Physiotherapy in a patient with diastasis of the rectus abdominis muscle after childbirth

Czech version

Authors: R. Dudič ¹; E. Vaská ²
Authors‘ workplace: Gynekologicko-pôrodnícka klinika LF UPJŠ a UNLP, Košice, Slovenská republika ¹; Katedra Fyzioterapie, Fakulta zdravotníckych vied Univerzity sv. Cyrila a Metoda v Trnave, Slovenská republika ²
Published in: Ceska Gynekol 2023; 88(3): 180-185
Category: Case Report
doi: https://doi.org/10.48095/cccg2023180

Overview

Background: Examination for the presence of diastasis of the rectus abdominis muscle and examination of the entire posture is very important in postpartum women. Currently, examination by 2D ultrasound, caliper and palpation is used. It is examined at rest and during stress tests. Methods: Case study of a patient with diastasis of the direct abdominal muscle after a first spontaneous uncomplicated delivery at the age of 32 years. Examination to confirm diastasis of the rectus abdominis muscle – the width of linea alba was measured with a 2D linear probe by ultrasound 4.5 cm above the umbilicus, in the region of the umbilicus and 4.5 cm below the umbilicus. Lying on the back at rest, and with elevation of the lower limbs. The degree of severity was classified into four grades. A standard physiotherapy postural examination was performed. A part of the intervention was individual exercise with activation of the m. transversus abdominis to reduce diastasis of the direct abdominal muscles. The exercise program included postural adjustment, modification of breathing stereotype and quality, and activation of pelvic floor muscles. Exercises to reduce pain in the ligamentous apparatus and training in correct ergonomics were also performed. The dosage of exercise was 15 min per day in the ^1st week of treatment, 2–4 week of treatment 20 min per day, 5–12 week of treatment 30 min per day, 5 days per week, for 12 weeks. Conclusion: The effect of exercise with activation of m. transversus abdominis on the reduction of diastasis of the direct abdominal muscle in the postpartum patient was objectively proven by the above mentioned objectification methods.

Keywords:

exercise – diastasis of the rectus abdominis muscle – objectification

Sources

1. Bowman K. Diastasis recti: the whole body solution to abdominal weakness and separation. Washington: Propriometrics Press 2016.

2. Emanuelsson P. Alternatives in the treatment of abdominal rectus muscle diastasis. Stockholm: Karolinska Institutet 2014.

3. Bø K, Hilde G, Tennfjord MK et al. Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: prospective cohort study. Neurourol Urodyn 2017; 36 (3): 716–721. doi: 10.1002/nau.23005.

4. Benjamin DR, Frawley HC, Shields N et al. Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy 2019; 105 (1): 24–34. doi: 10.1016/j.physio.2018.07.002.

5. Carlstedt A, Bringman S, Egberth M et al. Management of diastasis of the rectus abdominis muscles: recommendations for swedish national guidelines. Scand J Surg 2021; 110 (3): 452–459. doi: 10.1177/1457496920961000.

6. Doubkova L, Andel R, Palascakova-Springrova I et al. Diastasis of rectus abdominis muscles in low back pain patients. J Back Musculoskelet Rehabil 2018; 31 (1): 107–112. doi: 10.3233/BMR-169687.

7. Hills NF, Graham RB, McLean L. Comparison of trunk muscle function between women with and without diastasis recti abdominis at 1 year postpartum. Phys Ther 2018; 98 (10): 891–901. doi: 10.1093/ptj/pzy083.

8. Hagovská M, Švihra J, Nagyova I et al. Effect of an exercise programme for reducing abdominal fat on overactive bladder symptoms in young overweight women. Int Urogynecol J 2020; 31 (5): 895–902. doi: 10.1007/s00192-019-04157-8.

9. Hagovská M, Švihra J. Evaluation of duloxetine and innovative pelvic floor muscle training in women with stress urinary incontinence (DULOXING): study protocol clinical trial (SPIRIT compliant). Medicine (Baltimore) 2020; 99 (6): e18834. doi: 10.1097/MD.0000000000018 834.

10. Hagovská M, Švihra J, Breza J Jr et al. A randomized, intervention parallel multicentre study to evaluate duloxetine and innovative pelvic floor muscle training in women with uncomplicated stress urinary incontinence – the DULOXING study. Int Urogynecol J 2021; 32 (1): 193–201. doi: 10.1007/s00192-020-04516-w.

11. Hagovska M, Švihra J, Horbacz A et al. The impact of different intensities of exercise on body weight reduction and overactive bladder symptoms – randomised trial. Eur J Obstet Gynecol Reprod Biol 2019; 242: 144–149. doi: 10.1016/j.ejogrb.2019.09.027.

12. Hagovská M, Komarovský R. Klinický štandard fyzioterapie diastázy priameho brušného svalu u žien po pôrode. Ministerstvo zdravotníctva Slovenskej republiky podľa § 45 ods. 1 písm. c) zákona č. 576/2004 Z. z. o zdravotnej starostlivosti, službách súvisiacich s poskytovaním zdravotnej starostlivosti a o zmene a doplnení niektorých zákonov v znení neskorších predpisov vydáva štandardný postup 2019.

13. Keramidas E, Rodopoulou S, Gavala MI. A proposed classification and treatment algorithm for rectus diastasis: a prospective study. Aesthetic Plast Surg 2022; 46 (5): 2323–2332. doi: 10.1007/s00266-021-02739-w.

14. Benjamin DR, Frawley HC, Shields N et al. Conservative interventions may have little effect on reducing diastasis of the rectus abdominis in postnatal women – a systematic review and meta-analysis. Physiotherapy 2023; 119: 54–71. doi: 10.1016/j.physio.2023.02.002.

15. Reinpold W, Köckerling F, Bittner R. Classification of rectus diastasis – a proposal by the German Hernia Society (DHG) and the International Endohernia Society (IEHS). Front Surg 2019; 6: 1. doi: 10.3389/fsurg.2019.00001.

16. Sperstad JB, Tennfjord MK, Hilde G et al. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med 2016; 50 (17): 1092–1096. doi: 10.1136/bjsports-2016-096065.

17. van de Water AT, Benjamin DR. Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): a systematic review of their measurement properties and meta-analytic reliability generalisation. Man Ther 2016; 21: 41–53. doi: 10.1016/j.math.2015.09.013.

18. Avery K, Donovan J, Peters TJ et al. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 2004; 23 (4): 322–330. doi: 10.1002/nau.20041.

19. Kolář P et al. Rehabilitace v klinické praxi. 1. vyd. Praha: Galén 2019.

20. Gluppe S, Hilde G, Tennfjord MK et al. Effect of a postpartum training program on the prevalence of diastasis recti abdominis in postpartum primiparous women: a randomized controlled trial. Phys Ther 2018; 98 (4): 260–268. doi: 10.1093/ptj/pzy008.

21. Pascoal AG, Dionisio S, Cordeiro F et al. Inter-rectus distance in postpartum women can be reduced by isometric contraction of the abdominal muscles: a preliminary case-control study. Physiotherapy 2014; 100 (4): 344–348. doi: 10.1016/j.physio.2013.11.006.