Diastasis Rectus Abdominis in Postpartum Women－The Effects of Therapeutic Exercises

• Main Authors: Shin-Mei Liu, 劉欣玫
• Other Authors: Shih-fen Hsiao
• Format: Others
• Language: zh-TW
• Published: 2005
• Online Access: http://ndltd.ncl.edu.tw/handle/03595330251736181970

碩士 === 高雄醫學大學 === 行為科學研究所碩士班 === 93 === Background and Purpose: Diastasis rectus abdominis (DRA) is common to postpartum women. As a result of the growing fetus in both its size and weight, the linea alba can be over stretched to an extent that it often becomes a thin, slack membrane. Eventually, the distance between the two RA. (the inter-recti distance; IRD) is increased. In addition to the changes in body image and posture, normal muscle mechanics and physiology can be affected to a great extent as the IRD increased. The laxity of the abdominal wall will also change the resting length of the RA, subsequently it might also reduce the force production due to the effects of decreased resting muscle tonus and increased the angle of pull during active contraction. Movement functions related to the RA, such as maintenance of posture, stability of pelvis, etc., can also be compromised as the mechanical output from the maximal voluntary contractions (MVCs) reduced. This study aimed to understand the extent of changes in RA functions in postpartum women, and how could regular exercise affect it. A group of nonparaous female was recruited as comparison. Method: There were 28 postpartum women (34.32 ± 1.03 years) and 23 nonparous females (33.43 ± 1.20 years) participated in this study. The postpartum group was further divided into two, general or specific exercise groups, for 12 weeks training in RA function. Both exercise groups were tested for RA function before and after exercise training, though the control group was only tested once, without implementing exercise program. For assessment of RA function, musculoskeletal ultrasound imaging was used to measure the IRD at areas above and below umbilicus. Mechanical and electrical output of RA and other related trunk muscles were collected with a hand-held dynamometer and surface electromyography (EMG). Static & dynamic endurance performance of the RA was also recorded. Result: The postpartum women showed larger DRA, particularly on the upper margin of umbilicus, than the controls (p<0.0001). Their RA strength seems unaffected, but with a lower RA endurance and recruitment. After 12 weeks of therapeutic exercise, obvious improvement IRD, endurance and normal recruitment pattern could be found on both exercise groups, especially in those with specific exercise. Conclusion: The DRA phenomenon is common in postpartum women and those who showed increased IRD also exhibited lower RA endurance and recruitment in trunk movement such as sit-up. The training program designed in this study demonstrated effects in reducing the IRD as well as improving the endurance and strength, even in very basic forms. There is also a need to explore whether these effects can also reduce the problems possibly caused by reinforce abdominal function (such as back pain and incontinence). The finding of these investigations is important not only in better understanding of women health, but also leading to better utilization of physical therapy in treating these dysfunction associated with pregnancy.