Effectiveness of NMES and Taping on Diastasis Recti in Postnatal Women
Keywords:Core Stabilization Exercises, Diastasis Recti, Inter Recti Distance, Kinesiotaping, Low Back Pain, Neuromuscular Electrical Stimulation
AbstractThe release of hormones like relaxin and estrogen occur during the gestational period and the fetal growth takes place which expands the uterus resulting in increased pressure against the abdominal wall. This causes stretching of the connective tissue, linea alba and as the weeks proceed the fetal growth occurs more and more rapidly resulting in further stretching of the connective tissue and the abdominal muscles causing an eventual decrease contraction strength weakening of muscles and can lead to a separation and widening of the space between the two rectus abdomen is muscles known as Diastasis of Recti Abdominis Muscles (DRAM). Diastasis recti is thus most common during pregnancy having a prevalence of 100% at gestational week 35 and can lead to various secondary problems like low back pain, shallow breathing and pelvic region pain. Though it is the most commonly occurring condition, it might not be painful in most cases initially and thus goes unnoticed and untreated. Purpose of the study was to compare the effects of NeuroMuscular Electrical Stimulation (NMES) and Kinesiotaping along with core stabilization exercises on diastasis recti in postnatal women, in terms of inter recti distance, abdominal muscle strength and low back pain. A total of 40 women with significant diastasis recti, 6 weeks postnatal, participated in the study. They were equally divided with random selection of 20 subjects in two groups each, Group A was treated with NMES and Group B received Kinesiotaping and both the groups in addition received core stabilization exercises. The results revealed very significant improvement in both the groups in all the measured parameters, (p<0.05). However, the intergroup comparisons showed significant improvement in all the measured parameters in group A (p<0.05). Thus, the study concluded that NMES along with core stabilization exercises is effective in recovery of diastasis recti and increasing abdominal muscle strengthas well as improvement in its complications like low back pain.
Kamel DM, Yousif AM. Neuromuscular electrical stimulation and strength recovery of postnatal diastaseisrecti abdomin is muscles. Annals of Rehabilitation Medicine. 2017 Jun; 41(3):465. https://doi.org/10.5535/arm.2017.41.3.465.
Dalal K, Kaur A, Mitra M. Correlation between diastasis rectus abdominis and lumbopelvic pain and dysfunction. Indian Journal of Physiotherapy and Occupational Therapy. 2014;8(1):210.
Yalfani A, Bigdeli N, Ahmadi M. Effectiveness of abdominal strengthening exercises in the treatment of diastasisrecti in postpartum period. The Scientific Journal of Rehabilitation Medicine. 2019;8(4): 280-290. https://doi.org/10.22037/jrm.2019.111509.2045.
Lalingkar RA, Gosavi PM, Jagtap VK, Yadav TS. Effect of electrical stimulation followed by exercises in postnatal diastasisrecti abdominis. International Journal of Health Sciences and Research. March 2019; 9(3):88-92. https://www.ijhsr.org/IJHSR_Vol.9_Issue.3_March2019/13.pdf.
Acharry N, Kutty R K. Abdominal exercise with bracing, atherapeutic efficacy in reducing diastasis-recti among postpartal females. Int. J. Physi other. Res.2015;3(2):999-1005. https://doi.org/10.16965/ijpr.2015.122.
Pawar P A, Yeole UL, Navale M, Patil K. Effect of kinesiotaping on diastasis recti in post-partum women. Indian Journal of Public Health Research and Development. 2020 Jun 1; 11(6).
Kale A, Suryawanshi A, Bellare B. Effect of postnatal physiotherapy during puerperal management of low back painand diastasis recti. Archives of Medicine and Health Sciences.2020 Jul 1; 8(2):278.
Calguneri M, Bird H A,Wright V. Changes in joint laxity occurring during pregnancy. Ann. Rheum. Dis. 1982; 41:126128. https://doi.org/10.1136/ard.41.2.126.
Maha Mohamed Mady. Kinesiotaping therapy techniques for treating postpartum rectus diastases: A comparative study. IOSR Journal of Nursing and Health Science (IOSR-JNHS). 2018;7(3):67-74.
Parker MA, Millar LA, Dugan SA. Diastasis rectus abdominis and lumbo-pelvic pain and dysfunction-are they related? Journal of Women's Health Physical Therapy. 2009 Jul 1; 33(2):15-22. https://doi.org/10.1097/01274882-200933020-00003.
Gitta S, Magyar Z, Tardi P, Füge I, Járomi M, ícs P, Garai J, Bódis J, Hock M. How to treat diastasis recti abdominis with physical therapy: A case report. Journal of Diseases. 2016; 3(2):16-20. https://doi.org/10.18488/journal.99/2016.3.2/18.104.22.168.
