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Physiotherapy in diastasis of the rectus abdominis muscle for woman during pregnancy and postpartum – a review paper

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Gruszczyńska D., Truszczyńska-Baszak A.

Medical Rehabilitation

2019

vol. 23(3)

31-38

Wstęp: Rozstęp mięśni prostych brzucha definiowany jest jako zwiększenie odległości na wysokości pępka pomiędzy dwoma mięśniami prostymi brzucha położonymi po obu stronach kresy białej. Dochodzi do niego u kobiet w ciąży i po porodzie z powodu rozluźnienia kresy białej w przebiegu ciąży pod wpływem hormonów i rozwijającego się płodu. Najczęstsze czynniki ryzyka wystąpienia rozstępu to: duży płód, duża objętość wód płodowych, ciąża mnoga, nadmierna praca mięśni brzucha w trzecim trymestrze ciąży, otyłość oraz zbyt intensywne parcie podczas porodu. Cel pracy: Celem pracy było przedstawienie diagnostyki oraz leczenia operacyjnego i nieoperacyjnego kobiet z rozstępem mięśni prostych brzucha z powodu ciąży i w okresie połogu. Diagnostyka rozstępu obejmuje przede wszystkim badanie palpacyjne, suwmiarką, USG i TK. Materiał i metoda: Prześledzono bazy naukowe takie jak Pubmed, Sciencedirect i Google Scholar, Ebsco. Wyniki: Łącznie zgromadzono 48 doniesień naukowych z baz Pubmed, Sciencedirect i Google Scholar. Wnioski: Rozejście mięśnia prostego brzucha może być leczone zapobiegawczo przez wprowadzenie odpowiedniej profilaktyki, która ma na celu wzmocnienie mięśnia poprzecznego i mięśnia prostego brzucha oraz naukę odpowiedniej postawy i zasad prawidłowego wykonywania czynności takich jak np. podnoszenie ciężkich przedmiotów. W przypadku wystąpienia rozejścia w połogu, można w sposób nieinwazyjny zmniejszyć jego rozmiar lub nawet całkowicie zlikwidować po wprowadzeniu odpowiednich ćwiczeń, wspomagając się w razie konieczności zaopatrzeniem ortopedycznym. Ćwiczenia powinny być indywidualnie dobierane przez terapeutę oraz wykonywane pod jego kontrolą w początkowym etapie treningu aby nauczyć pacjenta prawidłowej aktywacji mięśnia poprzecznego brzucha. Kobiety w ciąży, które nie mają przeciwwskazań do aktywności fizycznej, wykonując odpowiednie ćwiczenia mogą zmniejszyć ryzyko wystąpienia RMPB.

Introduction: Diastasis recti abdominis (DRA) is defined as the increase between two abdominal rectal muscles located on both sides of the linea alba at the height of the navel. It occurs in pregnant and postpartum women due to the loosening of the linea alba during pregnancy under the influence of hormones and the developing foetus. The most common risk factors for dehiscence are: large foetus, large volume of foetal waters, multiple pregnancy, excessive abdominal muscle overload during the third trimester, obesity and too intense pressure during delivery. Study aim: The aim of the study was to present diagnostics and surgical as well as non-operative treatment for women with abdominal muscle diastasis due to pregnancy and during the puerperium period. Diagnosis of dehiscence primarily includes palpation, calliper measurements, ultrasound and CT scan. Materials and methods: Scientific bases such as Pubmed, Sciencedirect, Google Scholar and Ebsco were searched. Results: A total of 48 scientific reports from Pubmed, Sciencedirect and Google Scholar were collected. Conclusions: Diastasis of the rectus abdominis muscle can be treated preventively by introducing appropriate prophylaxis, which aims to strengthen the transverse and the rectus abdominis muscles, as well as learning the right posture and principles of proper performance of activities such as lifting heavy objects. In the event of diastasis occurring in the puerperium period, its size can be reduced in a non-invasive manner or even completely eliminated after introducing appropriate exercises, being supported with orthopaedic equipment if necessary. Exercises should be individually selected by a therapist and performed under his/her supervision at the initial stage of training to teach the patient to properly activate the transverse abdominal muscle. Pregnant women who do not have contraindications to physical activity can reduce the risk of the DRA by performing appropriate exercises.

Exercises for pregnant and postpartum women with diastasis recti abdominis – literature review

100%

Gruszczyńska D., Truszczyńska-Baszak A.

Advances in Rehabilitation

2018

vol. 32

issue 3

27-35

Introduction Diastasis recti abdominis is a pathological condition at the linea alba in which rectus abdominis muscles separate. It occurs mainly in pregnant and postpartum women. Changes in the linea alba area are caused by stress to the tissue and pregnancy induced hormonal changes which lead to the loosening of abdominal connective tissue. This pathological condition is not manifested with any pain symptoms but the effects which may develop as a result of diastasis recti abdominis may cause pain. This literature review study discusses the non-surgical methods of treating diastasis recti abdominis by reducing the distance between the two parts of the rectus abdominis muscle. Material and methods Scientific literature on physiotherapy, surgical treatment and diagnostics of diastasis recti abdominis in pregnant and postpartum women from the last 15 years was analysed. Such databases as Google Scholar, PubMed, ScienceDirect, Ebsco and MedLine were used in the analysis and 11 publications were considered. Results Having analysed the available literature, it was concluded that abdominal exercises can prevent or reduce diastasis recti abdominis. However, the analysis did not reveal which method of treatment was the most effective. Conclusions This review of the literature revealed that there is not currently a gold standard method of treating diastasis recti abdominis. However, abdominal exercises during pregnancy reduce the risk of this condition postpartum. Diastasis recti abdominis may be reduced even a few years after childbirth by implementing appropriate treatment including a special training programme focusing on strengthening anterior abdominal wall and learning to maintain a proper body posture during activities of daily living.

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1 Advances in Rehabilitation

1 Medical Rehabilitation

1 2019

1 2018

2 Gruszczyńska D.

2 Truszczyńska-Baszak A.

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Physiotherapy in diastasis of the rectus abdominis muscle for woman during pregnancy and postpartum – a review paper

Exercises for pregnant and postpartum women with diastasis recti abdominis – literature review