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Espinoza-Bravo C, Rejano-Campo M, Domínguez-Navarro F, de Gasquet B, Fuentes-Aparicio L. Intraobserver Reliability of Two-Dimensional Ultrasound Measurements of the Linea Alba in Parous Women During Different Abdominopelvic Exercises. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2025. [PMID: 40234202 DOI: 10.1002/jum.16697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 02/23/2025] [Accepted: 03/23/2025] [Indexed: 04/17/2025]
Abstract
OBJECTIVE To assess the intraobserver reliability of Diastasis Recti Abdominis (DRA) measurement by ultrasonography during four specific abdominopelvic exercises, evaluating interrecti distance, Linea Alba (LA) thickness, and distortion index in parous women. METHODS Fifty-four parous women were assessed using ultrasound imaging for the LA. Four exercises were evaluated: crunch, abdominal drawing-in maneuver, pelvic floor muscle contraction, and one exercise based on the de Gasquet Method. Each exercise was performed three times. The ultrasound probe was placed 3 cm above and 2 cm below the umbilicus. Interrecti distance (IRD), distortion index, and LA thickness were measured and analyzed using ImageJ software by independent researchers. Intraobserver reliability was evaluated using the intraclass correlation coefficient (ICC) with a 95% confidence interval. RESULTS ICC values for the IRD ranged from 0.84 to 0.99 for the four exercises. The distortion index showed moderate to high reliability (ICC: 0.77-0.98), while LA thickness also demonstrated moderate to high reliability (ICC: 0.75-0.98). CONCLUSION The results demonstrate the reliability of ultrasound in measuring key parameters, including LA thickness, distortion, and IRD in women with DRA during various exercises. As a non-invasive tool, it supports evidence-based interventions in postpartum recovery and clinical practice.
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Affiliation(s)
| | - Montserrat Rejano-Campo
- Grupo de Investigación Prehabilitación y Rehabilitación de las disfunciones del movimiento, rendimiento, participación y calidad de vida., Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad Fernando Pessoa Canarias, Santa Maria de la Guía, Las Palmas, Spain
- Group in Physiotherapy of the Aging Processes: Social and Healthcare Strategies, Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Fernando Domínguez-Navarro
- Group in Physiotherapy of the Aging Processes: Social and Healthcare Strategies, Department of Physiotherapy, University of Valencia, Valencia, Spain
| | | | - Laura Fuentes-Aparicio
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
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Wu WC, Wu WH, Lee MF, Wu PY, Tu YK, Lin H, Chan CY, Huang CY. Comparative Efficacy and Acceptability of Non-surgical Treatments with or without Exercise for Diastasis Recti Abdominis in Postpartum Women: A Network Meta-Analysis of Randomized Controlled Trials. Sports Med 2025; 55:937-951. [PMID: 39878918 DOI: 10.1007/s40279-025-02179-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2025] [Indexed: 01/31/2025]
Abstract
BACKGROUND Diastasis recti abdominis (DRA), commonly occurring in postpartum women, is not only an aesthetic issue but is also highly associated with functional impairments. Various conservative treatment modalities have been employed in clinical practice to alleviate DRA. However, the comparative efficacy of these non-surgical treatments for improving the inter-recti distance (IRD) remains to be determined. AIM This current network meta-analysis (NMA) aims to compare the efficacy and acceptability of different non-surgical treatments with or without exercise for improving DRA in postpartum women. METHODS This NMA adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ClinicalKey, Cochrane Library, CINAHL, Embase, PubMed, Web of Science, and ClinicalTrials.gov were systematically searched for randomized controlled trial (RCT) studies up to April 2024. The analysis included studies that met the following criteria: (1) postpartum women diagnosed with DRA defined as an IRD greater than 2 cm; (2) intervention: any non-surgical treatments for at least 2 weeks; (3) comparator: no-treatment control; and (4) outcome: changes in IRD and acceptability. The relative efficacy between the non-surgical treatments tested and the probability of treatments were evaluated. RESULTS Twenty-one RCTs comprising 1195 participants aged from 18 to 45 years old were included. The forest plot revealed that exercise coupling with neuromuscular electrical stimulation systems (NMES) [mean difference (MD) - 1.12 cm, 95% confidence interval (CI) - 1.66 to - 0.58], acupuncture (MD - 0.81 cm, 95% CI - 1.54 to - 0.08), corset (MD - 0.65 cm, 95% CI - 1.24 to - 0.06), and exercise alone (MD - 0.48 cm, 95% CI - 0.80 to - 0.16) led to significant reductions in IRD compared with control. Further, the treatment ranking indicated that the combination of NMES with exercise has the highest probability (91.0%) of being the best treatment for reducing IRD, followed by acupuncture with exercise (71.1%). Treatments combined with exercise demonstrated better rankings for reducing IRD than individual treatments without exercise. Acceptability did not significantly differ between the groups. LIMITATIONS AND IMPLICATIONS This NMA encountered limitations due to participant variability, differing measurement methods, and sparse data, necessitating careful interpretation of findings regarding postpartum DRA interventions. CONCLUSIONS This NMA suggests NMES combined with exercise as the best treatment tested for DRA in postpartum women. PROSPERO REGISTRATION CRD42024541345.
