Modification of the Abstract submitted to JOSPT and IFOMPT 2016
Diane Lee and Associates, Surrey, B.C. Canada
Paul W Hodges
The University of Queensland, School of Health and Rehabilitation Sciences
Diastasis rectus abdominis (DRA) is very common in the obstetric patient. While most women recover both the cosmetic appearance and function of the abdominal wall in the postnatal period, persistent separation of the rectus abdominis muscles occurs in some. Rehabilitation has traditionally focused on exercises to ‘close the gap’ and reduce the inter-recti distance (IRD). New evidence shows that if this is the sole goal, function may not be restored.
New data, and a new interpretation, support exercises that prevent reduction of the separation and increase tension in the linea alba (prevent its distortion) to control the abdominal contents (cosmetic benefit) and transfer force between sides of the abdominal wall (functional benefit).
The IFOMPT presentation included both the research and clinical experience that has led to new protocols for treating women with postpartum DRA. The research (published July 2016 JOSPT) tested the hypothesis that strategies that narrow the IRD during a curl-up task may be counterproductive for optimal control of the trunk. Although activation of the lateral abdominal muscles may widen the IRD during a curl-up task, this strategy was hypothesized to create less distortion and thus more tension across the linea alba. This hypothesis was tested by comparison of the effect of different abdominal muscle activation patterns on the properties of the linea alba as measured by conventional ultrasound measures of IRD and a new measure of distortion of the linea alba in participants with and without DRA.
When women with DRA performed a short head and neck curl-up task without any cueing for pre-contraction of the transversus abdominis (TrA) (Auto-CU) the IRD reduced (narrowed) from resting values; however, the linea alba was more distorted. Pre-activation of TrA during the same task (TrA-CU) resulted in a wider IRD than during the Auto-CU, however; there was less distortion of the linea alba. The IRD and distortion did not change from rest or differ between tasks for control participants.
These findings show that IRD narrowing in parous women with DRA leads to more distortion of the linea alba and less potential for generating tension between sides of the abdominals. Further studies are planned to test this hypothesis in subgroups of women with DRA and clinical presentations of lumbopelvic pain and impairment.
The clinical implication is that IRD widening by TrA contraction, which has been discouraged in rehabilitation, may improve functional and cosmetic outcomes despite encouraging some increase in IRD widening. Clinicians should not focus only on training strategies that reduce the IRD especially if such strategies increase distortion of the linea alba.
National Health and Medical Research Council of Australia
(Fellowship [PWH] (APP1002190); CRE grant (ID455863); Program grant (ID631717))