Inter-recti Distance Research Articles

Effect of Exercise on Inter-Recti Distance and Associated Low Back Pain Among Post-Partum Females: A Randomized Controlled Trial.

Objective: This study aimed to emphasize facilitation training and strengthening of abdominal and core muscles in improving the inter-recti distance (IRD) and associated low back pain (LBP) among young postpartum females. Materials and methods: A single-blinded randomized controlled trial, among forty young postpartum females, was conducted at a community health center. The females were divided into two equal groups through the envelope method where Group A received abdominal crunch training protocol whereas group B received double straight leg raise (DSLR) exercise protocol for 6 weeks and pre and post IRD and Oswestry disability index (ODI) scores were recorded. Results: Group A showed improvement in IRD with a mean difference of 1.95±0.4 whereas in group B it was found to be 2.85±0.35 when assessed through finger palpation method. The mean difference of IRD, when measured through digital nylon caliper method in abdominal crunch and DSLR exercise group was 4.06±0.74 and 1.2±0.49 respectively. Moreover, ODI scores of group A were 2.70±1.05 whereas, group B scores were found to be 1.1±0.06 showing that LBP reduced in participants who performed abdominal crunch exercise. Conclusion: This study reveals that 6 weeks of exercise protocol was observed to be effective in the management of DRA. Thus, abdominal crunch exercise seemed to produce promising results in a reduction of IRD and associated LBP.

The prevalence and consequences of abdominal rectus muscle diastasis among Finnish women: an epidemiological cohort study

PurposePost-pregnancy abdominal rectus diastasis (ARD) has raised attention in the field of surgery in recent years, but there is no consensus about when to consider surgery. Our aim was to find out what is the normal inter-rectus distance in fertile aged, female population in Finland and to examine whether there is a linea alba width that would predispose to diastasis-related problems after pregnancy.MethodsFor this prospective cohort study, women participating early pregnancy ultrasound in Helsinki University Hospital Department of Obstetrics and Gynecology during 1.1.2018–8.3.2019, were recruited. The width of linea alba was measured by ultrasound during the early pregnancy ultrasound. Symptoms were measured by questionnaire including Health-Related Quality of Life (RAND-36) and Oswestry Disability Index for back symptoms and disability.ResultsLinea alba width was measured in total of 933 women. The average inter-rectus distance (IRD) among nulliparous women was 1.81 ± 0.72 cm. After one previous pregnancy, the average linea alba width was 2.36 cm ± 0.83 cm and after more pregnancies 2.55 ± 1.09 cm. There was a positive correlation between previous pregnancies and the increased linea alba width (p = 0.00004). We did not perceive any threshold value of linea alba width that would predispose to back pain or movement control problems in this cohort, in which severe diastasis (over 5 cm) was rare.ConclusionMean inter-rectus distance in parous population exceeds stated normative values. Moderate ARD (3.0–5.0 cm) alone does not seem to explain low back pain or functional disability in population level. Severe post-pregnancy diastasis (over 5.0 cm) is rare.

Efficacy of a Core Strengthening Program for Diastasis Rectus Abdominis in Postpartum Women: A Prospective Observational Study

Background: Diastasis rectus abdominis (DRA) is characterized by a widening between the rectus abdominis muscles and thinning of the linea alba. It is common during pregnancy and may contribute to postpartum low back pain (LBP) and stress urinary incontinence (SUI). Core strengthening is thought to improve DRA, but there is no widely accepted exercise program. Objectives: To assess changes in interrectus distance (IRD) and participant-reported outcomes (PROs) after an online core strengthening program in postpartum women with DRA. Study Design: Prospective observational study. Methods: Forty-three postpartum women (36.7 ± 3.5 years) with DRA, which was diagnosed as an IRD 2.0 cm or more using musculoskeletal ultrasound, participated in a 12-week online core strengthening program focused on daily transversus abdominis activation with coordinated breathing and pelvic floor muscle engagement. IRD and PROs were assessed at baseline and 12 weeks. A subset of 19 women participated in an additional 12-week maintenance phase, and outcomes assessments were performed at 24 weeks. Results: The 12-week online core strengthening program significantly decreased IRD above and below the umbilicus at rest (slope [95% confidence interval]: −0.56 [−0.74, −0.38] and −0.26 [−0.45, −0.06]; P < .001 and P = .009, respectively) and below the umbilicus during contraction (−0.39 [−0.58, −0.20]; P < .001). Improvements in LBP-related disability (P = .002) and SUI (P = .001) were also observed. Participation in the maintenance phase significantly improved IRD at 24 weeks compared with 12 weeks (P < .0125). Satisfaction averaged 7.43 ± 2.23. Conclusions: The 12-week online core strengthening program reduced IRD and improved LBP-related disability and SUI. Program participation for 12 additional weeks further reduced IRD. These results suggest that the online core strengthening program can be used in postpartum women with DRA.

