بررسـی حس عمقی و کنترل کمری-لگنی، در زنان با و بدون دیاستازیس رکتی و ارتباط آنها با درد و ناتوانی کمری پس از زایمان

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشیار، 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

3 استادیار گروه حرکات اصلاحی و آسیب شناسی ورزشی، دانشکده علوم ورزشی، دانشگاه رازی، کرمانشاه، ایران.

4 استادیار، دکترای تخصصی و جراح زنان و زایمان، گروه زنان و زایمان، دانشگاه علوم پزشکی همدان، همدان، ایران

چکیده

مقدمه و اهداف
به افزایش فاصله بین دو عضله راست شکمی در دوران بارداری و پس از آن دیاستازیس رکتی می­ گویند. شیوع این عارضه در زنان پس از زایمان، 66 درصد است. با توجه به بی­ثباتی ستون فقرات و لگن در این افراد، اختلال در حس عمقی و کنترل کمری-لگنی می­تواند یکی از عوامل درد و ناتوانی کمری در آنها باشد؛ در نتیجه هدف از مقاله حاضر بررسـی وضعیت حس عمقی و کنترل کمری-لگنی، در زنان با و بدون دیاستازیس رکتی و ارتباط آنها با درد و ناتوانی کمری پس از زایمان است.
مواد و روشها
18 خانم سالم با میانگین سن 4/55±25/77 سال و 18 خانم مبتلا به دیاستازیس رکتوس با میانگین سنی 5/69±28/83 سال که 2 الی 5 ماه از زایمان آنها گذشته بود، در مطالعه شرکت داشتند. میزان خطای بازسازی زاویه 30 درجه فلکشن کمر با گونیامتر در وضعیت چشم بسته و در حالت ایستاده ارزیابی شد؛  کنترل کمری-لگنی نیز با استفاده از تست میدانی گام جانبی(Lateral Step Down)  اندازه­ گیری شد.
یافتهها
یافته­های مطالعه نشان داد که میانگین خطای بازسازی زاویه فلکشن کمری-لگنی در گروه مبتلا به دیاستازیس رکتی به ­طور معناداری بیشتر از گروه سالم بود (0/0001=P). در تست گام جانبی نیز بین گروه سالم و مبتلا به این عارضه تفاوت معناداری دیده شد (0/0001=P).
نتیجه­ گیری
نتایج مطالعه حاضر نشان داد دیاستازیس رکتی که در برخی از خانوم­ها پس از زایمان رخ می­دهد، می­تواند مشکلاتی چون اختلال در حس عمقی و کنترل کمری-لگنی ایجاد نموده که ممکن است به درد و ناتوانی در کمر بیانجامد.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

Proprioception and Control of the Lumbopelvic in Women with and without Diastasis Rectus and Their Relationship with Postpartum Pain and Disability

نویسندگان [English]

  • Ali Yalfani 1
  • Nahid Bigdeli 2
  • Farzaneh Gandomi 3
  • Roghayeh Anvari Aliabad 4
1 Associate Professor, Sport rehabilitation Ph.D, 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
3 Assistant Professor, Sport Injuries and Corrective Exercises Department, Sport Sciences Faculty, Razi University, Kermanshah, Iran.
4 Assistant Professor, Department of Gynecology, School of medicine, Hamadan University of Medical Sciences, Hamadan, Iran
چکیده [English]

Background and Aims: Increase in the inter-recti abdominal muscle during pregnancy and postpartum is called diastasis rectus abdominis. Usually this distance must be more than 20 mm above the umbilicus and 25 mm in the umbilicus to be diagnosed. The prevalence of this disorder in women after postpartum is 66%. Due to the instability of the spine and pelvis in these individuals, impairment in proprioception and lumbopelvic control can be the causes of lumbar pain and disability. Thus, the present research was conducted to study the proprioception and lumbopelvic control in women with and without diastasis rectus and their relationship with postpartum pain and disability.
Materials and methods: A total of 18 healthy persons, with the mean age of 25/77±4/55 years, and 18 patients with diastasis rectus, with the mean age of 28/88±5/69 years, with 2-3 years passed since their delivery, were recruited. The amount of error in the reconstruction of the lumbar position was measured using a goniometer with the eye closed while standing at a 30° angle of lumbar flexion and lumbo-pelvic control with lateral step down field test. The results of the tests were calculated and analyzed.
Results:Mean error in 30° angle lumbar flexion reconstruction in patients with diastasis rectus was significantly higher than that in the healthy group (P <0.05). Also, in lateral step down test, there was a significant difference between healthy groups and patients suffering from this disorder (P <0.05).
Conclusion: The results of the present study showed that diastasis rectus causes problems in women with this problem, like disorder in proprioception and lumbopelvic control, which may lead to low back pain and disability.

کلیدواژه‌ها [English]

