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

Ali A Thabet, Mansour A Alshehri, Ali A Thabet, Mansour A Alshehri

Abstract

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.

Conflict of interest statement

The authors have no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study.

References

    1. Chiarello CM, Falzone LA, McCaslin KE, Patel MN, Ulery KR. The effects of an exercise program on diastasis recti abdominis in pregnant women. J Womens Health Phys Therap. 2005;29(1):11–6.
    1. Lo T, Candido G, Janssen P. Diastasis of the recti abdominis in pregnancy:risk factors and treatment. Physiother Can. 1999;51(l):32–7.
    1. Gilleard WL, Brown JM. Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period. Phys Ther. 1996;76(7):750–62.
    1. Noble E. Essential exercises for the childbearing year:a guide to health and comfort before and after your baby is born. 4th ed. Harwich, MA: New Life Images; 1995.
    1. Rett MT, Almeida TV. Factors relating to mother and child associated with separation of the rectus abdominis muscle in immediate puerperium. Rev Bras Saúde Matern Infant Recife. 2014;14(1):73–80.
    1. Rett MT, Braga MD, Bernardes NO, Andrade SC. Prevalence of diastasis of the rectus abdominis muscles immediately postpartum:comparison between primiparae and multiparae. Rev Bras Fisioter. 2009;13(4):275–80.
    1. Rath AM, Attali P, Dumas JL, Goldlust D, Zhang J, Chevrel JP. The abdominal linea alba:an anatomo-radiologic and biomechanical. Surg Radiol Anat. 1996;18(4):281–8.
    1. Boissonnault JS, Kotarinos RK. Diastasis Recti. Newyork: Churchill Livingstone; 1988.
    1. Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther. 1988;68(7):1082–6.
    1. Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods:a systematic review. Physiotherapy. 2014;100(1):1–8.
    1. Hanneford R, Tozer J. An investigation of the incidence, degree and possible predisposing factors of the rectus diastasis in the immediate postpartum period. J Nat Obstet Gynaecol. 1985;4:29–32.
    1. Candido G, Lo T, Janssen P. Risk factors for diastasis of the recti abdominis. J Assoc Chart Physiother Womens Health. 2005;97:49–54.
    1. Corrêa MC, Corrêa MD. Noções práticas de obstetrícia. 12a ed. Rio de Janeiro: Medisi; 1999. Puerpério.
    1. Moore KL. Anatomia orientada para a clínica. 3a ed. Rio de Janeiro: Guanabara Koogan; 1994.
    1. Whiteford B, Polden M. Exercícios pós-natais:Um programa de seis meses para a boa forma da mãe e do bebê. São Paulo: Maltese-Norma; 1992. Seu Corpo antes e depois do parto.
    1. Stephenson RG, O'connor LJ. Obstetric and gynecologic care in physical therapy. 2nd Ed. New York: Slack incorporated press; 2000.
    1. Mesquita LA, Machado AV, Andrade AV. Fisioterapia para redução da diástase dos músculos retos abdominais no pós-parto. Rev Bras Ginecol Obstet. 1999;21(5):267–72.
    1. Mota P, Pascoal AG, Sancho F, Bo K. Test-retest and intrarater reliability of 2-dimensional ultrasound measurements of distance between rectus abdominis in women. J Orthop Sports Phys Ther. 2012;42(11):940–6.
    1. Tupler J, Gould J. Lose your mummy tummy. Cambridge: Da Capo Press; 2005.
    1. Lee DG, Lee LJ, McLaughlin L. Stability, continence and breathing:the role of fascia following pregnancy and delivery. J Bodywork Move Ther. 2008;12(4):333–48.
    1. Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(3):321–8.
    1. Acharry N, Kutty RK. Abdominal exercise with bracing, a therapeutic efficacy in reducing diastasis-recti among postpartal females. Int J Physiother Res. 2015;3(2):999, 1005.
    1. Aguirre DA, Santosa AC, Casola G, Sirlin CB. Abdominal wall hernias:imaging features, complication, and diagnostic pitfalls at multi-detector row CT. Radiographics. 2005;25(6):1501–20.
    1. Elbaz JS, Flageul G. Plastic Surgery of the Abdomen. New York: Masson Publishing; 1979.
    1. Parker M, Millar L, Dugan S. Diastasis rectus abdominis and lumbo-pelvic pain and dysfunction - Are they related? J Womens Health Phys Therap. 2009;33(2):15–22.
    1. Ranney B. Diastasis recti and umbilical hernia causes, recognition and repair. S D J Med. 1990;43(10):5–8.
    1. Opala-Berdzik A, Dabrowski S. Physiotherapy in diastasis of the rectus muscles of abdomen in women during pregnancy and postpartum. Fizjoterapia. 2009;17(4):67–70.
