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Journal of Physiotherapy Jul 2023What is the effect of a 12-week, home-based, abdominal exercise program containing head lifts and abdominal curl-ups on inter-recti distance (IRD) in women with... (Randomized Controlled Trial)
Randomized Controlled Trial
Curl-up exercises improve abdominal muscle strength without worsening inter-recti distance in women with diastasis recti abdominis postpartum: a randomised controlled trial.
QUESTION
What is the effect of a 12-week, home-based, abdominal exercise program containing head lifts and abdominal curl-ups on inter-recti distance (IRD) in women with diastasis recti abdominis (DRA) 6 to 12 months postpartum? What is the effect of the program on: observed abdominal movement during a curl-up; global perceived change; rectus abdominis thickness; abdominal muscle strength and endurance; pelvic floor disorders; and low back, pelvic girdle and abdominal pain?
DESIGN
This was a two-arm, parallel-group, randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis.
PARTICIPANTS
Seventy primiparous or multiparous women 6 to 12 months postpartum, having a single or multiple pregnancy following any mode of delivery, with a diagnosis of DRA (IRD > 28 mm at rest or > 25 mm during a curl-up).
INTERVENTION
The experimental group was prescribed a 12-week standardised exercise program including head lifts, abdominal curl-ups and twisted abdominal curl-ups 5 days a week. The control group received no intervention.
OUTCOME MEASURES
The primary outcome measure was change in IRD measured with ultrasonography. Secondary outcomes were: observed abdominal movement during a curl-up; global perceived change; rectus abdominis thickness; abdominal muscle strength and endurance; pelvic floor disorders; and low back, pelvic girdle and abdominal pain.
RESULTS
The exercise program did not improve or worsen IRD (eg, MD 1 mm at rest 2 cm above the umbilicus, 95% CI -1 to 4). The program improved rectus abdominis thickness (MD 0.7 mm, 95% CI 0.1 to 1.3) and strength (MD 9 Nm, 95% CI 3 to 16) at 10 deg; its effects on other secondary outcomes were trivial or unclear.
CONCLUSION
An exercise program containing curl-ups for women with DRA did not worsen IRD or change the severity of pelvic floor disorders or low back, pelvic girdle or abdominal pain, but it did increase abdominal muscle strength and thickness.
REGISTRATION
NCT04122924.
Topics: Pregnancy; Female; Humans; Rectus Abdominis; Pelvic Floor Disorders; Abdominal Muscles; Postpartum Period; Exercise Therapy; Diastasis, Muscle; Abdominal Pain
PubMed: 37286390
DOI: 10.1016/j.jphys.2023.05.017 -
Scientific Reports Dec 2019Pelvic floor muscles (PFMs) play a crucial role in urinary continence. Therefore, training the PFMs remains the most popular conservative treatment for urinary... (Randomized Controlled Trial)
Randomized Controlled Trial
Pelvic floor muscles (PFMs) play a crucial role in urinary continence. Therefore, training the PFMs remains the most popular conservative treatment for urinary incontinence (UI). The effect of training other body muscles on the PFMs is unclear and mostly hypothetical. The objective of our study was to evaluate the effectiveness of postoperative diaphragm muscle, abdominal muscle and PFM training on PFM strength (PFMS) and endurance (PFME) as well as on UI in men after radical prostatectomy (RP). Per-protocol PFMS, PFME and urine loss measurements were performed at 1, 3, and 6 months postoperatively. The primary endpoints were PFMS and PFME differences among the study groups. The secondary endpoint was the correlation between UI and PFMS and PFME. In total, 148 men were randomized to the treatment groups. An increase in PFMS and PFME was observed in all groups compared to baseline (p < 0.001). The greatest difference in PFMS was in the PFM training group, but diaphragm training had the best effect on PFME. The highest (from moderate to strong) correlation between UI and PFME and PFMS (r = -0.61 and r = -0.89, respectively) was observed in the diaphragm training group. Despite different but significant effects on PFMS and PFME, all rehabilitation-training programmes decreased UI in men after RP.
Topics: Abdominal Muscles; Aged; Diaphragm; Education; Exercise Therapy; Humans; Male; Middle Aged; Muscle Strength; Muscle, Skeletal; Pelvic Floor; Prospective Studies; Prostate; Prostatectomy; Treatment Outcome; Urinary Incontinence
PubMed: 31844133
DOI: 10.1038/s41598-019-55724-4 -
Physical Therapy Aug 2020There is a lack of consensus on which abdominal or pelvic floor muscle (PFM) exercises to recommend for the treatment of diastasis recti abdominis (DRA). The objective...
