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Faculty Advisor(s)

Betsy K Donahoe-Fillmore, PT, PhD

Description

Purpose/Hypothesis: The separation between the rectus abdominal muscles caused by a widening and thinning linea alba, called diastasis recti abdominis (DRA), contributes to impairments in strength of the abdominal and trunk muscles. DRA is most frequently observed during pregnancy and may recede after childbirth but can be present at 12 months or later after giving birth. The purpose of this study was to determine if a focused 12 or 24 week exercise program improves inter-rectus distance and abdominal strength in women who have given birth.

Number of Subjects: Forty-eight women 27-49 years (mean 37 years) were randomized into a 12 (n=16) or 24 week intervention group (n=17) or a control group (n=15).

Materials and Methods: Outcome testing occurred at baseline, 12 and 24 weeks. The inter-rectus distance (IRD) was measured at rest at the level of umbilicus with digital calipers. Abdominal strength was assessed with manual muscle testing (MMT) as described by Kendall. The intervention groups were instructed in exercises to be performed 3x/week, 5 repetitions each: strengthening (Preactivation transversus abdominis (TrA) with curl-up exercise with verbal and palpation cues to monitor the tension in the linea alba), breathing education including lower rib mechanics and engaging the TrA, and postural education. The control group was not provided with exercise. An intention to treat analysis using the last measure carried forward was conducted. Within group change in IRD was analyzed with paired sample t-tests. Change in IRD and MMT was compared using ANCOVA, with time since delivery as a covariate. Significance was 0.05, a priori.

Results: Subjects were similar at baseline on age, BMI, and number of pregnancies, however time since delivery was significantly longer (69 months, compared to 43 months in 24 week group, 32 months in 12 week group; p=0.016) in the control group. All groups saw a decrease of IRD from baseline to 12 and 24 weeks (p

Conclusions: While there were decreases in the IRD among all groups, these were significantly better at 12 and 24 weeks in both exercise groups in comparison to control with the exercise groups showing clinically relevant change in comparison to control. Since both the 12 and 24 week exercise groups saw statistically and clinically significant change at 12 weeks, this may be long enough to encourage ongoing resolution of DRA. Meaningful strength changes, however, require a longer intervention of 24 weeks rather than 12.

Clinical Relevance: This program challenges the conventional treatment of DRA by incorporating the curl-up exercise and emphasizing the importance of utilizing linea alba tension and transverse abdominis activation. The comprehensive approach aims to optimize outcomes for individuals with DRA.

Publication Date

5-2024

Disciplines

Physical Therapy | Rehabilitation and Therapy

Efficacy of Curl up Task As Abdominal Exercise Program for Diastasis Recti Abdominis

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