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Publication date: 01.03.2023
DOI: 10.51871/2782-6570_2023_02_01_6
UDC 616-001.7; 612.062; 615.825

PHYSICAL REHABILITATION IN THE CORRECTION OF DIASTASIS IN WOMEN IN THE LATE POSTPARTUM PERIOD: A LITERATURE REVIEW

M.V. Severtseva1,2, N.V. Lunina1,3

1Russian State University of Physical Culture, Sports, Youth and Tourism, Moscow, Russia

2Stretching Studio “ProstoShpagat”, Moscow, Russia

3FSBI “North-Caucasian Federal Research and Clinical Center of the Federal Medical and Biological Agency”, Essentuki, Russia

Annotation. The article presents an overview of Russian and foreign studies in the field of physical rehabilitation in the correction of diastasis recti in women in the late postpartum period. Statistical data indicate a high risk of developing diastasis in women both during pregnancy and in different periods of the postpartum period. Along with other, the most significant active means of correcting diastasis are physical exercises, the effectiveness and differentiated use of which are presented in an analytical review. The data obtained made it possible to identify the main directions in the use of physical rehabilitation means in the late postpartum period for the correction of diastasis recti.

Keywords: diastasis recti, pelvic floor muscles, transverse abdominis muscle, physical rehabilitation, exercise, women, postpartum period, health, quality of life.

Introduction. Diastasis recti is a pathological state described by the broadened and thinned linea alba, in severe cases – a whole muscular and aponeurotic carcass of the anterior abdominal wall, up to semilunar line [1].

According to the statistical data, diastasis can be found in both men (27.9%) and women (72.1%) mainly in the age of 25-35 years. Moreover, women are more interested in keeping an optimal functional state and form of the anterior abdominal wall compared to men, which predetermined the direction of studying the diastasis development in this group of patients. In addition, diastasis is found in 24-70% of cases in women during different postpartum terms [2].

Due to the fact that there is not enough data on diagnosis of postpartum complications related to the core, such as diastasis and weakness of the pelvic floor muscles, examination of the issue is of great relevance [3].The purpose of this study was a theoretical analysis of ways and methods of physical rehabilitation for correcting diastasis in women in the late postpartum period.

Methods and organization. The study used the content analysis of scientific works of Russian and foreign authors, presented in peer-reviewed scientific journals, Russian and foreign databases. The authors have examined 35 sources, 20 of them were chosen.

Results and discussion. The studies show that immediately after delivery, due to stress caused by it, up to 53% of women have a number of issues related to diastasis [4]. J. Sperstad et al. and P.G. Fernandes da Mota revealed a connection between the disease and terms of pregnancy: on the 21st week of pregnancy, the incidence rate amounted to 33.1%, 6 weeks
after birth – 60.0%, 6 months after birth – 45.5%, 12 months after birth – 32.6% [5].

Main risks factors of diastasis are: multiparous, hydramnious and consecutive pregnancies [2], which, accompanied by hypomobility and sedentary lifestyle, may cause changes requiring usage of effective recovery means [6]. Age, height, average body mass before pregnancy, mass gain during pregnancy, operative delivery, baby’s body mass, benign hypermobility syndrome, physical fitness level of the abdominal cavity and pelvic floor muscles, total physical fitness were not attributed to risk factors of diastasis development [7].

The degree of diastasis’s progression is classified by the distance between two medial borders of the abdominal rectus muscles (the table presents the R.P. Askerkhanov’s classification).

Table

Diastasis recti classification (according to R.P. Askerkhanov)

Diastasis degree

Distance between the muscles at rest, mm

I

22-50

II

51-80

III

>80

Pregnancy leads to the overstretched abdominal muscles, weakness of the pelvic floor muscles, which is a frequent cause of back, lower back and collar zone pain in the postpartum period [6]. Accompanied with pain and discomfort in the abdominal region, there are also disorders in the function of the musculoskeletal system, urogynecology, changes in body parameters, deteriorated quality of life [8].

Moreover, diastasis is not considered as a problem for many postpartum women. They think that the issue will solve itself due to an increase of daily activity related to a child’s delivery, which leads to preservation of diastasis recti for many years [4].

If diastasis recti remains 9 months after delivery, then this state requires elective surgical treatment [9]. However, currently there is no universal, “ideal” surgery that would solve all issues of a woman body connected to diastasis in the postpartum period [10].

Application of physical loads is considered as a way of comprehensive treatment directed towards prevention of disorders in the postpartum period, including the period after the surgical treatment of diastasis. Physical rehabilitation programs have different variants and are aimed at reducing a defect of the linea alba.

Physical exercises are one of the main means of physical rehabilitation that solve the issues occurring in a woman’s body after pregnancy. Accompanied with other measures, they can be used during pregnancy to prevent possible complications [11].

According to O.N. Likhacheva [12], women who engage in special gymnastics are less likely to have complications compared to women who lead a sedentary lifestyle [12].

This statement corresponds with the data from other studies, which show a risk of developing diastasis reduced by 35% in case if pregnant women performed a special kinesiologic set of exercises for the abdominal muscles [13]. The study of M.M. Yul’tsova on diastasis correction recommends following exercises: bottom lifts while lying; alternate leg lifts while lying, legs half-bent; leg lifts while lying followed by leg bends and pulls to the body; respiratory exercises, in which one needs to suck in the stomach on the inhale and relax it on the exhale [13]. According to the author’s opinion, following exercises are not recommended: stretching and curling exercises with objects and equipment; yoga positions with overstretching the anterior abdominal wall; exercises that lead to increased abdominal pressure, provoke overstretching of the anterior abdominal wall; simultaneous leg pulls to stomach without control over the linea alba [13].