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Affiliation(s)
- Wen-Chieh Wu
- Department of Nutrition, China Medical University, Taichung, Taiwan
| | - Wen-Hong Wu
- Ma Kuang United Clinics of Traditional Chinese Medicine, Kaohsiung, Taiwan
| | - Ming-Fen Lee
- Department of Nutrition, China Medical University, Taichung, Taiwan
| | - Pei-Yu Wu
- Department of Nutrition, China Medical University, Taichung, Taiwan
| | - Yu-Kang Tu
- Institute of Health Data Analytics and Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Hsuan Lin
- MinYou Chinese Medicine Clinic, Kaohsiung, Taiwan
| | - Chien-Yi Chan
- Department of Nutrition and Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Chun-Yin Huang
- Department of Nutrition, China Medical University, Taichung, Taiwan.
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Davenport MH, Christopher S, Deering RE, Prevett C, Dufour S, Forte M, Beamish N, Adamo K, Bo K, Brockwell E, Brunet-Pagé É, Chari R, De Vivo M, Fleming K, Hassan A, Hayman M, Lane KN, Mottola MF, Neil-Sztramko SE, Santos-Rocha RA, Szumilewicz A, Ruchat SM. International Delphi study of clinical and exercise professionals' opinion of physical activity prescreening and contraindications for participating in postpartum physical activity. Br J Sports Med 2025; 59:527-538. [PMID: 40054885 PMCID: PMC12013588 DOI: 10.1136/bjsports-2024-109104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 02/20/2025] [Indexed: 04/02/2025]
Abstract
OBJECTIVE To establish expert consensus on prescreening and contraindications to moderate-to-vigorous intensity physical activity (MVPA) during the first year postpartum. METHODS A Delphi survey of clinical and exercise professionals working with postpartum women and people was conducted until consensus was reached (≥75% agreement). Round I consisted of questions about relative and absolute contraindications to MVPA. Rounds II and III included additional questions based on the thematic coding of open-ended responses from the previous rounds. The results were used to develop a postpartum MVPA preparticipation screening tool. RESULTS 120 participants completed round I, 105 completed round II and 95 completed round III. Consensus was reached in 46/49 (94%) statements. Twenty-four relative contraindications to MVPA were identified: (loss of consciousness; neurological symptoms; kidney disease; calf pain or swelling suggestive of deep vein thrombosis; severe abdominal pain; vaginal bleeding not associated with menses; postpartum cardiomyopathy; caesarean section with symptoms that worsen with MVPA; unstable hypertension; eating disorder; malnutrition; anaemia; excessive fatigue; fractures or other significant musculoskeletal injuries; haemodynamic instability; breathing difficulties; acute systemic infection accompanied by fever, body aches, or swollen lymph glands; the new onset of chest pain, discomfort, and other angina-like symptoms with exertion; dizziness or lightheadedness during MVPA; new symptoms of heart disease, stroke; and other medical or physical conditions that may affect the ability to be physically active. Key biopsychosocial barriers to MVPA were identified. CONCLUSION This Delphi study recommends relative contraindications to MVPA for the first year postpartum that were incorporated into a postpartum MVPA pre-participation screening tool the Get Active Questionnaire for Postpartum.
