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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 -
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 -
Anesthesiology Nov 2019In this narrative review article, the authors discuss the anatomy, nomenclature, history, approaches (posterior vs. lateral vs. subcostal), techniques, pharmacology,... (Review)
Review
In this narrative review article, the authors discuss the anatomy, nomenclature, history, approaches (posterior vs. lateral vs. subcostal), techniques, pharmacology, indications, and complications of transversus abdominis plane blocks, as well as possible alternative truncal blocks.Despite the scarcity of evidence and contradictory findings, certain clinical suggestions can nonetheless be made. Overall transversus abdominis plane blocks appear most beneficial in the setting of open appendectomy (posterior or lateral approach). Lateral transversus abdominis plane blocks are not suggested for laparoscopic hysterectomy, laparoscopic appendectomy, or open prostatectomy. However, transversus abdominis plane blocks could serve as an analgesic option for Cesarean delivery (posterior or lateral approach) and open colorectal section (subcostal or lateral approach) if there exist contraindications to intrathecal morphine and thoracic epidural analgesia, respectively.Future investigation is required to compare posterior and subcostal transversus abdominis plane blocks in clinical settings. Furthermore, posterior transversus abdominis plane blocks should be investigated for surgical interventions in which their lateral counterparts have proven not to be beneficial (e.g., laparoscopic hysterectomy/appendectomy, open prostatectomy). More importantly, because posterior transversus abdominis plane blocks can purportedly provide sympathetic blockade and visceral analgesia, they should be compared with thoracic epidural analgesia for open colorectal surgery. Finally, transversus abdominis plane blocks should be compared with newer truncal blocks (e.g., erector spinae plane and quadratus lumborum blocks) with well-designed and adequately powered trials.
Topics: Abdominal Muscles; Cesarean Section; Colorectal Surgery; Humans; Nerve Block; Pain, Postoperative
PubMed: 31283738
DOI: 10.1097/ALN.0000000000002842 -
International Journal of Environmental... Jul 2021Trunk stability exercises that focus on either deep or superficial muscles might produce different effects on lumbar segmental motion. This study compared outcomes in 34... (Randomized Controlled Trial)
Randomized Controlled Trial
The Effects of Core Stabilization Exercise with the Abdominal Drawing-in Maneuver Technique versus General Strengthening Exercise on Lumbar Segmental Motion in Patients with Clinical Lumbar Instability: A Randomized Controlled Trial with 12-Month Follow-Up.
Trunk stability exercises that focus on either deep or superficial muscles might produce different effects on lumbar segmental motion. This study compared outcomes in 34 lumbar instability patients in two exercises at 10 weeks and 12 months follow up. Participants were divided into either Core stabilization (deep) exercise, incorporating abdominal drawing-in maneuver technique (CSE with ADIM), or General strengthening (superficial) exercise (STE). Outcome measures were pain, muscle activation, and lumbar segmental motion. Participants in CSE with ADIM had significantly less pain than those in STE at 10 weeks. They showed significantly more improvement of abdominal muscle activity ratio than participants in STE at 10 weeks and 12 months follow-up. Participants in CSE with ADIM had significantly reduced sagittal translation at L4-L5 and L5-S1 compared with STE at 10 weeks. Participants in CSE with ADIM had significantly reduced sagittal translations at L4-L5 and L5-S1 compared with participants in STE at 10 weeks, whereas STE demonstrated significantly increased sagittal rotation at L4-L5. However, at 12 months follow-up, levels of lumbar sagittal translation were increased in both groups. CSE with ADIM which focuses on increasing deep trunk muscle activity can reduce lumbar segmental translation and should be recommended for lumbar instability.
Topics: Abdominal Muscles; Follow-Up Studies; Humans; Joint Instability; Lumbar Vertebrae; Lumbosacral Region; Torso
PubMed: 34360103
DOI: 10.3390/ijerph18157811 -
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 -
The Journal of International Medical... Feb 2013To assess the effect of pelvic floor muscle exercise in patients with chronic low back pain. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To assess the effect of pelvic floor muscle exercise in patients with chronic low back pain.
METHODS
Adults (aged ≥ 18 years) with chronic low back pain (with or without radiculopathy) were randomized to undergo either routine treatment (ultrasonography, short wave diathermy and lumbar strengthening exercises; control group) or routine treatment with pelvic floor exercises (intervention group) for 24 weeks. Pain, disability (Oswestry Disability Index [ODI] score) and trunk muscle function were assessed at baseline and after completion of treatment.