Diagnostic techniques for diastasis recti

Diastasis recti (DR) is an abnormality of the anterior abdominal wall, characterized by a separation of the rectus abdominis muscles along the linea alba. A thorough history and physical exam can diagnose most cases of diastasis recti. Classification schemes for diastasis recti have been created based on inter-rectus distance and location of the defect, which can help with management decisions. Imaging modalities such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) can aid in the classification of diastasis recti and guide surgical planning. Planning is most important when contemplating the plan of care for the repair of hernias within a rectus diastasis.

Effect of Abdominal Physiotherapy in Reduction of Inter Recti Distance in Postpartum Females

Aim: To see the effect of abdominal exercises in the recovery of diastasis recti in post natal females. Methodology: A Quasi Experimental study design was used to enroll 40 participants from OPD of Gynecology and Obstetrics from a Tertiary Care Hospital Lahore between ages ranged from 18 to 30 years. Using purposive sampling all postpartum females having diastasis of rectus abdominis muscles with inter recti distance more than 2 fingers width were enrolled. All the study participants received abdominal muscle exercises program for 30 min a day in 8 week program. inter recti distance was measured by using two finger palpation method. All the pre intervention and post intervention data were recorded into a short structured proforma.Results were considered significant for p value ≤ 0.05. Results: 40 participants were selected in this study with an age from 18- 30 years. The inter recti distance was significantly reduced as p value was ≤ 0.05 for both (above umbilicus and below umbilicus) groups. Conclusion: It was observed that abdominal exercises helped in the recovery of diastasis and reduced the separation between the muscles in postpartum women. It also enlightens the importance of the prescription of physiotherapy in reduction of post partum complications. Keywords: Abdominal Exercises, Diastasis Recti, Pregnancy, Postnatal period,

Muscle elasticity is different in individuals with diastasis recti abdominis than healthy volunteers

ObjectiveTo determine the value of shear wave elastography (SWE) in assessing abdominal wall muscles, including rectus abdominis (RA), external oblique muscle (EO), internal oblique muscle, and transversus abdominis (TrA) in patients with diastasis recti abdominis (DRA) and healthy controls.MethodsFrom October 2018 to December 2019, 36 postpartum DRA patients and 24 nulliparous healthy women were identified. Inter-rectus distance (IRD) measurements were taken by B-mode ultrasound. Shear wave speed (SWS) values were acquired by one operator at ten specific locations. Clinical and ultrasound variables, including demographics, IRD, muscle thickness, and muscle SWS, were compared between the two groups using Student’s t test or Fisher's exact test. Pearson correlation analyses were conducted for the variables of IRD, muscle thickness, and SWS in the 36 DRA patients.ResultsThe maximum diameter of recti abdominus separation was located at the umbilicus in DRA patients (4.59 ± 1.14 cm). The SWS value was significantly lower in the RA (p = 0.003) and higher in the TrA muscle (p < 0.001) in DRA patients compared with the age-matched controls. However, SWS in both muscles (RA and TrA) showed a statistically positive correlation with IRD (p < 0.05). In addition, the SWS value in EO statistically decreased in DRA patients compared with the healthy controls (1.65 ± 0.15 vs. 1.79 ± 0.14, p = 0.001).ConclusionsThe application of SWE to abdominal wall muscles in DRA patients is feasible. The correlation between SWS value and IRD in RA should be interpreted with caution.

Exercises, Tubigrip and taping: can they reduce rectus abdominis diastasis measured three weeks post-partum?