OBJECTIVE
There is a lack of consensus on which abdominal or pelvic floor muscle (PFM) exercises to recommend for the treatment of diastasis recti abdominis (DRA). The objective of this study was to investigate the immediate effect of abdominal and PFM exercises on interrecti distance (IRD) in women with DRA who are parous.
METHODS
In this cross-sectional study, 38 women who were parous, with a mean age of 36.2 years (SD = 5.2), diagnosed with DRA participated. IRD was assessed with 2-dimensional real-time ultrasonography during rest and during 8 randomly ordered different exercises. A paired t test was used to compare the IRD at rest with the IRD recorded during each exercise as well as the differences between exercises. Means with 95% CI are reported.
RESULTS
Head lift and twisted curl-up exercises significantly decreased the IRD both above and below the umbilicus. Above the umbilicus, the mean IRD difference from rest during head lift was 10 mm (95% CI = 7 to 13.2), whereas during twisted curl-up it was 9.4 mm (95% CI = 6.3 to 12.5). Below the umbilicus, the corresponding values were 6.1 mm (95% CI = 3.2 to 8.9) and 3.5 mm (95% CI = 0.5 to 6.4), respectively, but PFM contraction, maximal in-drawing, and PFM contraction + maximal in-drawing increased the IRD (mean difference = -2.8 mm [95% CI = -5.2 to 0.5], -4.7 mm [95% CI = -7.2 to -2.1], and - 5.0 mm [95% CI = -7.9 to -2.1], respectively).
CONCLUSIONS
Head lift and twisted curl-up exercises decreased the IRD both above and below the umbilicus, whereas maximal in-drawing and PFM contraction exercises only increased the IRD below the umbilicus. A randomized controlled trial is needed to investigate whether head lift and twisted curl-up exercises are effective in permanently narrowing the IRD.
IMPACT
To date there is scant scientific knowledge of which exercises to recommend in the treatment of DRA. In-drawing and PFM contraction leads to an acute increase in IRD, while head lift and twisted curl-up leads to an acute decrease in IRD in postpartum women. There is a need for high-quality randomized controlled trials to investigate if there is a long-term reduction in IRD by doing these exercises over time. The acute IRD increase and decrease during the different exercises is also present in a sample of women with larger separations.
Topics: Abdominal Muscles; Adult; Cross-Sectional Studies; Diastasis, Muscle; Exercise Therapy; Female; Humans; Muscle Contraction; Palpation; Parity; Pelvic Floor; Pregnancy; Rectus Abdominis; Ultrasonography
PubMed: 32302393
DOI: 10.1093/ptj/pzaa070 -
Hernia : the Journal of Hernias and... Dec 2021To systematically review technical aspects and treatment regimens of botulinum toxin A (BTA) injections in the lateral abdominal wall musculature. We also investigated... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To systematically review technical aspects and treatment regimens of botulinum toxin A (BTA) injections in the lateral abdominal wall musculature. We also investigated the effect of BTA on abdominal muscle- and hernia dimensions, and clinical outcome.
METHODS
PubMed, EMBASE, CENTRAL, and CINAHL were searched for studies that investigate the injection of BTA in the lateral abdominal wall muscles. Study characteristics, BTA treatment regimens, surgical procedures, and clinical outcomes are presented descriptively. The effect of BTA on muscle- and hernia dimensions is analyzed using random-effects meta-analyses, and exclusively for studies that investigate ventral incisional hernia patients.
RESULTS
We identified 23 studies, comprising 995 patients. Generally, either 500 units of Dysport or 200-300 units of Botox are injected at 3-5 locations bilaterally in all three muscles of the lateral abdominal wall, about 4 weeks prior to surgery. No major procedural complications are reported. Meta-analyses show that BTA provides significant elongation of the lateral abdominal wall of 3.2 cm per side (95% CI 2.0-4.3, I = 0%, p < 0.001); 6.3 cm total elongation, and a significant but heterogeneous decrease in transverse hernia width (95% CI 0.2-6.8, I = 94%, p = 0.04). Furthermore, meta-analysis shows that BTA pretreatment in ventral hernia patients significantly increases the fascial closure rate [RR 1.08 (95% CI 1.02-1.16, I = 0%, p = 0.02)].
CONCLUSION
The injection technique and treatment regimens of botulinum toxin A as well as patient selection require standardization. Bilateral pretreatment in hernia patients significantly elongates the lateral abdominal wall muscles, making fascial closure during surgical hernia repair more likely.