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Affiliation(s)
- Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Shefali Christopher
- Doctor of Physical Therapy Program, Department of Rehabilitation Sciences, Tufts University, Medford, Washington, USA
| | - Rita E Deering
- Department of Physical Therapy, Carroll University, Waukesha, Wisconsin, USA
| | - Christina Prevett
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Sinead Dufour
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Milena Forte
- Mount Sinai Hospital, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Beamish
- School of Kinesiology and Health Studies, Queen's University, Kingston, New York, Canada
| | - Kristi Adamo
- Prevention in the Early Years Lab, Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kari Bo
- Norwegian School of Sport Sciences, Department of Sports Medicine, Akershus University Hospital, Department of Obstetrics and Gynecology, Norwegian School of Sports Sciences, Oslo, Norway
- Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway
| | | | - Émilie Brunet-Pagé
- Department of Midwifery, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
| | - Radha Chari
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Marlize De Vivo
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
- The Active Pregnancy Foundation, Sheffield, UK
| | - Karen Fleming
- Department of Family & Community Medicine, University of Toronto, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Amal Hassan
- Kynisca Innovation Hub, Washington Spirit Soccer LLC, London, UK
| | - Melanie Hayman
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Kirstin N Lane
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Michelle F Mottola
- R. Samuel McLaughlin Foundation- Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children's Health Research Institute, The University of Western Ontario, London, Ontario, Canada
| | - Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence & Impact, National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Ontario, Canada
| | - Rita A Santos-Rocha
- ESDRM Sport Sciences School of Rio Maior, SPRINT Sport Physical Activity and Health Research & Innovation Center, Santarém Polytechnic University, Rio Maior, Portugal
- Neuromechanics of Human Movement Group, CIPER Interdisciplinary Centre for the Study of Human Performance, Cruz Quebrada, Portugal
| | - Anna Szumilewicz
- Department of Physical Culture, Gdansk University of Physical Education and Sport, Gdansk, Pomorskie, Poland
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Quebec, Canada
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Ruchat SM, Beamish N, Pellerin S, Usman M, Dufour S, Meyer S, Sivak A, Davenport MH. Impact of exercise on musculoskeletal pain and disability in the postpartum period: a systematic review and meta-analysis. Br J Sports Med 2025; 59:594-604. [PMID: 39922568 DOI: 10.1136/bjsports-2024-108488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2025] [Indexed: 02/10/2025]
Abstract
OBJECTIVE To examine the impact of exercise on musculoskeletal pain (low back pain (LBP), pelvic girdle pain (PGP), lumbopelvic pain (LBPP) and bodily pain) and kinesiophobia during the postpartum period. DESIGN Systematic review with random effects meta-analysis. STUDY ELIGIBILITY CRITERIA Online databases were searched from database inception to 12 January 2024. Studies of all designs (except case studies) of any publication date or language were included if they contained information on the population (women and people in the first year postpartum), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone ('exercise-only') or in combination with other interventions (eg, electrotherapy, infrared irradiation, ultrasound; 'exercise+cointervention')), comparator (no exercise or different exercise measures) and outcome (symptom severity of LBP/PGP/LBPP, related disability, bodily pain and kinesiophobia). RESULTS 37 studies (N=3769 participants) from 15 countries were included. Moderate certainty evidence showed that exercise-only interventions, including various strengthening exercises targeting the trunk muscles, were associated with a greater reduction in LBPP symptom severity (4 randomised controlled trials (RCTs), n=210; mean difference -2.21 points (on a 0-10 Visual Analogue Scale) 95% CI -3.33 to -1.08) and related disability (6 RCTs, n=296; standardised mean difference -1.17, 95% CI -1.92 to -0.43; large effect size) as compared with no exercise. Similar results were found for bodily pain (2 RCTs, n=318). Evidence was limited and inconclusive regarding the impact of exercise interventions on kinesiophobia. CONCLUSION Postnatal exercises, including a variety of muscular strengthening exercises targeting the trunk muscles, decrease the symptom severity of LBPP and related disability.
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Affiliation(s)
- Stephanie-May Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
| | - Nicole Beamish
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Sophie Pellerin
- University of Montreal Faculty of Medicine, Trois-Rivières, Quebec, Canada
| | - Muhammad Usman
- McMaster Evidence Review and Synthesis Centre and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Sinead Dufour
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Sarah Meyer
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Allison Sivak
- Geoffrey & Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
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Beamish NF, Davenport MH, Ali MU, Gervais MJ, Sjwed TN, Bains G, Sivak A, Deering RE, Ruchat SM. Impact of postpartum exercise on pelvic floor disorders and diastasis recti abdominis: a systematic review and meta-analysis. Br J Sports Med 2025; 59:562-575. [PMID: 39694630 PMCID: PMC12013572 DOI: 10.1136/bjsports-2024-108619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 11/07/2024] [Indexed: 12/20/2024]
Abstract
OBJECTIVE To examine the effect of exercise during the first year postpartum on pelvic floor disorders and diastasis recti abdominis. DESIGN Systematic review with random effects meta-analysis. DATA SOURCES MEDLINE, EMBASE, CINAHL, SPORTDiscuss, Evidence-Based Medicine Reviews (Ovid), Scopus, Web of Science and ClinicalTrials.gov were searched until 12 January 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies of all designs (except case studies) and languages were included if they contained information on the Population (individuals in the first year postpartum), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise alone ('exercise-only') or in combination with other intervention (eg, biofeedback; 'exercise+co-intervention')), Comparator (no exercise or different exercise measures) and Outcome (symptom severity and risk of urinary incontinence, anal incontinence, pelvic organ prolapse, diastasis recti abdominis and sexual function). RESULTS 65 studies (n=21 334 participants) from 24 countries were included. 'Moderate' certainty of evidence revealed that pelvic floor muscle training reduced the odds of urinary incontinence by 37% (seven randomised controlled trials (RCTs), n=1930; OR 0.63, 95% CI 0.41 to 0.97, I2 72%) and pelvic organ prolapse by 56% (one RCT, n=123; OR 0.44, 95% CI 0.21 to 0.91) compared with control groups. 'Low' certainty of evidence showed a greater reduction in inter-rectus distance measured at rest and during a head lift following abdominal muscle training compared with no exercise. Evidence on the effect of exercise on the risk of anal incontinence and diastasis recti abdominis, as well as the severity of anal incontinence, urinary incontinence, pelvic organ prolapse and sexual function, is limited. CONCLUSION Evidence supports the effectiveness of postpartum pelvic floor muscle training in reducing the odds of urinary incontinence and pelvic organ prolapse and postpartum abdominal exercise training in reducing inter-rectus distance. PROSPERO REGISTRATION NUMBER CRD42022359282.