BackgroundRectus abdominis diastasis is regarded as a risk factor for abdominal muscle dysfunction and reduced quality of life postpartum. It is thought that specific exercises and additional physical support might reduce the diastasis, with a need to establish efficacy in doing so. ObjectivesDetermine the effect of four abdominal exercises as well as Tubigrip or taping in reducing rectus abdominis diastases three weeks postpartum. DesignCross-sectional repeated measures comparison. Methods32 women undertook a single session of ultrasound imaging. Ultrasound measurements of inter-rectus distance were taken at rest and during: 1) crook lying abdominal “drawing in” exercise; 2) crook lying trunk curl-up; 3) early Sahrmann level leg raise; 4) McGill side lying plank. The curl-up and abdominal “drawing in” exercises were assessed under two further conditions: a) wearing Tubigrip, b) taping across the diastasis. Data analyses involved repeated measures ANOVA. ResultsAt rest the mean inter-rectus distance above and below the umbilicus was 3.5 cm (SD:1.1) and 2.6 cm (SD:1.2) respectively. A significant decrease (19%, p < 0.05) was observed at both measurement points during the curl-up exercise. No other exercises elicited a significant difference compared to resting. At rest, wearing Tubigrip reduced the inter-rectus distance (7%, p < 0.05). During exercise, there was no additional change in the inter-rectus distance (p > 0.05) with supports. ConclusionThe curl-up exercise was most effective in reducing inter-rectus distance. As no exercises invoked an increase in the rectus diastasis, they could not be regarded as potentially detrimental. Tubigrip and taping did not add to the effects of these exercises.

A new minimally invasive technique for the repair of diastasis recti: a pilot study

BackgroundDiastasis recti is an abdominal wall defect that occurs frequently in women during pregnancy. Patients with diastasis can experience lower back pain, uro-gynecological symptoms, and discomfort at the level of the defect. Diastasis recti is diagnosed when the inter-rectus distance is > 2 cm. Several techniques, including both minimally invasive and open access surgical treatment, are available. Abdominoplasty with plication of the anterior rectus sheath is the most commonly used, with the major limitation of requiring a wide skin incision. The new technique we propose is a modification of Costa’s technique that combines Rives–Stoppa principles and minimally invasive access using a surgical stapler to plicate the posterior sheaths of the recti abdominis.MethodsIt is a fully laparoscopic technique. The pneumoperitoneum is induced from a sovrapubic trocar, placed using an open access technique. The posterior rectus sheath is dissected from the rectus muscle using a blunt dissector to create a virtual cavity. The posterior sheets of the recti muscles are plicated using an endo-stapler. A mesh is then placed in the retromuscular space on top of the posterior sheet without any fixation. Using a clinical questionnaire, we analyzed the outcomes in 74 patients who underwent minimally invasive repair for diastasis of the rectus abdominis sheath.ResultsSeventy-four patients (9 men and 65 women) were treated using this technique. Follow-up was started two months after surgery. All procedures were conducted successfully. There were no major complications or readmissions. No postoperative infections were reported. There were two recurrences after six months. There was a significant reduction in symptoms.ConclusionsThis new method is feasible and has achieved promising results, even though a longer follow-up is needed to objectively assess this technique.

Predictors of Disability Attributed to Symptoms of Increased Interrecti Distance in Women after Childbirth: An Observational Study.

ObjectiveThe purpose of this study was to investigate how various physical and psychological factors are linked to disability attributed to symptoms from increased interrecti distance (IRD) in women after childbirth.MethodsIn this cross-sectional observational study, 141 women with an IRD of at least 2 finger-widths and whose youngest child was between the ages of 1 and 8 years participated. A multiple linear regression model was performed, with disability as the outcome variable and fear-avoidance beliefs, emotional distress, body mass index, lumbopelvic pain, IRD, and physical activity level as predictor variables.ResultsThe regression model accounted for 60% (R2 = 0.604, adjusted R2 = 0.586) of the variance in disability (F6,132 = 33.5). The 2 strongest predictors were lumbopelvic pain, with a regression coefficient of 1.4 (95% CI = 1.017 to 1.877), and fear avoidance, with a regression coefficient of 0.421 (95% CI = 0.287 to 0.555). The actual IRD, with a regression coefficient of −0.133 (95% CI = −1.154 to 0.888), did not contribute significantly to the variation in disability.ConclusionDisability attributed to symptoms from an increased IRD is explained primarily by the level of lumbopelvic pain but also by the degree of fear-avoidance beliefs and emotional distress.ImpactThis study highlights pain intensity and psychological factors as crucial factors for understanding disability attributed to increased IRD.

