These two case reports describe the rehabilitation program of exercises in two male participants aged 19 and 21 with diastasis rectus abdominis.
Objective
This paper aims to improve high inter-rectus distance, lumbar pain, abdominal and lumbopelvic function, Due to the lack of literature, this paper looks to provide clinicians with guidance in the rehabilitation of this injury.
Methods
Both cases participated in a multimodal program that included lumbopelvic stabilization, strengthening, and hypopressive exercises. Sociodemographic, clinical and muscular information was collected, as well as ultrasound measurements at three points: above the umbilicus, below the umbilicus, and at the midpoint between the xiphoid process and the umbilicus. Specific maneuvers and functional tests were used to assess changes in abdominal muscles.
Results
The results showed improvements in both clinical and ultrasound scores. In terms of improvement in inter-rectus distance, case 1 had a reduction of 25% above the umbilicus and case 2 showed a 23.9% improvement in inter-rectus distance at the midpoint.
Conclusions
It is concluded that a combination of superficial contractions and isometric exercises may be effective in reducing inter-rectus distance and improving abdominal function, suggesting the need for further research in this area.
ReinpoldWKöckerlingFBittnerR, et al.Classification of rectus diastasis-a proposal by the German Hernia Society (DHG) and the International Endohernia Society (IEHS). Front Surg2019; 6. DOI: https://doi.org/10.3389/FSURG.2019.00001
2.
BrooksDRosenMChenW. Overview of abdominal wall hernias in adults. 2024 Mar 29. In: UpToDate [Internet]. Waltham, MA: Wolters Kluwer; 2017. Available from: Overview of abdominal wall hernias in adults - UpToDate.
3.
KaufmannRLReinerCSDietzUA, et al.Normal width of the linea alba, prevalence, and risk factors for diastasis recti abdominis in adults, a cross-sectional study. Hernia2022; 26: 609–618.
BenjaminDRFrawleyHCShieldsN, et al.Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy2019; 105: 24–34.
6.
CorvinoADe RosaDSbordoneC, et al.Diastasis of rectus abdominis muscles: patterns of anatomical variation as demonstrated by ultrasound. Pol J Radiol2019; 84: e542–e548.
7.
MommersEHHPontenJEHAl OmarAK, et al.The general surgeon’s perspective of rectus diastasis. A systematic review of treatment options. Surg Endosc2017; 31: 4934–4949.
8.
KöhlerGLuketinaRREmmanuelK. Sutured repair of primary small umbilical and epigastric hernias: concomitant rectus diastasis is a significant risk factor for recurrence. World J Surg2015; 39: 121–126.
9.
CarlstedtABringmanSEgberthM, et al.Management of diastasis of the rectus abdominis muscles: recommendations for Swedish national guidelines. Scand J Surg2021; 110: 452–459.
10.
GluppeSBEnghMEBøK. Immediate effect of abdominal and pelvic floor muscle exercises on interrecti distance in women with diastasis recti abdominis who were parous. Phys Ther2020; 100: 1372–1383.
11.
SanchoMFPascoalAGMotaP,et al.Abdominal exercises affect inter-rectus distance in postpartum women: a two-dimensional ultrasound study. Physiotherapy2015; 101: 286–291.
12.
TheodorsenNMStrandLIBøK. Effect of pelvic floor and transversus abdominis muscle contraction on inter-rectus distance in postpartum women: a cross-sectional experimental study. Physiotherapy2019; 105: 315–320.
13.
Arranz-MartínBNavarro-BrazálezBSánchez-SánchezB, et al.The impact of hypopressive abdominal exercise on linea Alba morphology in women who are postpartum: a short-term cross-sectional study. Phys Ther2022; 102. DOI: https://doi.org/10.1093/PTJ/PZAC086
14.
ThabetAAAlshehriMA. Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: A randomised controlled trial. Journal of Musculoskeletal Neuronal Interactions2019; 19: 62–68.
15.
GluppeSEnghMEBøK. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis. Braz J Phys Ther2021; 25: 664–675.
16.
LiawLJHsuMJLiaoCF, et al.The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study. J Orthop Sports Phys Ther2011; 41: 435–443.
17.
KuorinkaIJonssonBKilbomA, et al.Standardised nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon1987; 18: 233–237.
18.
HawkerGAMianSKendzerskaT,et al.Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res (Hoboken)2011; 63. DOI: https://doi.org/10.1002/acr.20543
19.
Alcántara-BumbiedroSFlórez-GarcíaMTEchávarri-PérezCGarcía-PérezF. Escala de incapacidad por dolor lumbar de Oswestry. Rehabilitacion (Madr)2006; 40: 150–158.
20.
AnjaraSGBonettoCVan BortelT,et al.Using the GHQ-12 to screen for mental health problems among primary care patients: psychometrics and practical considerations. Int J Ment Health Syst2020; 14. DOI: https://doi.org/10.1186/S13033-020-00397-0
21.
AversDBrownM. Daniels and Worthingham’s Muscle Testing - Techniques of Manual Examination and Performance Testing. 10th Ed. St. Louis: Elsevier, 2019.