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Affiliation(s)
- Nicole F Beamish
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Muhammad Usman Ali
- McMaster Evidence Review and Synthesis Centre and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Matthew J Gervais
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Talia Noel Sjwed
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Gyanjot Bains
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Allison Sivak
- Geoffrey & Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Rita E Deering
- Physical Therapy, Carroll University, Waukesha, Wisconsin, USA
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Quebec, Canada
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Pérez-Pascual P, Vegas-Sánchez E, Ortiz-Barahona S, García-Pérez-de-Sevilla G, García-Arrabé M, Jaén-Crespo G, González-de-la-Flor Á. Reliability of transversus abdominis thickness and inter-recti distance during forced expiration with limb adduction in primiparous women following vaginal delivery. BMC Pregnancy Childbirth 2025; 25:258. [PMID: 40057695 PMCID: PMC11889837 DOI: 10.1186/s12884-025-07374-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 02/24/2025] [Indexed: 05/13/2025] Open
Abstract
INTRODUCTION The postpartum period involves significant biomechanical changes that impact maternal health, particularly in the activation of the transversus abdominis (TrA) and the inter-recti distance (IRD), which may contribute to lumbo-pelvic pathologies. While lumbopelvic exercises are beneficial, it remains unclear whether upper or lower limb adduction combined with forced expiration is more effective in activating the TrA. Therefore, the primary objective of this study is to analyze changes in TrA thickness and IRD during four conditions. The secondary objective is to evaluate the intra-observer reliability of these ultrasound measurements. METHODS This cross-sectional study, conducted with a sample of 32 participants, assessed TrA thickness (primary outcome) and IRD (secondary outcome), quantified under four conditions: (1) resting position, (2) forced expiration, (3) forced expiration with upper limb adduction, and (4) forced expiration with lower limb adduction. Differences between the four conditions were analyzed using repeated measures ANOVA. The intra-observer reliability of these measurements was evaluated using intraclass correlation coefficients (ICC). RESULTS A total of 32 primiparous women between January and April 2024 were included in this study with a mean postpartum period of 9 ± 2.33. Significant variations in TrA thickness were observed across conditions (p < 0.001). Differences were noted between resting and forced expiration (MD = -0.17, p < 0.001) and forced expiration with lower limb adduction (MD = -0.20, p < 0.001) on both sides. For the right TrA, forced expiration differed from upper limb adduction (MD = -0.04, p = 0.007), while no difference was found between upper and lower limb adduction (MD = -0.005, p > 0.05). For IRD, no significant differences were detected across conditions, including resting and lower limb adduction (MD = -0.018, p = 0.727). Excellent intra-examiner reliability was demonstrated for all ultrasound measurements (ICC (1,3) 0.92-0.99). CONCLUSIONS There were no significant differences in TrA thickness between forced expiration isolated and when combined with adduction exercises. The high ICC values confirm the robustness of ultrasound measurements for TrA and IRD, highlighting the potential for future research in postpartum rehabilitation strategies.