The relationship of severity in diastasis recti abdominis and pelvic floor dysfunction: a retrospective cohort study

BackgroundDiastasis of rectus abdominis (DRA) refers to a separation of the rectus abdominis from the linea alba. This study aimed to investigate the association with the severity of DRA for developing pelvic floor dysfunction among women during the first year postpartum.MethodsThis is a retrospective cohort study which collected data from 229 postpartum women. DRA was defined as a separation of ≥ 20 mm at any point 4.5 cm above, at and 4.5 cm below the umbilicus. The data for analysis includes pelvic organ prolapse quantification (POP-Q), medical history of urinary incontinence (UI), the strength of rectus abdominis muscle and pelvic floor muscle. The differences in women with and without DRA were compared with independent samples t-test and Chi-square test.ResultsPrevalence of DRA was 82.6% during the first postpartum year. Cesarean section and multiple parturitions are recognized as risk factors for DRA due to the odds ratio in our study were 3.48 (95% CI 1.42–8.56), 3.20 (95% CI 1.59–6.45) respectively. There was no difference in the occurrence of UI and pelvic organ prolapse (POP) comparing women with and without DRA, even changing the cut-off values (inter-rectus distance = 20 mm, 30 mm, 40 mm, 50 mm) for determining DRA. The women with weak rectus abdominis muscle and pelvic floor muscle have no statistical difference in two group.ConclusionThe relationship of the diastasis recti abdominis and pelvic floor dysfunction has no connection, even with the severity of inter-rectus distance increasing.

The ultrasound diagnostic criteria for diastasis recti and its correlation with pelvic floor dysfunction in early postpartum women.

There has been a long-standing controversy about diastasis recti diagnostic criteria and its relation to pelvic floor dysfunction (PFD). This study aimed to establish ultrasound diagnostic criteria for diastasis recti and investigate the correlation between it and PFD in early postpartum females. The inter-rectus distance (IRD) was measured at 3 locations in 116 healthy nulliparous females and 108 postpartum females. At the same time, they remained relaxed and then maintained a head-lift posture. The measurement for the 90th percentile was used to define the normal IRD in the nulliparous group. Afterward, the 108 postpartum females underwent an ultrasonographic examination of pelvic floor function. The correlations of these values with the IRD were then examined. We established the following ultrasonographic diagnostic criteria for diastasis recti: an IRD of >2 mm at 3 cm below the umbilicus, >20 mm at the umbilicus, and >14 mm at 3 cm above the umbilicus. The IRD was positively correlated with body mass index (BMI) in the nulliparous group (r=0.286, P<0.01) and with age in the postpartum group (r=0.230, P<0.05). The IRD was not relative to either the PFD ultrasound results or the clinical symptoms. We established a set of ultrasonographic diagnostic criteria for diastasis recti at 3 locations along the umbilicus. There is no clear correlation between diastasis recti and PFD in early postpartum females.

561 The effect of a postpartum diastasis rectus strengthening program

Diastasis rectus abdominis (DRA) is a separation of the abdominal wall that often occurs in pregnancy, including up to 60% of postpartum women. Several studies have shown core strengthening improved DRA, but there is no widely accepted exercise program directed at this condition. Our objective was to determine the effect of a core strengthening program on inter-rectus distance (IRD) in postpartum women diagnosed with diastasis rectus abdominis (DRA). We conducted a prospective non-randomized trial in which forty healthy, non-pregnant women who were 3-36 weeks postpartum were consecutively assigned to Group A (19) or Group B (21). DRA was diagnosed as an IRD ≥ 2.0cm on ultrasound. Group A participated in the online core training program for 12 weeks followed by a maintenance phase for 12 weeks, while Group B participated in the initial 12 weeks training program only. A single investigator performed all ultrasound measurements, and participants were asked to forgo all exercises outside of the program for its duration until final measurements were collected. The 12 week core strengthening program significantly decreased IRD above and below the umbilicus at rest (-0.57cm; p<0.001, -0.31; p=0.004, respectively), and below the umbilicus during contraction (-0.4cm; p<0.001). Significant improvements in stress urinary incontinence (SUI) p=0.002 and lower back pain (LBP) p=0.027 were also observed in both groups. Group A had significantly lower IRD at 24 weeks (2.79cm) compared to 12 weeks (1.95cm). The online 12-week core strengthening program reduced IRD, and improved SUI and LBP. Participation for an additional 12 weeks resulted in further IRD reduction. These results suggest that a core strengthening program is effective and safe at reducing IRD, and that continuation for 24 weeks further improves DRA.