STUDY REGISTRATION
A review protocol for this meta-analysis was registered at PROSPERO (CRD42020198246).
Topics: Abdominal Muscles; Abdominal Wall; Botulinum Toxins, Type A; Hernia, Ventral; Herniorrhaphy; Humans; Neuromuscular Agents; Preoperative Care; Surgical Mesh
PubMed: 34546475
DOI: 10.1007/s10029-021-02499-1 -
Medicina (Kaunas, Lithuania) Jul 2021: Prior studies have reported an activation of abdominal muscles during hypopressive exercises in women with pelvic floor disfunction. However, no previous research...
: Prior studies have reported an activation of abdominal muscles during hypopressive exercises in women with pelvic floor disfunction. However, no previous research analyzed the effects of hypopressive exercise on abdominal muscles in healthy populations to understand the normal biomechanics of this area. The aim of this study was to examine the thickness of abdominal muscles at rest and during hypopressive exercise in supine and standing positions with ultrasound imaging in healthy adults. : A cross-sectional study was carried out in 99 healthy university students. The thickness of the abdominal muscles at rest and during hypopressive exercise was assessed with ultrasound imaging in supine and standing positions. : During hypopressive exercise, there was a significant increase in the muscle thickness of transversus abdominis ( < 0.001) and internal oblique ( < 0.001) in supine and standing positions. External oblique only increased its thickness significantly in the standing position ( < 0.001) and rectus abdominis did not change during the hypopressive exercise in any position ( > 0.05). In conclusion, hypopressive exercises seem to increase the thickness of the deepest and most stabilized muscles such as transversus abdominis and internal oblique. : These findings should be considered for future interventions with hypopressive exercises in healthy subjects.
Topics: Abdominal Muscles; Abdominal Oblique Muscles; Adult; Cross-Sectional Studies; Exercise; Female; Humans; Ultrasonography
PubMed: 34356983
DOI: 10.3390/medicina57070702 -
NeuroRehabilitation 2020Trunk stability has been identified as an important prerequisite of functional movement. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Trunk stability has been identified as an important prerequisite of functional movement.
OBJECTIVE
To investigate the effectiveness of core muscle contraction training on abdominal muscle thickness, balance, and gait ability in stroke patients.
METHODS
Thirty patients with stroke were randomly assigned to two experimental groups and a control group. All groups received conventional therapeutic exercise program for six weeks. The experimental groups additionally trained trunk stability exercise with abdominal hollowing or bracing maneuvers within training time. Primary outcome measures were evaluated abdominal muscle thickness using the sonography. Secondary outcome measures were evaluated by the Functional Reach Test (FRT), Berg Balance Scale (BBS), 10-meter walk test (10MWT), and Timed Up and Go test (TUG).
RESULTS
Compared with the control group, the effect of trunk stability training for the experimental groups on the abdominal muscles thickness change was observed (p < 0.05). The values in balance and gait measures, BBS, FRT, 10MWT, and TUG, showed significant improvement after the intervention periods (p < 0.05), although no significant differences were found in scores of gait and balance scales among groups.
CONCLUSIONS
Trunk stability training with selective abdominal muscles activation has beneficial effects on abdominal muscles, balance, and mobility in stroke patients. Our findings might provide support for introducing stroke rehabilitation.
Topics: Abdominal Muscles; Aged; Aged, 80 and over; Exercise Therapy; Female; Gait; Hemiplegia; Humans; Male; Middle Aged; Muscle Strength; Postural Balance; Stroke; Stroke Rehabilitation; Treatment Outcome
PubMed: 33136074
DOI: 10.3233/NRE-203133 -
Archives of Physical Medicine and... Nov 2023To compare the effects of Swiss ball stabilization training (SBST) and stable surface stabilization training (SSST) on the trunk control, abdominal muscle thickness,... (Randomized Controlled Trial)
Randomized Controlled Trial
Effect of Swiss Ball Stabilization Training on Trunk Control, Abdominal Muscle Thickness, Balance, and Motor Skills of Children With Spastic Cerebral Palsy: A Randomized, Superiority Trial.
OBJECTIVES
To compare the effects of Swiss ball stabilization training (SBST) and stable surface stabilization training (SSST) on the trunk control, abdominal muscle thickness, balance, and motor skills of children with spastic cerebral palsy (CWSCP).
DESIGN
Single-blind, randomized superiority trial.
SETTING
General Community and Referral Center.
PARTICIPANTS
Thirty CWSCP, aged 6-12 years, with Gross Motor Function Classification System levels I-III were randomly assigned to the SBST and SSST groups (N=30).