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Affiliation(s)
- Patricia Pérez-Pascual
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, 28670, Spain
| | - Elena Vegas-Sánchez
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, 28670, Spain
| | - Sandra Ortiz-Barahona
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, 28670, Spain
| | - Guillermo García-Pérez-de-Sevilla
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, 28670, Spain
| | - María García-Arrabé
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, 28670, Spain.
| | - Gonzalo Jaén-Crespo
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, 28670, Spain
| | - Ángel González-de-la-Flor
- Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Villaviciosa de Odón, Madrid, 28670, Spain
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Soto-González M, Da Cuña-Carrera I, Lantarón-Caeiro EM, Pascoal AG. Effect of hypopressive and conventional abdominal exercises on postpartum diastasis recti: A randomized controlled trial. PLoS One 2024; 19:e0314274. [PMID: 39666696 PMCID: PMC11637234 DOI: 10.1371/journal.pone.0314274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 11/05/2024] [Indexed: 12/14/2024] Open
Abstract
BACKGROUND Diastasis recti abdominis (DRA) is the separation of the rectus abdominis muscles along the linea alba, often occurring during pregnancy due to hormonal and mechanical changes. While DRA usually resolves post-childbirth, some women experience persistent issues. Exercise may help reduce the inter-rectus distance, though more research is needed. OBJECTIVES Analyze the immediate and long-term effects of hypopressive and conventional abdominal exercises on inter-rectus distance (IRD) in postpartum women, focusing on parity differences. METHODS Twenty-eight women who met specific inclusion criteria were randomly assigned to either the hypopressive group (n = 14) or the conventional group (n = 14). The exercise programs for both groups lasted 6 weeks. Ultrasound measurements were taken of the IRD at two locations above the umbilicus, 2 cm (AB2) and 5 cm (AB5), before and after exercise programs. RESULTS The IRD decreased after both exercise programs compared to baseline measurements in AB2 (mean difference: 3.06 mm, 95% CI: 1.06 to 5.05) and in AB5 (mean difference: 2.88 mm, 95% CI: 1.59 to 4.17), confirming the long-term effect of exercise. No differences were found between the application of the conventional exercise program or the hypopressive exercises, indicating that both had a similar positive effect. Regarding the immediate effect, after the performance of both programs, the IRD was greater during rest compared to abdominal contraction. This effect was more pronounced at AB5 location (mean difference: 1.00mm, 95% CI: 0.97 to 1.89). Conventional exercises result in a reduction during resting condition (mean difference: 4.52mm, 95% CI: 2.62 to 6.79), whereas with hypopressive exercises, the reduction occurs during muscle contraction (mean difference: 3.43mm, 95% CI: 1.21 to 5.65). With regard to parity, multiparous women benefit most from the application of exercise programs. CONCLUSION A reduction in IRD has been achieved with the implementation of both exercise programs in postpartum women, with multiparous women benefiting the most. Specifically, at 5 cm above umbilicus, conventional exercises result in a reduction during the rest condition, whereas with hypopressive exercises, the reduction occurs during muscle contraction. TRIAL REGISTRATION Clinical trial registration: NCT05439668.
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Affiliation(s)
- Mercedes Soto-González
- Faculty of Physical Therapy, Department on Functional Biology and Health Science, University of Vigo, Pontevedra, Spain
- Galicia Sur Health Research Institute, Clinical Physiotherapy Group, Vigo, Spain
| | - Iria Da Cuña-Carrera
- Faculty of Physical Therapy, Department on Functional Biology and Health Science, University of Vigo, Pontevedra, Spain
- Galicia Sur Health Research Institute, Clinical Physiotherapy Group, Vigo, Spain
| | - Eva María Lantarón-Caeiro
- Faculty of Physical Therapy, Department on Functional Biology and Health Science, University of Vigo, Pontevedra, Spain
- Galicia Sur Health Research Institute, Clinical Physiotherapy Group, Vigo, Spain
| | - Augusto Gil Pascoal
- Faculty of Human Kinetics, Interdisciplinary Centre for the Study of Human Performance, Biomechanics and Functional Morphology Laboratory, University of Lisbon, Lisbon, Portugal
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Toprak Celenay S, Balaban M, Ozer Kaya D. Immediate effects of corrective exercise versus curl-up in women with diastasis recti abdominis. J Bodyw Mov Ther 2024; 40:1610-1614. [PMID: 39593499 DOI: 10.1016/j.jbmt.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/10/2024] [Accepted: 08/13/2024] [Indexed: 11/28/2024]
Abstract
BACKGROUND/AIM It is still unclear what types of exercise, beneficial to prevent and/or decrease diastasis recti abdominis (DRA). This study purposed to examine immediate effects of corrective exercise versus curl-up exercise on interrecti distance (IRD) and linea alba (LA) distortion in women with DRA. MATERIALS AND METHODS Twenty-three women with DRA were included. The IRD and the LA distortion (with distortion index formula) were measured with ultrasound imaging at rest, during curl-up and corrective exercise. RESULTS The IRD, measured at above and below umbilicus, and the distortion index were different between the measurements at rest, during curl up and correction exercise (p < 0.05). In corrective exercise, the change in the IRD at above umbilicus decreased more than rest (p = 0.009) and curl-up (p = 0.004). The change in the IRD at below umbilicus decreased more in corrective exercise than rest (p = 0.033) and curl-up (p = 0.028). The distortion index increased more in corrective exercise than rest (p = 0.006). The index increased more in curl-up than rest (p = 0.029). CONCLUSION The corrective exercise may be helpful in the treatment of DRA. Moreover, different muscle contractions that will provide the LA distortion should be taken into account in the treatment of DRA.