Correlates of Inter-Rectus Distance in Nigerian Parous Women

ABSTRACT Background: Diastasis Recti Abdominis (DRA) or increased inter-rectus distance (IRD) is among the most common pregnancy-related physical disorders in women. Studies are scarce on its correlates in an African population. Objectives: The aim of this study was to determine anthropometric and maternal correlates of DRA in Nigerian parous women. Materials and Methods: Eighty nine (89) consenting parous women (20–45 years) participated in this observational study. The IRD was measured with an electronic digital caliper at the umbilical level alongside other anthropometric measurements (weight, height, waist circumference (WC), hip circumference (HC)). Information on participants’ age, mode of delivery (MOD), parity, and age of last child (AOLC) was obtained. Data were analyzed with descriptive statistics and inferential statistics of Pearson’s and Spearman’s rank correlations, respectively, with subsequent linear regression analysis at an alpha level of P &lt; 0.05. Results: The IRD significantly correlated with WC (r= 0.213, P = 0.045) and waist-to-hip ratio (WHR), (r = 0.357, P = 0.001). Significant regression equations were determined for the prediction of IRD based on WC and WHR. However, the other variables studied showed no significant (P &gt; 0.05) correlation with IRD. Conclusion: WC and WHR are predictors of IRD in parous women, and these should be considered as important variables in the management of DRA associated with pregnancy.

The relationship between diastasis rectus abdominus, pelvic floor trauma and function in primiparous women postpartum.

A functional interaction exists between the pelvic floor and the abdominal wall. The study was aimed at investigating the clinical and morphological relationships between diastasis rectus abdominus (DRA) and pelvic floor trauma in primiparous women. Eighteen women suffering from DRA and 18 women without DRA (non-DRA group), all primiparous with pelvic floor trauma, were enrolled in the study. Ultrasound was performed on the 36 women examining the inter-rectus distance, pelvic floor morphology, abdominal muscle force (MMT), Static Abdominal Flexion Endurance Test (SFET), and Dynamic Abdominal Flexion Endurance Test (DFET), abdominal circumference, visual analog scale, and responses to the Oswestry Low Back Pain Questionnaire and the Pelvic Floor Distress Inventory questionnaire (PFDI). A significant increase in the urinary symptoms portion of the in PFDI-20 questionnaire was found in the DRA group (non-DRA = 12.5 ± 22.8, DRA = 26.8 ± 18.2, p = 0.01). A significant reduction in abdominal force and endurance was observed in the DRA2-3 group compared with the DRA0-1 group (0.025 < p < 0.04). DFET (average repetitions) in the DRA0-1 group measured 13.4 ± 11.8 and 6.46 ± 4.59 in the DRA2-3 group (p = 0.025). SFET was 20.48 ± 14.46s in the DRA0-1 group and 10.62 ± 10.6s in the DRA2-3 group (p = 0.031). MMT was 4 in the DRA0-1 group and 3 in the DRA2-3 group (p = 0.04). Diastasis rectus abdominus does not correlate with morphological changes in the pelvic floor, but does correlate with higher scores in the urinary symptoms portion of the PFDI-20. Women suffering from DRA do not endure more pain or greater lumbar disability than non-DRA women. In extended DRA, the abdominal muscles are significantly compromised and weaker.

Intra-rater reliability of measurement of abdominal perimuscular connective tissue thickness on ultrasound images.

[Purpose] The thickness of the perimuscular connective tissue (PMCT) reflects muscular atrophy and decreased flexibility that may cause low back pain. However, few studies have used ultrasound imaging to measure PMCT thickness. We aimed to examine and confirm the reliability of ultrasound in measuring the thickness of the PMCT of the abdominal wall muscle. [Participants and Methods] The participants were 38 healthy adult males without chronic back pain. The images were acquired in B mode with the participants in the supine position and the PMCT thickness of the abdominal wall muscle was measured on the images. The intraclass correlation coefficient (ICC) was used to confirm reliability. [Results] The ICC for both within-day and between-day PMCT measurements by ultrasound were 0.7–0.9. The 95% confidence interval ranged from 0.5–0.9. The standard error of measurement (SEM) was 0.02–0.1 mm in the abdominal wall muscle and 0.5 mm in the interrecti distance (IRD). The 95% confidence interval (95% CI) of the minimum detectable change (MDC95) was 0.1–0.3 mm in the abdominal wall muscle and 1.3–1.4 mm in the IRD. [Conclusion] We conducted a study to confirm the reliability of ultrasound-based measurement of PMCT thickness of the abdominal wall muscle, and the ICC results established reliability. However, since the values measured were small (0.02–1.4 mm) and there is a limit to visual observation, it was necessary to measure using computer software.

