McNair P.1, Depledge J.2, Ellis R.1
1Auckland University of Technology, Physiotherapy, Auckland, New Zealand, 2Auckland District Health Board, Physiotherapy, Auckland, New Zealand
Background: Diastasis of the rectus abdominis, which occurs during pregnancy, is a common and potentially disabling condition that can lead to herniation of abdominal contents and back pain during tasks of daily function that involve lifting type activities. This is particularly problematic for the mother of a young baby. Exercise and bracing of the abdominal area has the potential to reduce the size of the diastasis and lead to less discomfort and better function during daily activities. However, research concerning the effectiveness of specific exercises to achieve this goal is limited, and no studies have examined the effect of supports and exercise early post partum.
Purpose: To determine the effect of four different abdominal exercises as well as tubigrip or taping in reducing the inter-rectus distance (diastasis) in women three weeks after giving birth.
Methods: Thirty two women (mean age: 32 yrs) who had given birth a mean of 21 days previously participated. All participants undertook a single session of ultrasound scanning in which one point above and below the umbilicus was measured. Measurements were taken of the inter-rectus distance at rest and during performance of the following exercises:
1) crook lying abdominal drawing in exercise with pelvic floor activation;
2) crook lying trunk curl up (to shoulders off plinth);
3) Crook lying flexed knee with hip flexion (early Sahrmann level leg raise);
4) McGill side lying plank.
Participants also performed the curl up and abdominal drawing in exercises under two further conditions:
a) wearing firmly fitting tubigrip,
b) taping across the diastasis.
The order of all exercises and conditions (tubigrip/taping/no support) was randomly assigned. Data analyses involved repeated measures ANOVA.
Results: At rest, the mean and standard deviation (SD) of the inter-rectus distance above and below the umbilicus was 3.5 (SD:1.1) and 2.6 (SD:1.2) cm respectively. At both these measurement points, a significant decrease (19%, p 0.05) was observed when performing the curl up exercise. No other exercises elicited a significant difference compared to the resting condition. In respect of tubigrip versus taping versus the no support condition, at rest wearing tubigrip led to a significant (p 0.05) reduction (7%) in the inter-rectus distance. When exercises were performed, there was no significant difference (p>0.05) across these conditions when performing either the abdominal drawing in or curl up exercises. Across all support conditions, the curl-up exercise elicited a significantly (p 0.05) greater mean reduction (23%) in inter-rectus distance compared to the abdominal drawing in exercise.
Conclusion(s): The curl up exercise was the most effective in reducing inter-rectus distance. In respect to supports, tubigrip provided a small reduction at rest which may be of benefit when worn over extended periods of time. None of the exercises led to a detrimental increase the inter-rectus distance.
Implications: The findings provide important information that may improve the prescription and effectiveness of exercise regimes for women with rectus abdominis diastasis early post-partum.
Funding acknowledgements: Auckland District Health Board Charitable Trust
Topic: Women's & mens pelvic health
Ethics approval: The New Zealand Ministry of Health, Northern Regional Ethics Committee
All authors, affiliations and abstracts have been published as submitted.
