Investigating the effect of three contrasting interventions on recovery of abdominal muscle separation after childbirth
A feasibility randomised controlled trial of three contrasting interventions for recovery of persistant post-natal diastasis of the rectus abdominis muscle
Dr Tanja Miokovic
100 participants
Jun 11, 2021
Interventional
Conditions
Summary
This aim of this pilot trial is to assess the best management approach to rehabilitation of postnatal Diastasis of the Rectus Abdominis Muscle (DRAM), commonly referred to as abdominal muscle separation, 100 first-time mothers will be recruited for this study. Participants with DRAM at 6-8 weeks postnatal will be allocated to one of three intervention groups: advice only; abdominal binder; back and abdominal muscle exercise. Ultrasound imaging will be used to collect images of the abdominal muscles for the linea alba distortion index (primary outcome measure) and inter-rectii distance. Additional outcome measures include- low back pain, pelvic girdle pain, stress urinary incontinence and body image. It is hypothesised that: 1) the linea alba tension rather than the inter-rectii distance will have more of an impact on functional outcomes of low back and pelvic girdle pain, body image and pelvic floor function; and 2) the exercise group will demonstrate significantly less linea alba distortion than the control or abdominal binder groups.
Eligibility
Inclusion Criteria4
- aged > 18 years;
- <2 weeks postnatal at time of enrolment into study;
- Primiparous (first pregnancy or first pregnancy beyond 20 weeks’ gestation);
- Willing/able to travel to follow up appointments at site of data collection
Exclusion Criteria14
- Obstetric anal sphincter injury;
- Caesarean section;
- BMI > 30;
- Any major medical condition that precludes performance of an exercise program;
- History of musculoskeletal pain sufficient to limit function in the 3 years prior to
- conception;
- Provision of Physiotherapy management for pregnancy related musculoskeletal or pelvic
- floor function in the past 6 months;
- Urinary incontinence prior to conception;
- Pre-existing pelvic organ prolapse (if known);
- History of spinal/pelvic fractures or lumbar spine surgery;
- Neurological or neuromuscular conditions;
- Chronic Respiratory conditions;
- Inability to read/understand English.
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Interventions
Participants will be enrolled in the study prior to two weeks post-natal. The first baseline data (outcome measure) collection timepoint will take place at two weeks postnatal. Participants will be re-assessed at eight weeks post-natal and those that have persistent diastasis of the rectus abdominis muscle allocated to one of three groups for intervention (of 12 weeks duration): 1. Advice only 2. Abdominal support - these participants will be required to wear an abdominal support for 10-12 hours/day for 12 weeks. The abdominal support is an easily removable elasticised garment worn in a double layer extending from the pubic symphysis to the xiphoid process of the sternum. Instructions for wear and fitting will be provided by an experienced Women's Health Physiotherapist. Participants will be asked to complete a diary to monitor adherence to the intervention. 3. Abdominal exercise- these participants will be required to see a Physiotherapist for 7 sessions over 12 weeks for exercise prescription and progression and be asked to perform these exercises at home 5 times per week for 20 minutes. Exercises will commence with static activation of the transverses abdominis muscle in crook-lying, side-lying and 4-point-kneel position. These will be progressed to including arm and/or leg movements and further progressed to involve movement of the Thorax on the lumbar spine i.e. curl-up, Russian twist. Exercises are of a low-moderate intensity and will be performed until fatigue. This will be assessed via monitoring of posture, breathing and correct muscle activation patterns. Participants will be asked to complete an exercise diary to monitor adherence to the intervention. Outcome measures will be reassessed at the end of the intervention i.e. at 20 weeks post-natal, with the final outcome measure data collection to take place 3 months following the end of the intervention i.e. when participants are 32 weeks post-natal.
Locations(1)
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ACTRN12621000613808