بررسی اثربخشی تمرینات تقویتی شکم در درمان دیاستازیس رکتی در دوره پس از زایمان

نوع مقاله: مقاله مروری

نویسندگان

1 دکتری توانبخشی ورزشی، گروه آسیب شناسی ورزشی و حرکات اصلاحی، دانشکده تربیت بدنی، دانشگاه بوعلی سینا، همدان، ایران

2 دانشجوی کارشناسی ارشد، گروه آسیب شناسی ورزشی و حرکات اصلاحی، دانشکده تربیت بدنی، دانشگاه بوعلی سینا، همدان، ایران

چکیده

مقدمه و اهداف
در طی و پس از بارداری، بسیاری از زنان افزایش در فاصله­ی بینابینی عضلات راست شکمی را به دلیل افزایش حجم رحم در این دوره، کشش و نازک شدن لینه آلبا تجربه می­کنند. این بیماری به طور متوسط 66 درصد زنان را تحت تاثیر قرار می­دهد و با درد و بی­ثباتی ستون فقرات، ضعف عضلات کف لگن، ضعف عضلات شکمی و در نهایت فتق شکمی ارتباط دارد. هدف از مقاله حاضر، بررسی اثربخشی تمرینات تقویتی شکمی در درمان دیاستازیس رکتی در دوران پس از زایمان بر اساس نتایج مطالعات اخیر است.
مواد و روش ­ها
در مطالعه حاضر، پایگاه­های دادهGoogle Scholar ، EM Base، Medline، PubMed و جستجوی گوگل با ترکیب واژه­های کلیدی "بارداری"، "دیاستازیس رکتوس"، "دیاستاز رکتی"، "لینه آلبا"، "عضله راست شکمی"، "تمرینات تقویتی"، جستجو شد. این مطالعه شامل تحقیقات مختلف در زمینه تمرینات تقویت عضلات شکمی در درمان دیاستازیس رکتی می­باشد.
یافته­ ها
به طور کلی، 800 مقاله در زمینه مطالعات موردی، مطالعات پایلوت (آزمایشی) و کارآزمایی­های بالینی به دست آمد. از این مطالعات، بر اساس معیارهای ورود به مطالعه، تنها 11 مورد در خصوص تأثیر تمرینات تقویتی در درمان دیاستازیس رکتی انتخاب شدند. نتایج مطالعات موجود در تعدادی از مقالات نشان داد که تمرینات تقویتی شکم در کاهش کمردرد، کاهش عملکرد، بی­ثباتی پاسچرال و ضعف عضلانی موثر است.
نتیجه­ گیری
با توجه به نتایج و کیفیت مطالعات، تمرینات تقویتی عضلات شکم می­تواند روش موثری در درمان دیاستازیس رکتی در دوره پس از زایمان باشد.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

Effectiveness of Abdominal Strengthening Exercises in the Treatment of Diastasis Recti in Postpartum Period

نویسندگان [English]

  • Ali Yalfani 1
  • Nahid Bigdeli 2
  • Mohammad Reza Ahmadi 2
1 Associate Professor in Sport Rehabilitation, Department of Sport Injuries and Corrective Exercises, Bu Ali Sina University, Hamedan, Iran
2 Master of Sport Injuries and Corrective Exercises, Department of Sport Injuries and Corrective Exercises, Bu Ali Sina University, Hamedan, Iran
چکیده [English]

Background and Aims: During and after pregnancy, many women experience an increase in the inter-recti abdominal muscle due to increased uterine volume as well as stretching and thinning of the linea alba. This disease, on average, affects 66% of women and is associated with spinal pain and instability, pelvic floor muscle weakness, abdominal muscle weakness, and abdominal hernia. The aim of the present review article was to study the effectiveness of abdominal strengthening exercises in the treatment of diastasis recti in postpartum period, based on the results of the recent studies.
Materials and Methods: Google scholar, EM base, Medline, and PubMed databases as well as Google search were searched using the following keywords: pregnancy, diastasis rectus, diastasis recti, linea alba, rectus abdominal muscles, and strengthening exercises. Our study includes different researches on abdominal muscle strengthening exercises in the treatment of diastasis recti.
Results: Generally, 800 articles were found in the field of case studies, pilot studies, and clinical trials. From among these studies, only 11 studies were selected according to the inclusion criteria. The results of these studies showed that abdominal strengthening exercises have been effective in minimizing low back pain and decreasing functional, postural instability as well as muscle weakness.
Conclusion: According to the results and quality of the studies, abdominal muscles strengthening exercises can be an effective method in the treatment of diastasis recti in postpartum period.
 

کلیدواژه‌ها [English]