Diastasis recti abdominis in adult women based on abdominal computed tomography imaging: Prevalence, risk factors and its impact on life.

This study aimed to obtain the incidence of diastasis recti abdominis (DRA) and analyse possible risk factors in adult females. Moreover, the relationships between DRA and lower back pain, pelvic floor function and quality of life were also analysed. Diastasis recti abdominis is a separation of the abdominal muscles at the linea alba. Currently, studies on the prevalence rates, risk factors and consequences of DRA are varied. In particular, reports on DRA among adult women are lacking. A one-sample questionnaire study design is used following the STROBE checklist. The inter-rectus distance was measured by computed tomography in 644 women. Custom questionnaires, the Oswestry Disability Index, The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were used to investigate personal information, the subjects' back pain, pelvic floor function and quality of life, respectively. The incidence of DRA was 28.4%. Age, the number of pregnancies, BMI and diabetes were influencing factors for DRA. After age stratification, pregnancy and diabetes were found to be risk factors for DRA in young women, and obesity and diabetes were risk factors for DRA in older women. This study showed that the association between DRA and low back pain was highly significant. Diastasis recti abdominis is common in adult women. Avoiding multiple pregnancies, preventing diabetes and controlling weight may prevent DRA, which may be beneficial for decreasing low back pain in women. The findings have important implications for the health of adult women which can provide the basis for appropriate nursing implementation for DRA patients. The application of specific prevention and intervention measures for the risk factors may reduce the severity of low back pain.

Women\u2019s experiences of living with increased inter-recti distance after childbirth: an interview study

BackgroundAlthough an increased inter-recti distance, also known as diastasis recti, is common after pregnancy, evidence-based knowledge about the condition is relatively limited. In particular, little is known about the consequences as perceived by the women. The objective of the present study was to describe how postpartum women with increased inter-recti distance experience the condition as well as the contacts they have had with healthcare providers regarding their symptoms.MethodsA purposeful sampling approach was used to recruit 19 participants from an existing study cohort of 144 women. All participants had an inter-recti distance of at least two finger widths and at least one child, with the youngest child between the ages of 1 and 6 years. Individual interviews based on a semi-structured interview guide were performed and subsequently analysed using qualitative content analysis.ResultsFour categories emerged from the interviews: the body’s function and ability has changed; the body does not look like it used to; uncomprehending attitudes and treatment in their surroundings; and trying to acquire an understanding of and strategies to cope with the diastasis. The findings reveal that women with increased inter-recti distance might experience fear of movement and engage in avoidance behaviour. In combination with feelings of physical instability in the midsection of their bodies and body dissatisfaction, many of the women restrict their everyday lives and physical activities.ConclusionsThe findings indicate that increased inter-recti distance is a complex phenomenon that affects the women in a multitude of ways, highlighting the importance of considering the condition for each individual in her own context from a biopsychosocial perspective.

Effect of Trunk Extensor Muscle Fatigue on Postural Stability in Women Undergone Lower Segment Cesarean Section

Background: Cesarean delivery involves thorough disruption of the anterior abdominal wall and is relatedwith greater reports of postpartum pain and slower more painful recovery than vaginal birth. An increase inthe inter-recti distance puts postural stability in hazard. It also weakens the abdominal muscles and influencetheir functions. This can result in an altered trunk mechanics, impaired pelvic stability and postural change,that leaves the lumbar spine and pelvis more susceptible to injury. Low endurance of back and hip muscleshas been reported in women after delivery which can result into pelvic girdle pain and lumbar pain. Thereis lack of research on this topic, indeed this made us to study the effect of trunk extensor muscle fatigue onpostural stability in women undergone lower segment cesarean section.Objectives: To find the effect of trunk extensor muscle fatigue on postural stability in women undergonelower segment cesarean section.Method: In this observational study, 37 women undergone cesarean section in age group 22 to 35 years wereincluded. One- Leg Standing Balance Test and Functional Reach Test were the major outcome measures toassess postural stability in three conditions: No fatigue, Fatigue and Recovery Condition. Borg 6-20 scalewas used to check the exertion level after inducing fatigue in women. Later, data was collected and analysiswas done.Result: Both One- Leg Standing Balance Test and Functional Reach Test showed a decrease from Nofatigue condition to Fatigue condition. The results indicate that postural stability was significantly reducedin the Fatigue condition as compared to the No fatigue condition.Conclusion: Trunk extensor muscle fatigue significantly reduces the postural stability in women undergonelower segment cesarean section.