Chiarello C M, Falzone L A, Mc Caslin K E, Patel M N, Ulery K R. The effects of an exercise program on diastasisrecti abdominisin pregnant women. Journal of Women's Health Physical Therapy. 2005 Apr1; 29(1):11-16. https://doi.org/10.1097/01274882200529010-00003.
Litos K. Progressive the rapeutic exercise program for success ful treatment of a postpartum woman with a severe diastasis rectiabdominis. Journal of Women's Health Physical Therapy. 2014 May 1; 38(2):58-73. https://doi.org/10.1097/JWH.0000000000000013.
Jessen M L, í–berg S, Rosenberg J. Treatment options for abdominal rectus diastasis. Frontiers in Surgery. 2019 Nov 19;6:65. https://doi.org/10.3389/fsurg.2019.00065.
Bobowik P Å», Dć…bek A. Physiotherapy in women with diastasis of the rectusabdominis muscles. Advances in Rehabilitation. 2018; 2018(3):11-17. https://doi.org/10.5114/areh.2018.80964.
Keeler J, Albrecht M, Eberhardt L, Horn L, Donnelly C, Lowe D. Diastasis recti abdominis: A survey of women's health specialists for current physical therapy clinical practice for postpartum women. Journal of Women's Health Physical Therapy. 2012 Sep 1;36(3):131-142. https://doi.org/10.1097/JWH.0b013e318276f35f.
Mady M M. Effec to fKinesiotaping the rapy on waist circumferences in postpartum women. Journal of Medicine in Scientific Research. 2018 Jan1;1(1):48. https://doi.org/10.4103/ JMISR.JMISR_12_18.
Kalinowski P, Krawulska A. Kinesiotaping vs. place bo in reducing pregnancy-related low back pain: A cross-over study. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2017; 23:6114. https://doi.org/10.12659/MSM.904766.
Gürşen C, ć°nanoğlu 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):557565. https://doi.org/10.1007/s00404-015-3862-3.
Sanjivani Ramesh Khandale, Deepali Hande. Effects of Abdominal Exercises on Reduction of Diastasis Rectiin Postnatal Women. International Journal of Health Sciences and Research. June 2016;6(6):182-191. https://www.ijhsr.org/IJHSR_Vol.6_ Issue.6_June2016/32.pdf.
Porcari JP, Miller J, Cornwell K, Foster C, Gibson M, McLean K, Kernozek T. The effects of neuromuscular electrical stimulation training on abdominal strength, endurance, and selected anthropometric measures. Journal of Sports Science and Medicine. Mar 2005;4(1):66.
Gluppe SL, Hilde G, Tennfjord MK, Engh ME, Bí¸K. Effect of a postpartum training program on the prevalence of diastasis rectiabdominis in postpartum primiparous women: A randomized controlled trial. Physical Therapy. 2018 Apr 1; 98(4):260-268. https://doi.org/10.1093/ptj/pzy008.
Cuthbert SC, Goodheart GJ. On the reliability and validity of manual muscle testing: A literature review. Chiropractic and Osteopathy. 2007 Dec;15(1):1-23. https://doi.org/10.1186/1746-1340-15-4.
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.
Hwang UJ, Kwon OY, Jung SH, Kim HA, Gwak GT. Effect of neuromuscular electrical stimulation training for abdominal muscles on change of muscle size, strength, endurance and lumbopelvic stability. The Journal of Sports Medicine and Physical Fitness. 2020 Feb 1; 60(2):206-213. https://doi.org/10.23736/ S0022-4707.19.09998-5.
Parmentier M. Diastasis recti: A solution. 2003. https:// www.kinesiotaping.com/console/uploads/material_ document/2003-1.pdf.
Magyar Z, Tardi P, Jaromi M, Acs P, Garai J, Bodis J, Hock M. How to treat diastasis recti abdominis with physical therapy: A case report. Journal of Diseases, Conscientia Beam. 2016; 3(2):16-20. https://ideas.repec.org/a/pkp/joudis/2016p16-20.html.
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 Dec 7; 5(12):4441-4446. https://doi.org/10.18203/2320-1770.ijrcog20164360.
Cañamero-de León S, Da Cuña-CarreraI, dela Hoz González CA, Soto-González M. Effects of an exercise program on diastasis recti in women. International Journal of Health Sciences and Research. October 2019; 9(10);90-99. https://www.ijhsr.org/IJHSR_Vol.9_Issue.10_Oct2019/14.pdf