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Faculty Advisor(s)

Betsy Donahoe-Fillmore, PT, PhD

Description

Purpose/Hypothesis: Ehlers Danlos Syndrome (EDS) is a connective tissue disorder characterized by the inappropriate functioning and synthesis of collagen, elastin, and fibrillin in the body, affecting many systems including the musculoskeletal system. In hypermobility-type EDS, individuals can present with instability at various locations in the body and may result in joint dislocations and pain. This can result in difficulty activating the abdominal muscles. The purpose of this study is to determine if a focused 3 to 6 month rehabilitation program improves inter-rectus distance (IRD), abdominal strength, and body image in women diagnosed with EDS.

Number of Subjects: Women (n=24) 33-62 years (mean 45 years) were randomized into an intervention group (EX) (n=11) or a control group (CON) (n=13).

Materials and Methods: Outcome testing occurred at baseline, 12 and 24 weeks. The IRD was measured at rest and with curl-up at the level of umbilicus with digital calipers. Abdominal strength was assessed with manual muscle testing (MMT) as described by Kendall. EX was instructed in exercises 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. CON was not provided with exercise. An intention to treat analysis using last measure carried forward was conducted. Groups were compared at baseline for age, BMI, time since last birth, and activity level using independent samples t-tests. IRD was analyzed with a repeated measures ANOVA and strength via Friedman’s ANOVA. Significance was 0.05, a priori.

Results: Participants were similar at baseline on age, BMI, time since last birth, and activity level as measured by the IPAQ questionnaire. The umbilical IRD at rest and with curl-up improved from baseline (33.64 (6.9) and 29.82 (5.76) respectively) at 12 (25.36 (4.8), p=.001; 21 (5.71), p=< .001) and 24 weeks (15.55 (5.09) and 11.09 (4.01), p< .001) only in EX. IRD at rest and with curl-up improved in EX compared to CON at both 12 (p=.003 and < .001) and 24 weeks (p=< .001). Strength improved in EX from baseline (2.64 (.381)) to 12 (3.36 (.51), p=.021) and 24 weeks (3.91 (.7), p=.006), and compared to CON (3.33 (.65)) at 24 weeks (p=.038).

Conclusions: There were significantly improved IRD at rest and with curl-up in the intervention group at 12 and 24 weeks in comparison to control. Meaningful strength changes 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

5-8-2025

Disciplines

Physical Therapy | Rehabilitation and Therapy

Comments

Presented on February 13, 2025 at APTA Combined Sections Meeting

Efficacy of Abdominal Curl up Task As Abdominal Exercise for Diastasis Recti Abdominis for Ehlers Danlos Syndrome

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