IRDs between 2.5 and 5 cm, two studies [ 43 , 47 ] encompassed IRDs <2.5 cm, whereas one case series [ 52 ] included women with IRDs >7 cm. However, 7 studies [ 21 , 23 , 32 , 34 , 37 , 45 , 48 ] included postpartum women with combined normal and borderline IRD, according to established classification systems [ 1 ]. Fig.…”
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.
“…Diaphragmatic breathing with transversus abdominis (TrA) and PFM activation was completed in a variety of positions to train neuromuscular control patterns and change the tension through the shoulder complex to assist in proper posture. 32,39,60,[71][72][73][74][75] The patient was also educated to complete 10 repetitions of breathing with isolated TrA activation 3 times per day, 7 days per week, with 4-count inhalation and exhalation.…”
Section: Interventionmentioning
confidence: 99%
“…Due to the patient's subjective report of “core weakness” and the requirement for management of intra-abdominal pressure changes during high-intensity functional conditioning activities, exercises for abdominal strength and PFM activation were also given in the home exercise program. Diaphragmatic breathing with transversus abdominis (TrA) and PFM activation was completed in a variety of positions to train neuromuscular control patterns and change the tension through the shoulder complex to assist in proper posture 32,39,60,71–75. The patient was also educated to complete 10 repetitions of breathing with isolated TrA activation 3 times per day, 7 days per week, with 4-count inhalation and exhalation.…”
Background: Physiological and biomechanical changes must be considered when evaluating and treating musculoskeletal impairments in a perinatal female athlete, whether or not these impairments are directly related to their pregnant or postpartum state. Case Description: This case report describes a 34-year-old woman active in high-intensity functional conditioning, recreational volleyball, and running, seeking care for shoulder and thoracic back pain from birth to 1 year postpartum. Her primary complaint of shoulder pain was exacerbated by overhead activities. She also presented with a secondary complaint of "weakness" through her core, preventing return to sport. Treatment focused on joint mobilizations, neuromuscular reeducation, and core strength using biotensegrity principles throughout the postpartum journey of return to sport. Outcomes: The patient was highly motivated and met her desired goals to (1) compete in recreational sand and indoor volleyball starting at 6 weeks postpartum, (2) participate in a relay trail race at desired pace, and (3) compete in a weightlifting competition at 8 months postpartum without an increase in shoulder pain. Discussion: This case demonstrates the importance of addressing the entire kinetic chain in the postpartum athlete while addressing what may be considered a "straightforward" orthopedic condition. Understanding birth and postpartum healing is essential for physical therapists working with active mothers. Knowledge of the physiological and biomechanical changes during and after pregnancy is essential to appropriate treatment of these patients.
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