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Affiliation(s)
- Seyda Toprak Celenay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey.
| | - Mehtap Balaban
- Department of Radiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Derya Ozer Kaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
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A Abdel Hady D, Abd El-Hafeez T. Utilizing machine learning to analyze trunk movement patterns in women with postpartum low back pain. Sci Rep 2024; 14:18726. [PMID: 39134567 PMCID: PMC11319340 DOI: 10.1038/s41598-024-68798-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/29/2024] [Indexed: 08/15/2024] Open
Abstract
This paper presents an analysis of trunk movement in women with postnatal low back pain using machine learning techniques. The study aims to identify the most important features related to low back pain and to develop accurate models for predicting low back pain. Machine learning approaches showed promise for analyzing biomechanical factors related to postnatal low back pain (LBP). This study applied regression and classification algorithms to the trunk movement proposed dataset from 100 postpartum women, 50 with LBP and 50 without. The Optimized optuna Regressor achieved the best regression performance with a mean squared error (MSE) of 0.000273, mean absolute error (MAE) of 0.0039, and R2 score of 0.9968. In classification, the Basic CNN and Random Forest Classifier both attained near-perfect accuracy of 1.0, the area under the receiver operating characteristic curve (AUC) of 1.0, precision of 1.0, recall of 1.0, and F1-score of 1.0, outperforming other models. Key predictive features included pain (correlation of -0.732 with flexion range of motion), range of motion measures (flexion and extension correlation of 0.662), and average movements (correlation of 0.957 with flexion). Feature selection consistently identified pain, flexion, extension, lateral flexion, and average movement as influential across methods. While limited to this initial dataset and constrained by generalizability, machine learning offered quantitative insight. Models accurately regressed (MSE < 0.01, R2 > 0.95) and classified (accuracy > 0.94) trunk biomechanics distinguishing LBP. Incorporating additional demographic, clinical, and patient-reported factors may enhance individualized risk prediction and treatment personalization. This preliminary application of advanced analytics supported machine learning's potential utility for both LBP risk determination and outcome improvement. This study provides valuable insights into the use of machine learning techniques for analyzing trunk movement in women with postnatal low back pain and can potentially inform the development of more effective treatments.Trial registration: The trial was designed as an observational and cross-section study. The study was approved by the Ethical Committee in Deraya University, Faculty of Pharmacy, (No: 10/2023). According to the ethical standards of the Declaration of Helsinki. This study complies with the principles of human research. Each patient signed a written consent form after being given a thorough description of the trial. The study was conducted at the outpatient clinic from February 2023 till June 30, 2023.
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Affiliation(s)
- Doaa A Abdel Hady
- Department of Physical Therapy for Women's Health, Faculty of Physiotherapy, Deraya University, EL-Minia, Egypt.
| | - Tarek Abd El-Hafeez
- Department of Computer Science, Faculty of Science, Minia University, EL-Minia, Egypt.
- Computer Science Unit, Deraya University, EL-Minia, Egypt.