  • Diastasis Rectus
  • Linea Alba
  • Lumbopelvic Proprioceptive
  • lumbopelvic control
  • Low back pain
  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. Jorurnal- Association of  Chartered Physiotherapists in Womens Health. 2005; 97:49. ##
  11. Maluf KS, Sahrmann SA, Van Dillen LR. Use of a classification system to guide nonsurgical management of a patient with chronic low back pain. Phys Ther 2000; 80(11):1097-111. ##
  12. Van Dillen LR, Sahrmann SA, Wagner JM. Classification, intervention, and outcomes for a person with lumbar rotation with flexion syndrome. Phys Ther 2005;85(4):336-51. ##
  13. Van Dillen LR, Maluf KS, Sahrmann SA. Further examination of modifying patient-preferred movement and alignment strategies in patients with low back pain during symptomatic tests. Man Ther 2009;14(1):52-60. ##
  14. Van Dillen LR, Sahrmann SA, Norton BJ, Caldwell CA, McDonnell MK, Bloom N. The effect of modifying patient-preferredspinal movement and alignment during symptom testing in patients with low back pain: a preliminary report. Arch Phys Med Rehabil 2003;84(3):313-22. ##
  15. Sahrmann S. Diagnosis and Treatment on Movement Impairment Syndromes. St Louis: MO:Mosby; 2002. ##
  16. Sahrmann S. Movement system Impairment Syndromes. St. Louis: MO:Mosby; 2011. ##
  17. Scholtes SA, Gombatto SP, Van Dillen LR. Differences in lumbopelvic motion between people with and people without low back pain during two lower limb movement tests. Clin Biomech (Bristol, Avon) 2009;24(1):7-12. ##
  18. Gombatto SP, Collins DR, Sahrmann SA, Engsberg JR, Van Dillen LR. Gender differences in pattern of hip and lumbopelvic rotation in people with low back pain. Clin Biomech (Bristol, Avon). 2006 Mar;21(3):26371##
  19. Stillman BC. Making Sense of Proprioception: The meaning of proprioception, kinaesthesia and related terms. Physiotherapy2002;88(11):667-76. ##
  20. Cholewicki J, Polzhofer GK, Radebold A. Postural control of trunk during unstable sitting. Journal of biomechanics. 2000 Dec 1;33(12):1733-7. ##
  21. Prentice WE. Rehabilitation techniques in sports medicine. Dubuque, IA, USA: WCB/McGraw-Hill; 2015. ##
  22. Page P, Frank C, Lardner R. Assessment and treatment of muscle imbalance: The Janda approach. Journal of orthopedic & sports physical therapy. 2011 Oct;41(10):799-800##
  23. Brumagne S, Lysens R, Swinnen S, Verschueren S. Effect of paraspinal muscle vibration on position sense of the lumbosacral spine. Spine (Phila Pa 1976)1999 Jul 1;24(13):1328-31. ##
  24. Brumagne SPT, Cordo PP, Lysens RMDP, Verschueren SP, Swinnen SP. The Role of Paraspinal Muscle Spindles in Lumbosacral Position Sense in Individuals with and Without Low Back Pain. Spine2000;25(8):989-94. ##
  25. Brumagne S, Janssens L, Knapen S, Claeys K, Suuden-Johanson E. Persons with recurrent low back pain exhibit a rigid postural control strategy. European Spine Journal2008;17(9):1177-84. ##
  26. Mahalakshmi V, Sumathi G, Chitra TV, Ramamoorthy V. Effect of exercise on diastasis recti abdominis among the primiparous women: a quasi-experimental study. Int J Reprod Contracept Obstet Gynecol. 2016;5(12):4441-6. ##
  27. Liaw LJ, Hsu MJ, Liao CF, Liu MF, Hsu AT. The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study. journal of orthopaedic & sports physical therapy. 2011 Jun;41(6):435-43. ##
  28. Chiarello CM, McAuley JA. Concurrent validity of calipers and ultrasound imaging to measure interrecti distance. journal of orthopaedic & sports physical therapy. 2013 Jul;43(7):495-503. ##
  29. Van de Water AT, Benjamin DR. Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): a systematic review of their measurement properties and meta-analytic reliability generalisation. Manual therapy. 2016 Feb 1; 21:41-53. ##
  30. Boxer S, Jones S. Intra-rater reliability of rectus abdominis diastasis measurement using dial calipers. Australian Journal of Physiotherapy. 1997 Jan 1;43(2):109-14. ##
  31. Vianin M. Psychometric properties and clinical usefulness of the Oswestry Disability Index. Journal of chiropractic medicine. 2008 Dec 1;7(4):161-3. ##
  32. Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain. 1983 May 1;16(1):87-101. ##
  33. Newcomer KL, Laskowski ER, Yu B, Johnson JC, An KN. Differences in repositioning error among patients with low back pain compared with control subjects. Spine. 2000 Oct 1;25(19):2488-93. ##
  34. De Blaiser C, De Ridder R, Willems T, Danneels L, Roosen P. Reliability of two functional clinical tests to evaluate trunk and lumbopelvic neuromuscular control and proprioception in a healthy population. Brazilian journal of physical therapy. 2019 Nov 1;23(6):541-8. ##
  35. 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. ##
  36. 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. In Proceedings of World Academy of Science, Engineering and Technology 2013 Jan 1 (No. 73, p. 742). World Academy of Science, Engineering and Technology (WASET). ##
  37. Cholewicki J, Silfies SP, Shah RA, Greene HS, Reeves NP, Alvi K, Goldberg B. Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 2005 Dec 1;30(23):2614-20. ##
  38. Zheng YL, Wang XF, Chen BL, Gu W, Wang X, Xu B, Zhang J, Wu Y, Chen CC, Liu XC, Wang XQ. Effect of 12-week whole-body vibration exercise on lumbopelvic proprioception and pain control in young adults with nonspecific low back pain. Medical science monitor: international medical journal of experimental and clinical research. 2019; 25:443. ##
  39. Winter DA. A review of kinematic parameters in human walking. Gait analysis: theory and application. 1995. ##
  40. Akuthota V, Nadler SF. Core strengthening. Archives of physical medicine and rehabilitation. 2004 Mar 1; 85:86-92. ##
  41. 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. ##
  42. Chiarello CM, Falzone LA, McCaslin KE, Patel MN, Ulery KR. The effects of an exercise program on diastasis recti abdominis in pregnant women. Journal of Women’s Health Physical Therapy. 2005 Apr 1;29(1):11-6. ##
  43. 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. ##
  44. 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. ##
  1. Rajabi R, Karimizadeh Ardakani M. determine the reliability of Iranian new tool measure for ankle proprioception. Journal of sport medicine. 2013; 12:43-52. ##