  • pregnancy
  • Diastasis Recti
  • Linea Alba
  • Rectus Abdominal Muscles
  • Strengthening Exercises
  1. Coldron Y, Stokes MJ, Newham DJ, Cook K. Postpartum characteristics of rectus abdominis on ultrasound imaging. Manual therapy. 2008 Apr 1;13(2):112-21. ##
  2. Axer H, Keyserlingk DG, Prescher A. Collagen fibers in linea alba and rectus sheaths: I. General scheme and morphological aspects. Journal of Surgical Research. 2001 Mar 1;96(1):127-34. ##
  3. Lo T. Diastasis of the recti abdominis in pregnancy: risk factors and treatment. Physiot Canada. 1999:32-7. ##
  4. Mota PG, Pascoal AG, Carita AI, Bø K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual therapy. 2015 Feb 1;20(1):200-5. ##
  5. Mota P, Pascoal AG, Sancho F, Carita AI, Bo K. Reliability of the inter-rectus distance easured by palpation. Comparison of palpation and ultrasound measurements. Man Ther 2013; 18:294–8##
  6. Bursch SG. Interrater reliability of diastasis recti abdominis measurement. Physical therapy. 1987 Jul 1;67(7):1077-9. ##
  7. Lee DG, Lee LJ, McLaughlin L. Stability, continence and breathing: the role of fascia following pregnancy and delivery. Journal of bodywork and movement therapies. 2008 Oct 1;12(4):333-48. ##
  8. Fast AV, Weiss L, Ducommun EJ, Medina EV, Butler JG. Low-back pain in pregnancy. Abdominal muscles, sit-up performance, and back pain. Spine. 1990 Jan;15(1):28-30. ##
  9. Rett MT, Braga MD, Bernardes NO, Andrade SC. Prevalence of diastasis of the rectus abdominis muscles immediately postpartum: comparison between primiparae and multiparae. Brazilian Journal of Physical Therapy. 2009 Aug;13(4):275-80. ##
  10. Candido G, Lo T, Janssen PA. Risk factors for diastasis of the recti abdominis. JOURNAL-ASSOCIATION OF CHARTERED PHYSIOTHERAPISTS IN WOMENS HEALTH. 2005; 97:49. ##
  11. Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year. Physical therapy. 1988 Jul 1;68(7):1082-6. ##
  12. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Journal of Epidemiology & Community Health. 1998 Jun 1;52(6):377-84. ##
  13. Samoocha D, Bruinvels DJ, Elbers NA, Anema JR, van der Beek AJ. Effectiveness of web-based interventions on patient empowerment: a systematic review and meta-analysis. Journal of medical Internet research. 2010 Apr;12(2). ##
  14. El-Mekawy HS, Eldeeb AM, El-Lythy MA, El-Begawy AF. Effect of abdominal exercises versus abdominal supporting belt on post-partum abdominal efficiency and rectus separation. InProceedings of World Academy of Science, Engineering and Technology 2013 Jan 1 (No. 73, p. 742). World Academy of Science, Engineering and Technology (WASET). ##
  15. Gürşen C, İnanoğlu D, Kaya S, Akbayrak T, Baltacı G. Effects of exercise and Kinesio taping on abdominal recovery in women with cesarean section: a pilot randomized controlled trial. Archives of gynecology and obstetrics. 2016 Mar 1;293(3):557-65. ##
  16. Thabet AA, Alshehri MA. Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial.2018##
  17.  Pereira1, C., D. A. S., & (PT), D. S. G. To study the added effect of modified dynamic core stability plank exercise program on diastasis recti abdominis closure and pelvic floor disability: a pilot study. [Research article]. international Journal of Allied Medical Sciences and Clinical Research (IJAMSCR), 2018 6(2), 8. ##
  18. Khandale SR, Hande D. Effects of abdominal exercises on reduction of diastasis recti in postnatal women. IJHSR. 2016;6(6):182-91. ##
  19. Litos K. Progressive therapeutic exercise program for successful treatment of a postpartum woman with a severe diastasis recti abdominis. Journal of Women’s Health Physical Therapy. 2014 May 1;38(2):58-73. ##
  20. Mahalakshmi V, Sumathi G, Chitra TV, Ramamoorthy V. Effect of exercise on diastasis recti abdominis among the primiparous women: a quasi-experimental study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2016 Dec 7;5(12):4441-6. ##
  21. Kamel DM, Yousif AM. Neuromuscular electrical stimulation and strength recovery of postnatal diastasis recti abdominis muscles. Annals of rehabilitation medicine. 2017 Jun 1;41(3):465-74. ##
  22. Tuttle LJ, Fasching J, Keller A, Patel M, Saville C, Schlaff R, Walker A, Mason M, Gombatto SP. Noninvasive Treatment of Postpartum Diastasis Recti Abdominis: A Pilot Study. Journal of Women’s Health Physical Therapy. 2018 May 1;42(2):65-75. ##
  23. Izadi, khalkhali Z, mino Phd, Akbarzade B. Structural response of abdominal muscles to six weeks of strengthening exercise in women with Diastasis recti, 2018, Nov 22;21(9):71-82. ‎ [In Persian] ##
  24. Walton LM, Costa A, LaVanture D, McIlrath S, Stebbins B. The effects of a 6-week dynamic core stability plank exercise program compared to a traditional supine core stability strengthening program on diastasis recti abdominis closure, pain, Oswestry disability index (ODI) and pelvic floor disability index scores (PFDI). Physical Therapy and Rehabilitation. 2016 Apr 11;3(1):3. ##
  25. Pascoal AG, Dionisio S, Cordeiro F, Mota P. Inter-rectus distance in postpartum women can be reduced by isometric contraction of the abdominal muscles: a preliminary case–control study. Physiotherapy. 2014 Dec 1;100(4):344-8. ##
  26. Benjamin DR, Van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014 Mar 1;100(1):1-8. ##
  27. Kisner C, Colby LA, Borstad J. Therapeutic exercise: foundations and techniques. Fa Davis; 2017 Oct 18. ##
  28. Snijders T, Verdijk LB, Beelen M, McKay BR, Parise G, Kadi F, van Loon LJ. A single bout of exercise activates skeletal muscle satellite cells during subsequent overnight recovery. Experimental physiology. 2012 Jun 1;97(6):762-73. ##
  29. Neumann DA. Kinesiology of the musculoskeletal system-e-book: foundations for rehabilitation. Elsevier Health Sciences; 2013 Aug 7. ##
  30. Nahabedian MY. Management Strategies for Diastasis Recti. InSeminars in plastic surgery 2018 Aug (Vol. 32, No. 03, pp. 147-154). Thieme Medical Publishers. ##