INTERVENTIONS
The participants were randomized to receive either SBST or SSST for 5 weeks, 3 days a week.
OUTCOME MEASURES
The Trunk Control Measurement Scale (TCMS), abdominal muscle thickness, Pediatric Balance Scale (PBS), standing and walking sections of Gross Motor Function Measure (GMFM-88), and mobility section of the Pediatric Evaluation of Disability Inventory (PEDI) were assessed.
RESULTS
After 5 weeks of the intervention and 9 weeks of follow-up, the SBST group showed statistically significant improvements in the TCMS, GMFM-88, PEDI, thickness of the internal oblique muscle at rest and contraction, and thickness of the transverse abdominis muscle at rest and contraction compared with the SSST group (P<.0001). Contrarily, the thickness of the external oblique muscle increased statistically significantly in the SSST group compared with the SBST group after 5 weeks of the intervention and 9 weeks of follow-up both at rest (P<.0001 and P=.0001, respectively) and contraction (P=.015 and P=.017, respectively). No statistically significant difference was found between the groups regarding the PBS score after 5 weeks of intervention.
CONCLUSION
The SBST could improve the trunk control, balance, and motor skills of CWSCP and increase the thickness of local abdominal muscles. Also, SBST was more effective than SSST for CWSCP.
Topics: Child; Humans; Cerebral Palsy; Motor Skills; Single-Blind Method; Switzerland; Abdominal Muscles
PubMed: 37442218
DOI: 10.1016/j.apmr.2023.05.011 -
Anesthesiology Feb 2019
Review
Topics: Abdominal Muscles; Humans; Nerve Block
PubMed: 30688787
DOI: 10.1097/ALN.0000000000002524 -
NeuroRehabilitation 2020Neurodevelopmental treatment (NDT) and Dynamic neuromuscular stabilization (DNS)-based exercise is effective for improving core stability and postural control in stroke... (Randomized Controlled Trial)
Randomized Controlled Trial
Effects of dynamic core-postural chain stabilization on diaphragm movement, abdominal muscle thickness, and postural control in patients with subacute stroke: A randomized control trial.
BACKGROUND
Neurodevelopmental treatment (NDT) and Dynamic neuromuscular stabilization (DNS)-based exercise is effective for improving core stability and postural control in stroke patients.
OBJECTIVE
To compare the effects of DNS and conventional NDT exercises on diaphragm movement, abdominal muscle thickness, and postural control in stroke patients.
METHODS
The participants were randomly allocated into DNS (n = 16) and NDT (n = 15) for 30 minutes each per day, 3 days a week for 4 weeks. Diaphragm movement and abdominal muscle thickness were determined using ultrasonography. The trunk impairment scale (TIS) and Berg Balance Scale (BBS) were used to measure postural control. The functional ambulation category (FAC) was used to evaluate gait ability. Analysis of covariance (ANCOVA) was used to evaluate post-test differences in the DNS and NDT exercise groups.
RESULTS
ANCOVA revealed the superior effects of DNS in diaphragm movement and abdominal muscle thickness (transversus abdominis, internal oblique), as well as clinical BBS and FAC tests, compared with those of NDT (p < 0.05).
CONCLUSIONS
This novel clinical trial suggests that DNS training was more effective than NDT training in improving postural movement control and gait ability via a balanced co-activation of the diaphragm and TrA/IO in stroke patients.
Topics: Abdominal Muscles; Diaphragm; Exercise; Exercise Therapy; Humans; Postural Balance; Stroke; Stroke Rehabilitation
PubMed: 32250328
DOI: 10.3233/NRE-192983 -
Clinics in Sports Medicine Apr 2021Core muscle injury is a common but difficult problem to treat. Although it can affect all individuals, it is most commonly seen in male athletes in cutting, twisting,... (Review)
Review
Core muscle injury is a common but difficult problem to treat. Although it can affect all individuals, it is most commonly seen in male athletes in cutting, twisting, pivoting, and explosive sports. Owing to the high association of femoroacetabular impingement, we believe these individuals are best treated with a multidisciplinary approach involving both orthopedic and general surgeons. Conservative treatment should be the first step in management. When conservative means are unsuccessful, operative intervention to correct all the pathologic issues around the pubis can have extremely high success rates.
Topics: Abdominal Muscles; Athletes; Athletic Injuries; Femoracetabular Impingement; Groin; Humans; Magnetic Resonance Imaging; Male; Muscles
PubMed: 33673890
DOI: 10.1016/j.csm.2020.12.001