22.
McGillSMChildsALiebensonC. Endurance times for low back stabilization exercises: clinical targets for testing and training from a normal database. Arch Phys Med Rehabil1999; 80: 941–944.
23.
HidesJWilsonSStantonW, et al.An MRI investigation into the function of the transversus abdominis muscle during “drawing-in” of the abdominal wall. Spine (Phila Pa 1976)2006; 31. DOI: https://doi.org/10.1097/01.BRS.0000202740.86338.DF
24.
OliveiraCBFilhoRFNFrancoMR, et al.Psychometric Properties of the Deep Muscle Contraction Scale for Assessment of the Drawing-in Maneuver in Patients With Chronic Nonspecific Low Back Pain. J Orthop Sports Phys Ther2017; 47: 432–441.
25.
Opala-BerdzikARudek-ZeprzałkaMNiesporekJ, et al.Technical aspects of inter-recti distance measurement with ultrasonographic imaging for physiotherapy purposes: the scoping review. Insights Imaging2023; 14. DOI: https://doi.org/10.1186/S13244-023-01443-4
WhittakerJLWarnerMBStokesMJ. Ultrasound imaging transducer motion during clinical maneuvers: respiration, active straight leg raise test and abdominal drawing in. Ultrasound Med Biol2010; 36: 1288–1297.
28.
Cervera-CanoMSáez-GarcíaMCValcárcel-LinaresD, et al.Real-time ultrasound evaluation of CORE muscle activity in a simultaneous contraction in subjects with non-specific low back pain and without low-back pain. Protocol of an observational case-control study. PLoS One2023; 18. DOI: https://doi.org/10.1371/JOURNAL.PONE.0285441
29.
HidesJAMiokovicTBelavýDL, et al.Ultrasound imaging assessment of abdominal muscle function during drawing-in of the abdominal wall: an intrarater reliability study. J Orthop Sports Phys Ther2007; 37: 480–486.
30.
TeyhenDSMiltenbergerCEDeitersHM, et al.The use of ultrasound imaging of the abdominal drawing-in maneuver in subjects with low back pain. J Orthop Sports Phys Ther2005; 35: 346–355.
31.
SapsfordRRHodgesPWRichardsonCA, et al.Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn2001; 20: 31–42.
32.
ThompsonJAO’SullivanPBBriffaNK,et al.Differences in muscle activation patterns during pelvic floor muscle contraction and valsalva maneuver. Neurourol Urodyn2006; 25: 148–155.
33.
HidesJAWongIWilsonSJ, et al.Assessment of abdominal muscle function during a simulated unilateral weight-bearing task using ultrasound imaging. J Orthop Sports Phys Ther2007; 37: 467–471.
34.
TeyhenDSWilliamsonJNCarlsonNH, et al.Ultrasound characteristics of the deep abdominal muscles during the active straight leg raise test. Arch Phys Med Rehabil2009; 90: 761–767.
35.
LeeDHodgesPW. Behavior of the linea Alba during a curl-up task in diastasis Rectus abdominis: an observational study. J Orthop Sports Phys Ther2016; 46: 580–589.
36.
Fernández-RodríguezRÁlvarez-BuenoCCavero-RedondoI, et al.Best exercise options for reducing pain and disability in adults with chronic low back pain: pilates, strength, core-based, and mind-body. A network meta-analysis. J Orthop Sports Phys Ther2022; 52: 505–521.
37.
HorsakBWunschRBernhartP, et al.Trunk muscle activation levels during eight stabilization exercises used in the functional kinetics concept: a controlled laboratory study. J Back Musculoskelet Rehabil2017; 30: 497–508.
38.
SkouraABillisEPapanikolaouDT, et al.Diastasis recti abdominis rehabilitation in the postpartum period: a scoping review of current clinical practice. Int Urogynecol J2024; 35: 491–520.
39.
LeopoldMSantiagoKChengJ, et al.Efficacy of a core strengthening program for diastasis rectus abdominis in postpartum women: a prospective observational study. J Womens Health Phys Therap2021. DOI: https://doi.org/10.1097/JWH.0000000000000214
40.
MotaPPascoalAGCaritaAI,et al.The immediate effects on inter-rectus distance of abdominal crunch and drawing-in exercises during pregnancy and the postpartum period. J Orthop Sports Phys Ther2015; 45: 781–788.
41.
GluppeSLHildeGTennfjordMK, et al.Effect of a postpartum training program on the prevalence of diastasis recti abdominis in postpartum primiparous women: a randomized controlled trial. Phys Ther2018; 98: 260–268.
42.
BeamishNGreenNNieuwoldE,et al.Differences in linea Alba stiffness and linea Alba distortion between women with and without diastasis recti abdominis: the impact of measurement site and task. J Orthop Sports Phys Ther2019; 49: 656–665.
43.
YuanSWangHZhouJ. Prevalence and risk factors of hernia in patients with rectus abdominis diastasis: a 10-year multicenter retrospective study. Front Surg2021; 8. DOI: https://doi.org/10.3389/FSURG.2021.730875/FULL
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