    1. Keeler J, Albrecht M, Eberhardt L, Horn L, Donnelly C, Lowe D. Diastasis recti abdominis:a survey of women's health specialists for current physical therapy clinical practice for postpartum women. J Womens Health Phys Therap. 2012;36(3):131–42.
    1. Sheppard S. The role of transversus abdominus in postpartum correction of gross divarication recti. Man Ther. 1996;1(4):214–6.
    1. Mendes Dde A, Nahas FX, Veiga DF, Mendes FV, Figueiras RG, Gomes HC, Ely PB, Novo NF, Ferreira LM. Ultrasonography for measuring rectus abdominis muscles diastasis. Acta Cir Bras. 2007;22(3):182–6.
    1. Willson JD, Dougherty P, Ireland ML, Davis IM. Core stability and its relationship to lower extremity function and injury, American academy of orthopaedic surgeons, J Am Acad Orthop Surg. 2005;13(5):316–25.
    1. Akuthota V, Ferreiro A, Moore T, Fredericson M. Core Stability Exercise Principles. Curr Sports Med Rep. 2008;7(1):39–44.
    1. Hsia M, Jones S. Natural resolution of rectus abdominis diastasis. Two single case studies. Aust J Physiother. 2000;46(4):301–7.
    1. Chiarello CM, McAuley JA. Concurrent validity of calipers and ultrasound imaging to measure interrecti distance. J Orthop Sports Phys Ther. 2013;43(7):495–503.
    1. Ware JE, Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.
    1. McHorney CA, Ware JE, Jr, Raczek AE. The MOS 36-item short-form health survey (SF-36):II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31(3):247–63.
    1. McHorney CA, Ware JE, Jr, Lu JF, Sherbourne CD. The MOS 36-item short-form health survey (SF-36):III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994;32(1):40–66.
    1. Dallmeijer AJ, de Groot V, Roorda LD, Schepers VP, Lindeman E, van den Berg LH, Beelen A, Dekker J. Cross-diagnostic validity of the SF-36 physical functioning scale in patients with stroke, multiple sclerosis and amyotrophic lateral sclerosis:a study using Rasch analysis. J Rehabil Med. 2007;39(2):163–9.
    1. Kisner C, Colby L. Therapeutic exercise foundations and techniques. 5th Ed. Philadelphia: F.A. Davis; 2007.
    1. Snijders T, Verdijk LB, Beelen M, McKay BR, Parise G, Kadi F, van Loon LJ. A single bout of exercise activates skeletal muscle satellite cells during subsequent overnight recovery. Exp Physiol. 2012;97(6):762–73.
    1. Helal OF, Alshehri MA, Alayat MS, Alhasan H, Tobaigy A. The effectiveness of short-term high-intensity exercise on ventilatory function, in adults with a high risk of chronic obstructive pulmonary disease. J Phys Ther Sci. 2017;29(5):927–30.
    1. Walton L, Costa A, LaVanture D, McIlrath S, Stebbins B. The effects of a 6 week dynamic core stability plank exercise program compared to a traditional supine core stability strengthening program on diastasis recti abdominis closure, pain, oswestry disability index (ODI) and pelvic floor disability index scores (PFDI) Phy Ther Rehab. 2016;3(1):3.
    1. Rathi M. Effect of pelvic floor muscle strengthening exercises in chronic low back pain. IJPOT. 2013;7(1):121–5.
    1. El-Mekawy H, Eldeeb A, El- Lythy M, and El-Begawy A. Effect of Abdominal Exercises versus Abdominal Supporting Belt on Post-Partum Abdominal Efficiency and Rectus Separation. Int J Med Health Sci. 2013;7(1):75–9.
    1. Litos K. Progressive Therapeutic Exercise Program for Successful Treatment of a Postpartum Woman With a Severe Diastasis Recti Abdominis. J Womens Health Phys Therap. 2014;38(2):58–73.
    1. IDEA Health and Fitness Association. Inspire Women to Fitness. San Diego: IDEA; 2003.
    1. Sapsford R, Markwell S, Clarke B. The relationship between urethral pressure and abdominal muscle activity. Australian Continence J. 1998;4:102–10.
    1. Gill V, Neumann P. EMG evidence of abdominal activity during pelvic floor muscle contraction. Proceedings of the International Continence Society Conference, Denver. 1999;168:54–55.
    1. Carlson K, Eisenstat S, Zipory N. The new Harvard guide to women's health. 1st Ed. USA: Harvard University Press; 2004.
    1. Perry SE, Hockenberry MJ, Lowdermilk DL, Wilson D. Maternal Child Nursing Care. 5th Ed. Missouri: Elsevier Health Sciences; 2014.
    1. Thabet AA, Alshehri MA, Helal OF, Refaat B. The impact of closed versus open kinetic chain exercises on osteoporotic femur neck and risk of fall in postmenopausal women. J Phys Ther Sci. 2017;29(9):1612–6.

Source: PubMed

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