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Afzal U, Saeed Q, Anwar MN, Pervaiz S, Shahid M, Javed R, Ali MU, Lee SW. Comparison of Health Parameters in Postpartum Diastasis Recti: A Randomized Control Trial of SEMG Biofeedback-Assisted Core Strengthening Exercises with Kinesiotaping vs. Non-Assisted Exercises. Healthcare (Basel) 2024; 12:1567. [PMID: 39201126 PMCID: PMC11354019 DOI: 10.3390/healthcare12161567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 07/30/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
Current medical treatments for diastasis recti often involve exercises to strengthen the core muscles, along with abdominal binders or supports. However, there is limited evidence comparing the effectiveness of surface electromyography (SEMG) biofeedback-assisted core strengthening exercises combined with kinesiotaping to other approaches. This study aimed to assess the impact of three interventions on core strength, inter-rectus distance, and quality of life in postpartum women with diastasis recti. The interventions included core strengthening exercises with kinesiotaping and SEMG biofeedback-assisted core strengthening with kinesiotaping. This randomized controlled trial (NCT05897255) included 24 postpartum women divided into three groups. We measured inter-rectus distance, quality of life using the Short Form Health Survey 36, and core strength using the McGill torso battery test. The SEMG biofeedback provided auditory and visual cues. We used one-way analysis of variance to compare outcomes between groups, while a t-test for within-group analysis. Both the SEMG biofeedback-assisted and non-assisted core strengthening exercises with kinesiotaping groups showed significantly greater improvements in energy, bodily pain, general health, physical functioning, and limitations due to physical problems than the core strengthening group. Additionally, the SEMG biofeedback-assisted group demonstrated a greater reduction in inter-rectus distance. There were no statistically significant differences in core strength improvement among the three groups. Core strengthening exercises with SEMG-assisted kinesiotaping were superior to core strengthening alone in reducing inter-rectus distance, enhancing physical function, energy levels, and general health, and decreasing bodily pain and limitations due to physical problems. Core strength improvements were similar across all groups.
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Affiliation(s)
- Ujala Afzal
- Foundation University College of Physical Therapy, Foundation University Islamabad, Islamabad 44000, Pakistan; (U.A.); (Q.S.); (S.P.); (M.S.); (R.J.)
| | - Quratulain Saeed
- Foundation University College of Physical Therapy, Foundation University Islamabad, Islamabad 44000, Pakistan; (U.A.); (Q.S.); (S.P.); (M.S.); (R.J.)
- School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan;
| | - Muhammad Nabeel Anwar
- School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan;
| | - Sanna Pervaiz
- Foundation University College of Physical Therapy, Foundation University Islamabad, Islamabad 44000, Pakistan; (U.A.); (Q.S.); (S.P.); (M.S.); (R.J.)
- School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan;
| | - Manahil Shahid
- Foundation University College of Physical Therapy, Foundation University Islamabad, Islamabad 44000, Pakistan; (U.A.); (Q.S.); (S.P.); (M.S.); (R.J.)
| | - Rimsha Javed
- Foundation University College of Physical Therapy, Foundation University Islamabad, Islamabad 44000, Pakistan; (U.A.); (Q.S.); (S.P.); (M.S.); (R.J.)
| | - Muhammad Umair Ali
- Department of Artificial Intelligence and Robotics, Sejong University, Seoul 05006, Republic of Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, Republic of Korea
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Theodorsen NM, Bø K, Fersum KV, Haukenes I, Moe-Nilssen R. Pregnant women may exercise both abdominal and pelvic floor muscles during pregnancy without increasing the diastasis recti abdominis: a randomised trial. J Physiother 2024; 70:142-148. [PMID: 38472049 DOI: 10.1016/j.jphys.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/15/2024] [Accepted: 02/07/2024] [Indexed: 03/14/2024] Open
Abstract
QUESTION What is the effect of a 12-week abdominal and pelvic floor muscle exercise program during pregnancy on the inter-recti distance (IRD) in women with diastasis recti abdominis immediately after the 12-week intervention period and at follow-up 6 weeks postpartum? DESIGN An exploratory, parallel-group, randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS Ninety-six pregnant women aged ≥ 18 years, either primigravida or multigravida, in gestation week 24 with an IRD of ≥ 28 mm measured at rest and/or a protrusion on initial assessment. INTERVENTION The experimental group participated in a 12-week abdominal and pelvic floor muscle exercise program during pregnancy. The control group received no intervention. OUTCOME MEASURES Change (mm) in IRD 2 cm above and below the umbilicus at rest from pre-intervention to immediately post-intervention and to 6 weeks follow-up measured with ultrasonography. RESULTS The IRD increased for both groups from baseline to immediately after the intervention and decreased from after the intervention to the follow-up at 6 weeks postpartum. The IRD was smallest for both groups at the follow-up. At 2 cm above the umbilicus, the intervention effect was 2 mm (95% CI -2 to 7) immediately after the intervention and -1 mm (95% CI -4 to 3) at follow-up. At 2 cm below the umbilicus, the intervention effect was -5 mm (95% CI -10 to 0) immediately after the intervention and 0 mm (95% CI -4 to 4) at follow-up. CONCLUSION Abdominal and pelvic floor muscle training during pregnancy have a negligible effect on the IRD immediately after 12 weeks of intervention and at 6 weeks post-partum. REGISTRATION NCT04960800.