RESULTS
The study included 47 patients (control group n = 24; intervention group n = 23). Pain severity and ODI scores were significantly lower in the intervention group than in the control group after 24 weeks. There were no significant between-group differences in trunk muscle function.
CONCLUSION
Pelvic floor exercise in combination with routine treatment provides significant benefits in terms of pain relief and disability over routine treatment alone.
Topics: Abdominal Muscles; Adult; Chronic Pain; Demography; Disability Evaluation; Exercise Therapy; Female; Humans; Low Back Pain; Male; Pelvic Floor; Ultrasonography
PubMed: 23569140
DOI: 10.1177/0300060513475383 -
Journal of Applied Physiology... Sep 2000In humans, when the stability of the trunk is challenged in a controlled manner by repetitive movement of a limb, activity of the diaphragm becomes tonic but is also...
In humans, when the stability of the trunk is challenged in a controlled manner by repetitive movement of a limb, activity of the diaphragm becomes tonic but is also modulated at the frequency of limb movement. In addition, the tonic activity is modulated by respiration. This study investigated the mechanical output of these components of diaphragm activity. Recordings were made of costal diaphragm, abdominal, and erector spinae muscle electromyographic activity; intra-abdominal, intrathoracic, and transdiaphragmatic pressures; and motion of the rib cage, abdomen, and arm. During limb movement the diaphragm and transversus abdominis were tonically active with added phasic modulation at the frequencies of both respiration and limb movement. Activity of the other trunk muscles was not modulated by respiration. Intra-abdominal pressure was increased during the period of limb movement in proportion to the reactive forces from the movement. These results show that coactivation of the diaphragm and abdominal muscles causes a sustained increase in intra-abdominal pressure, whereas inspiration and expiration are controlled by opposing activity of the diaphragm and abdominal muscles to vary the shape of the pressurized abdominal cavity.
Topics: Abdomen; Abdominal Muscles; Adult; Diaphragm; Electromyography; Extremities; Humans; Male; Motion; Movement; Muscle, Skeletal; Posture; Pressure; Respiration; Respiratory Physiological Phenomena; Ribs; Shoulder; Spine
PubMed: 10956340
DOI: 10.1152/jappl.2000.89.3.967 -
Anesthesiology Feb 2019
Review
Topics: Abdominal Muscles; Humans; Nerve Block
PubMed: 30688787
DOI: 10.1097/ALN.0000000000002524 -
International Journal of Environmental... Jun 2022To investigate the efficacy of exercise intervention using a real-time video conferencing platform (ZOOM) on inter-recti distance, abdominal muscle thickness, static... (Randomized Controlled Trial)
Randomized Controlled Trial
To investigate the efficacy of exercise intervention using a real-time video conferencing platform (ZOOM) on inter-recti distance, abdominal muscle thickness, static trunk endurance, and maternal quality of life, 37 women with diastasis recti between six months and one year postpartum were randomly divided into the online (n = 19) and offline (n = 18) groups. The online group underwent 40-min trunk stabilization exercise sessions twice a week for six weeks, through a real-time video conference platform, while the offline group attended the same program in person. The inter-recti distance and muscle thickness between the abdominal muscles were measured by rehabilitation ultrasound imaging, the Torso endurance test was used to compare the static trunk endurance, and the maternal quality of life questionnaire (MAPP-QOL, score) was applied. Significant improvements were observed in the inter-recti distance between the rectus abdominis, abdominal muscle thickness, static trunk endurance, and maternal quality of life in both groups (p < 0.001); a more significant improvement was observed in the offline group. No significant differences were observed between groups except for the left rectus abdominis thickness and Psychological/Baby and Relational/Spouse-Partner subscale in the maternal quality of life index (p > 0.05). Exercise interventions delivered in a real-time videoconferencing platform are effective at improving the inter-recti distance, trunk stability, and quality of life in postpartum women and may be an alternate to face-to-face intervention.
Topics: Exercise; Female; Humans; Postpartum Period; Quality of Life; Rectus Abdominis; Videoconferencing
PubMed: 35742279
DOI: 10.3390/ijerph19127031