Relationship between diastasis recti abdominis and back pain in postpartum women
Authors:
Hagovská M. 1; Dudič R. 2; Švihra J. 3; Urdzík P. 2; Vaská E. 4
Authors‘ workplace:
Klinika fyziatrie, balneológie a liečebnej rehabilitácie, Univerzita Pavla Jozefa Šafárika, Lekárska fakulta a UNLP, Košice, Slovenská republika
1; Gynekologicko-pôrodnícka klinika, Univerzita Pavla Jozefa Šafárika, Lekárska fakulta a UNLP, Košice, Slovenská republika
2; Urologická klinika, Univerzita Komenského v Bratislave, Jesseniova lekárska fakulta v Martine, Slovenská republika
3; Katedra fyzioterapie, Fakulta zdravotníckych vied, Univerzita sv. Cyrila a Metoda v Trnave, Slovenská republika
4
Published in:
Rehabil. fyz. Lék., 30, 2023, No. 1, pp. 18-23.
Category:
Original Papers
doi:
https://doi.org/10.48095/ccrhfl202318
Overview
Aim: The aim of the work was to monitor the relationship between rectus abdominis diastasis and back pain in women after childbirth. Study design: observational prospective study. The final cohort consisted of 118 postpartum women with diastasis m. rectus abdominis (DRA) with a mean age of 33.11 years. Methods: Examination of diastasis – inter recti distance (IRD) measured with a linear 2D ultrasound probe, 4.5 cm above the navel, in its area and 4.5 cm below the navel. Lying on the back at rest, and during the stress test (elevation of the lower limbs), back pain was assessed by the Oswestry Disability Index (ODI). Results: We correlated diastasis m. rectus abdominis above the umbilicus, in the area of the umbilicus and below it with and without weight with individual sections of the ODI questionnaire for the assessment of pain during activities of daily living. In the sitting, standing, sex life, social life, travel and total score sections, we identified several moderate significant correlations; mostly with diastasis above the navel during weight bearing, and subsequently with diastasis above the navel without weight. One significant correlation was recorded for diastasis in the navel area. Conclusion: Pain intensity and pain during activities of daily living in the observed group was minimal. It has been confirmed that women with diastasis have negative feelings about diastasis in their sexual life, but also in travel and social life due to the fact that it is also a problem of aesthetic nature.
Keywords:
back pain – diastasis – m. rectus abdominis
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: an evaluation. Stockholm: Karolinska Institutet 2014. [online]. Available from: https://openarchive.ki.se/xmlui/handle/10616/42245.
3. Bø K, Mørkved S, Frawley H et al. Evidence for benefit of transversus abdominis training alone or in combination with pelvic floor muscle training to treat female urinary incontinence: a systematic review. Neurourol Urodyn 2009; 28(5): 368–373. doi: 10.1002/nau.20700.
4. 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.
5. 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.
6. Keeler J, Albrecht M, Eberhardt L et al. Diastasis recti abdominis: a survey of women’s health specialists for current physical therapy clinical practise for postpartum women. J Women’s Health Phys Ther 2012; 36: 131–142. doi: 10.1097/JWH.0B013E318276F35F
7. Lee D, Hodges PW. Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study. J Orthop Sports Phys Ther 2016; 46(7): 580–589. doi: 10.2519/jospt.2016.6536.
8. 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. doi: 10.2519/jospt.2013.4449.
9. 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; (28)6: 1. doi: 10.3389/fsurg.2019.00001.
10. 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.
11. 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.
12. Fairbank JC, Pynset PB. The Oswestry Disability Index. Spine 2000; 25(22): 2940–2952. doi: 10.1097/00007632-200011150-00017.
13. 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.
14. Gitta S, Magyar Z, Tardi P et al. Prevalence, potential risk factors and sequelae of diastasis recti abdominis. Orv Hetil 2017; 158(12): 454–460. doi: 10.1556/650.2017.30703.
15. 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. 12. doi: 10.1016/j.physio.2018.07.002.
16. Gluppe SL, 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.
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Physiotherapist, university degree Rehabilitation Sports medicineArticle was published in
Rehabilitation and Physical Medicine
2023 Issue 1
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