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Affiliation(s)
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway; Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway
| | - Kjartan Vibe Fersum
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Inger Haukenes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rolf Moe-Nilssen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Christopher SM, Donnelly G, Brockwell E, Bo K, Davenport MH, De Vivo M, Dufour S, Forner L, Mills H, Moore IS, Olson A, Deering RE. Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement. Br J Sports Med 2024; 58:299-312. [PMID: 38148108 DOI: 10.1136/bjsports-2023-107489] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/28/2023]
Abstract
Female athletes have identified a lack of guidance as a barrier to successfully returning to running postpartum, and existing guidelines are vague. Our aim was to define the current practice of determining postpartum run-readiness through a consensus survey of international clinicians and exercise professionals in postpartum exercise to assist clinicians and inform sport policy changes.A three-round Delphi approach was used to gain international consensus from clinicians and exercise professionals on run-readiness postpartum. Professionals who work with postpartum runners participated in an online survey to answer open-ended questions about the following postpartum return-to-running topics: definitions (runner and postpartum), key biopsychosocial milestones that runners need to meet, recommended screening, timeline to initiate running, support items, education topics and factors that contribute to advising against running. Consensus was defined as ≥75% participant agreement.One hundred and eighteen professionals participated in round I, 107 participated in round II (response rate 90.6%) and 95 participated in round III (response rate 80.5%). Responses indicated that, following a minimum 3-week period of rest and recovery, an individualised timeline and gradual return to running progression can be considered. Screening for medical and psychological concerns, current physical capacity, and prior training history is recommended prior to a return to running.This study proposes recommendations for the initial guidance on return-to-running postpartum, framed in the context of current research and consensus from professionals. Future research is needed to strengthen and validate specific recommendations and develop guidelines for best practice when returning-to-running after childbirth.
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Affiliation(s)
- Shefali Mathur Christopher
- Department of Rehabilitation Sciences, Doctor of Physical Therapy, Tufts University, Seattle, Washington, USA
- Elon University, Elon, North Carolina, USA
| | - Gráinne Donnelly
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Kari Bo
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lorenskog, Norway
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Marlize De Vivo
- Perinatal Physical Activity Research Group, School of Psychology and Life Sciences, Section of Sport, Exercise and Rehabilitation Science, Canterbury Christ Church University, Canterbury, UK
- Active Pregnancy Foundation, None, UK
| | - Sinead Dufour
- The World of my Baby (WOMB), Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Lori Forner
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Hayley Mills
- Perinatal Physical Activity Research Group, School of Psychology and Life Sciences, Section of Sport, Exercise and Rehabilitation Science, Canterbury Christ Church University, Canterbury, UK
| | - Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Rita E Deering
- Department of Physical Therapy, Carroll University, Waukesha, Wisconsin, USA
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Chen B, Zhao X, Hu Y. Rehabilitations for maternal diastasis recti abdominis: An update on therapeutic directions. Heliyon 2023; 9:e20956. [PMID: 37867827 PMCID: PMC10589864 DOI: 10.1016/j.heliyon.2023.e20956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
Diastasis recti abdominis (DRA) affects a significant number of postpartum women, while its treatments are still under debate. This study aimed to systematically evaluate the effectiveness of rehabilitation training programs for postpartum DRA treatment. Four databases were systematically searched to identify eligible studies published up to February 1, 2023. We followed the PRISMA for scoping reviews guideline in this study. The characteristics and the main findings of the included studies were extracted. Sixteen studies enrolling 1129 women during the ante- and/or postnatal period were included. The common rehabilitation training for DRA included physical exercise, non-exercise physical therapy, acupuncture, and electrotherapy. The presence of DRA could be diagnosed by ultrasound, caliper, or palpation, of which ultrasound had the best reliability. Besides, these assessments could also be used for evaluating the therapeutic efficacy after the rehabilitation training programs. Several studies concluded that patients with DRA could be effectively improved by specific interventions. But a few included studies revealed rehabilitation training might be not more effective than no interventions when treating DRA. For example, some investigators did not recommend physical exercise for DRA patients due to this intervention during pregnancy kept the linea alba less stressed by maintaining abdominal tone, strength, and control, and therefore might aggravate DRA. However, it should be noted that this evidence was derived from limited studies (16/60, 27 % papers) with small samples. To some extent, women with postpartum DRA can benefit from the specific rehabilitation regimen by alleviating postpartum inter-rectus distance. Further research is still warranted to propose strategies for improving postpartum DRA.
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Affiliation(s)
- Beibei Chen
- Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou 310008, Zhejiang, China
| | - Xiumin Zhao
- Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou 310008, Zhejiang, China
| | - Yan Hu
- Department of Obstetrics and Gynecology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang, China
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