Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study

Lee, Diane and Hodges, Paul W. (2016) Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study. Journal of Orthopaedic and Sports Physical Therapy, 46 7: 580-589. doi:10.2519/jospt.2016.6536


Author Lee, Diane
Hodges, Paul W.
Title Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study
Journal name Journal of Orthopaedic and Sports Physical Therapy   Check publisher's open access policy
ISSN 0190-6011
1938-1344
Publication date 2016-07-01
Year available 2016
Sub-type Article (original research)
DOI 10.2519/jospt.2016.6536
Open Access Status Not yet assessed
Volume 46
Issue 7
Start page 580
End page 589
Total pages 10
Place of publication Alexandria, VA, United States
Publisher American Physical Therapy Association * Orthopedic Section
Collection year 2017
Language eng
Formatted abstract
Study Design: Cross-sectional repeated measures.

Background: Rehabilitation of diastasis rectus abdominis (DRA) generally aims to reduce the inter-rectus distance (IRD). We tested the hypothesis that activation of the transversus abdominis (TrA) before a curl-up would reduce IRD narrowing, with less linea alba (LA) distortion/deformation, which may allow better force transfer between sides of the abdominal wall.

Objectives: This study investigated behavior of the LA and IRD during curl-ups performed naturally and with preactivation of the TrA.

Methods: Curl-ups were performed by 26 women with DRA and 17 healthy control participants using a natural strategy (automatic curl-up) and with TrA preactivation (TrA curl-up). Ultrasound images were recorded at 2 points above the umbilicus (U point and UX point). Ultrasound measures of IRD and a novel measure of LA distortion (distortion index: average deviation of the LA from the shortest path between the recti) were compared between 3 tasks (rest, automatic curl-up, TrA curl-up), between groups, and between measurement points (analysis of variance).

Results: Automatic curl-up by women with DRA narrowed the IRD from resting values (mean U-point between-task difference, -1.19 cm; 95% confidence interval [CI]: -1.45, -0.93; P<.001 and mean UX-point between-task difference, -0.51 cm; 95% CI: -0.69, -0.34; P<.001), but LA distortion increased (mean U-point between-task difference, 0.018; 95% CI: 0.0003, 0.041; P = .046 and mean UX-point between-task difference, 0.025; 95% CI: 0.004, 0.045; P = .02). Although TrA curl-up induced no narrowing or less IRD narrowing than automatic curl-up (mean U-point difference between TrA curl-up versus rest, -0.56 cm; 95% CI: -0.82, -0.31; P<.001 and mean UX-point between-task difference, 0.02 cm; 95% CI: -0.22, 0.19; P = .86), LA distortion was less (mean U-point between-task difference, -0.025; 95% CI: -0.037, -0.012; P<.001 and mean UX-point between-task difference, -0.021; 95% CI: -0.038, -0.005; P = .01). Inter-rectus distance and the distortion index did not change from rest or differ between tasks for controls (P≥.55).

Conclusion: Narrowing of the IRD during automatic curl-up in DRA distorts the LA. The distortion index requires further validation, but findings imply that less IRD narrowing with TrA preactivation might improve force transfer between sides of the abdomen. The clinical implication is that reduced IRD narrowing by TrA contraction, which has been discouraged, may positively impact abdominal mechanics.
Keyword Diastasis rectus abdominis
Inter-rectus distance
Rehabilitation
Transversus abdominis
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
HERDC Pre-Audit
School of Health and Rehabilitation Sciences Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 0 times in Thomson Reuters Web of Science Article
Scopus Citation Count Cited 0 times in Scopus Article
Google Scholar Search Google Scholar
Created: Sun, 31 Jul 2016, 00:17:14 EST by System User on behalf of Learning and Research Services (UQ Library)