C0102 Diastasis recti changes during abdomini wall work in low back pain subject at long postpartum. a case report

Abstract

Background Lumbar stabilisation training has been described to be the best option for those with spondylolysis and spondylolisthesis, posterior pelvic pain associated with pregnancy, chronic low back pain (LBP). Rehabilitation strategies aiming to restore muscle function in individuals with these types of pathology include a training of the abdominal wall muscles to decrease pain, disability and the recurrence of LBP by reducing stress on the affected structures. Inter-recti distance (IRD) may reflect a weaknes of abdominal wall muscles which spans the linea alba (LA). Integrity of the anterior abdominal wall, including the LA, is an important component of lumbopelvic stability. However, every subject may present a different abdominal activation. Chiarello et al, described in parous women that IRD decreased from rest to curl-up. So IRD should be measured at rest and during contraction prior to initiating any abdominal exercise to ensure that IRD does not increase with contraction. Objective To describe the need of using ultrasound imaging while working abdominal wall with a subject with LBP. Methods Case report a 32 year-old woman at long postpartum (3 years ago) presents chonic LBP. Physical therapy assesment and treatment were monitorized while performing different exercises. A Logic P9 ultrasound scanner (GE Medical Systems Ultrasound. Hatfield, Hertfordshire, UK), with a ML6–15 linear probe (55 mm footprint) was used. The image was frozen and then downloaded to a computer. After the abdominal palpation, ultrasound images were taken at the same locations 2 cm above umbilical to obtain RA’s image. Physical therapists recorded the values with the subject relax and supine position, two measurements were taken in rest supine, lateral and plank positions recording RA thickness and the IRD. The subject was then asked to perform a RA contraction, transversus contraction, transversus plus leg levation and core exercises. The measurements were registered at every exercise and relaxed. The mean of two measurements were recorded. After 2 min rest, the procedure was repeated by the second physical therapist. Results The DRA increased when performing RA, transversus abdomini contraction and transversus plus leg levation. The DRA decreased when lateral core exercises were performed. Conclusions This case shows the importance of ultrasound assessment while working abdominal wall for and individualised treatment. More studies with a RCT design should be done to support this results.