The application of exercises in the early postpartum period has great importance. In their research, E.Z. Abraamyan, K.M. Nazhmutdinova, L.A. Yatskova came to a conclusion that most women who did not start health gymnastics in 6 weeks after delivery are not able to recover the pre-birth level of physical activity for several years [14].

For correction of the weakened abdominal muscles over a 1-2-month course, N.A. Danilova suggests daily repeated performance of simple respiratory exercises and a single performance of a complex of six simple corrective exercises for the abdominal muscles in following initial positions: standing, lying on the back, lying on the side, for the rectus abdominis, obliques and transversus abdominis, as well as the pelvic floor muscles [15].

The same guidelines are given by N.E. Kavtorova and O.A. Sultanova. Performance of physical exercises for obliques and transversus abdominis contributes to quicker recovery of the ligamentous and support system of the problematic area muscles [16].

In order to recover the anterior abdominal wall muscles effectively, V.L. Musnikov suggests performing respiratory exercise separately and combined with exercises for the abdominal muscles, pelvic floor muscles, adductors and abductors [17].

Implementation of various means and forms of physical rehabilitation to correct diastasis recti should have not only special, but a general direction as well, making a systemic health effect on a woman’s body during the postpartum period. For example, in the study of M.A. Topchieva et al, the use of fitball in gymnastics for comprehensive rehabilitation of postpartum women with diastasis revealed a significant improvement of not only the physical fitness, but also the functional state of the cardiovascular system [18].

According to Yu.B. Tkhamucheva, the most popular form of therapeutical physical culture is health gymnastics due to its systemic effect on the body and comprehensive health recovery in the postpartum period [19].

In O.V. Onofrijchuk’s opinion, the effectiveness of hypopressive gymnastics in comprehensive recovery of the body after birth is based on using postural exercises that contribute to an improvement and recovery of adequate muscle tone attributed to the deep front line [3].

In the modern research review by Majken Lyhne Jessen et al, dedicated to research of the effectiveness of existing methods of physical rehabilitation in diastasis recti correction, there are still questions that need clearance and further research. However, the authors confirm that the conservative method that includes therapeutic gymnastics for correction and strengthening of the problematic muscles, active correction combined with teaching how to preserve correct posture and passive correction in form of bandage and supporting accessories is the priority way of treatment [8].

Duration of the physical exercise course in the postpartum period defines its effectiveness, which is demonstrated in the work of Sandra L. Gluppe, Gunvor Hilde, Merete K. Tennfjord, Marie E. Engh and Kari Bø [20]. According to the authors’ findings, application of special exercises on the pelvic floor muscles and transversus abdominis leads to a decreased gap between the rectus abdominis immediately after labor. After a subsequent observation over women 6 and 12 months after birth, the researchers revealed that the highest correcting and lifting effect on the linea alba is noted in case of simultaneous pelvic floor muscles’ contraction with the obliques’ activation [20].

The diastasis recti correction does not only eliminates a defect of the anterior abdominal wall, contributes to more effective systemic recovery of health, but also significantly improves a woman’s quality of life. The study of Ali A. Thabet and Mansour A. Alshehri demonstrates that stabilization of the deep core muscles with the “deep core stability” system of exercises leads to a decreased gap of the recti abdominis and closely correlates with an improved quality of life in the postpartum period [4].

Conclusion. Diastasis recti, observed in women during pregnancy and the postpartum period, is not only a cosmetic, anatomical and functional defect of the problematic area muscles, but also a factor that prevents a full and systemic recovery of health after labor, decreasing a quality of life as well. Different active means and forms of physical rehabilitation, mainly physical exercises of general and special direction applied long-term in the postpartum period, serve as a basis for systemic correcting recovery of women with diastasis recti.

By conducting the literature analysis, we have managed to form a theoretical foundation on role and significance of applying different physical exercises for prevention and correction of diastasis recti. In future, it will serve as a basis for development of methodological guidelines and conduction of compre­hensive recovery events of corrective direction to restore health of women with diastasis after labor and improving their quality of life in the postpartum period.

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INFORMATION ABOUT THE AUTHORS:
Maria Vyacheslavovna Severtseva
– Master’s Student of the Department of Physical Rehabilitation, Massage and Health-Improving Physical Culture named after I.M. Sarkizov-Serazini, Russian State University of Physical Culture, Sports, Youth and Tourism; Co-founder, Coach and Rehabilitation Expert of the Stretching Studio “ProstoShpagat”, Moscow.
Natal’ya Vladimirovna Lunina – Candidate of Biological Sciences, Associate Professor, Associate Professor of the Department of Physical Rehabilitation, Massage and Health-Improving Physical Culture named after I.M. Sarkizov-Serazini, Russian State University of Physical Culture, Sports, Youth and Tourism, Moscow; Senior Researcher Center for Biomedical Technologies, FSBI “North-Caucasian Federal Research-Clinical Center of Federal Medical and Biological Agency”, Essentuki, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it..

For citation: Severtseva M.V., Lunina N.V. Physical rehabilitation in the correction of diastasis in women in the late postpartum period: a literature review. Russian Journal of Sports Science: Medicine, Physiology, Training, 2023, vol. 2, no. 1. DOI: 10.51871/2782-6570_2023_02_01_6