Which Exercises Close Diastasis Recti Abdominis In Parous Women? An Experimental Cross-sectional Study

Diastasis recti abdominis (DRA) is defined as an impairment with midline separation of the two rectus abdominis muscles along the linea alba. The condition affects a significant number of women during the antenatal- and postnatal period and is hypothesized to cause abdominal-, pelvic-, and low back pain, decreased abdominal muscle strength, as well as cosmetic concerns. A study among US physical therapists found that the most commonly used exercises in treatment of DRA were indrawing and pelvic floor muscles (PFM) exercises. However, experimental studies have found that both indrawing and PFM contraction increase the inter-recti distance (IRD). Randomized controlled trials (RCT) are few, and both interventions and results differ between studies. PURPOSE: To investigate the immediate effect of different abdominal- and PFM exercises on IRD in women with DRA. METHODS: Following power calculation of sample size, 38 parous women were included in this cross-sectional study. 2D ultrasound was used to measure IRD at rest and in random order of eight different exercises. A paired t-test was used to compare IRD at rest with IRD recorded during each of the exercises and differences between exercises. Means with 95% confidence intervals (CI) are reported. P-value was set to <0.05. RESULTS: Head lift and twisted crunch significantly decreased the IRD, both above and below the umbilicus. Above the umbilicus, the mean difference between rest and head lift was 10 mm (95% CI: 7, 13.2, p˂.001) and twisted crunch 9.4 mm (95% CI: 6.3, 12.5, p˂.001). Below the umbilicus, the mean difference between rest and head lift was 6.1 mm (95% CI: 3.2, 8.9, p˂.001) and twisted crunch 3.5 mm (95% CI: 0.5, 6.4, p =.02). PFM contraction, maximal in-drawing and PFM contraction+maximal in-drawing increased the IRD below the umbilicus, mean difference; -2.8 mm (95% CI: -5.2, 0.5, p =.02), -4.7 mm (95% CI: -7.2, -2.1, p˂.001) and -5.0 mm (95% CI: -7.9, -2.1, p˂.001), respectively. CONCLUSION: Head lift and twisted crunch decrease, while maximal in-drawing and PFM contraction increase the IRD. RCTs are needed to investigate whether head lift and twisted crunch are effective in permanently narrowing the IRD. The Norwegian Women`s Public Health Association fully founded the study.

Surgical treatment of diastasis recti: the importance of an overall view of the problem.

Diastasis recti (DR) is characterized by an alteration of the linea alba with increased inter-recti distance (IRD). It is more frequent in females, and when symptomatic or associated with midline hernia it needs to be surgically repaired. This retrospective study aims to demonstrate how an overall approach to DR leads to good results in terms of functional and morphological outcomes and quality of life (QoL). From January 2018 to December 2019, 94 patients were operated for DR > 50mm, with or without midline hernias. Three different surgical approaches were used: complete laparoabdominoplasty, laparominiabdominoplasty and minimally invasive (endoscopic) technique. QoL was assessed with the EuraHS-QoL tool. All patients were female except two males. We performed 26 endoscopic treatments (27.7%), 39 laparoabdominoplasties (41.5%) and 29 laparominiabdominoplasties (umbilical float procedure) (30.9%). The total median operative time was 160min. No intraoperative complications were registered. In three (4.2%) cases, major surgical complications occurred, all after open operations. In 13 open surgery cases, vacuum-assisted closure (VAC) therapy was used to repair the cutaneous ischemic defect. No recurrence was registered to date. Minimally invasive surgery showed fewer complications and lower hospital stay than the open approach. The QoL was significantly improved. Our experience shows the importance of an overall view of the functional and cosmetic impairment created by DR. The surgeon should obtain an optimal repair of the function, by open or minimally invasive surgery, also considering the morphological aspects, which are very important for the patients in terms of QoL.