IJPR.2021.137
Type of Article: Original Research
Volume 9; Issue 4 (July 2021)
Page No.: 3888-3894
DOI: https://dx.doi.org/10.16965/ijpr.2021.137
Assessment of Diastasis Recti Abdominis using Dial Caliper in Overweight and Obese Adults (18 years and above) and Its Relationship with Lumbopelvic Pain: A Pilot Study
Bharati D. Asgaonkar 1, Pooja P. Khedekar *2.
1 Associate Professor, Department of Physiotherapy, P.T. School and Centre, T.N.M.C, Mumbai, Maharashtra, India.
*2 Department of Physiotherapy, P.T. School and Centre, T.N.M.C, Mumbai, Maharashtra, India.
Corresponding Author: Dr. Pooja P. Khedekar, PT., Department of Physiotherapy, P.T. School and Centre, T.N.M.C, Mumbai, Maharashtra, India. E-Mail: Khedekar.pooja08@gmail.com
ABSTRACT
Background: Diastasis recti abdominis is present in both gender and is associated with increasing age, activities including regular lifting of heavy weights or sit-ups, a history of midline abdominal surgery, significant hormonal changes due to replacement therapy, menopause, congenital, chronic obstructive pulmonary disease and obesity. Studies have proven physiotherapy is beneficial in managing DRA but not many studies are done to show presence of DRA. Hence our study is a small attempt at diagnosing DRA in most vulnerable population i.e. overweight and obese population.
Objective: To assess presence of diastasis recti abdominis in overweight and obese adults (18 years and above) using dial caliper. To correlate diastasis recti abdominis with lumbopelvic pain, gender and parity.
Methods: 90 subjects were allocated in this study (30 overweight, 30 obese 1 and 30 obese 2). Presence of DRA was assessed using dial caliper in them and correlated with BMI. Subjects who had DRA present, their values were correlated further with Lumbopelvic pain, gender and parity.
Results: Out of 90 subjects, 67 (74%) had DRA present [21 (23.3%) in overweight, 22 (24.4%) in obese 1, 24 (26.6%) in obese 2].There is no correlation of Presence of DRA with BMI. DRA has no correlation with lumbopelvic pain and gender. DRA has moderate positive correlation with parity.
Conclusion: There is Presence of Diastasis Recti Abdominis in overweight, obese 1 and obese 2 adults; however, they are at equal risk of having DRA. Subjects with DRA are not more likely to have lumbopelvic pain than subjects without DRA. DRA can occur in males as well as females and multiparous females are at increased risk of developing DRA than nulliparous and primiparous.
Key words: Diastasis recti abdominis, overweight, obesity, physiotherapy, lumbopelvic pain.
REFERENCES
[1]. Chaurasia BD. Human Anatomy – Regional and Applied Dissection and Clinical; Lower Limb, Abdomen, and Pelvis. CBS; Volume 2; Fifth edition; pg 217.
[2]. Sperstad JB, Tennfjord MK, Hilde G, Ellstrom-Engh M, Kari B. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med 2016;0:1-6.
[3]. Mota P, Pascoal AG, Carita AI, et al. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther 2015;20:200–5.
[4]. Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther 1988;68:1082–6.
[5]. Parker MA, Millar AL, Dugan SA. Diastasis rectus abdominis and lumbo-pelvic pain and dysfunction—are they related? J Womens Health Phys Ther 2009;33:15–22.
[6]. Rett MT, Braga MD, Bernardes NO, et al. Prevalence of diastasis of the rectus abdominis muscles immediately postpartum: comparison between primiparae and multiparae. Rev Bras De Fisioterapia 2009;13:275–80.
[7]. Turan V, Colluoglu C, Turkyilmaz E, et al. Prevalence of diastasis recti abdominis in the population of young multiparous adults in Turkey. Ginekol Pol 2011;82:817–21.
[8]. Lockwood T. Rectus muscle diastasis in males: primary indication for endoscopically assisted abdominoplasty. Plast Reconstr Surg 1998;101:1685–91; discussion 92–4.
[9]. Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J Pelvic Floor Dysfunct 2007;18:321–8.
[10]. Keeler J, Albrecht M, Eberhardt L, et al. Diastasis recti abdominis: a survey of women’s health specialists for current physical therapy clinical practice for postpartum women. J Womens Health Phys Therapy 2012;36:131–42.
[11]. Blanchard PD. Diastasis recti abdominis in HIV-infected men with lipodystrophy. HIV Med.2005;6:54–56.
[12]. Lo T, Candido G, Janssen P. Diastasis of the recti abdominis in pregnancy: risk factors and treatment. Physiother Can. 1999;51(1):32–37.
[13]. Kisner C, Colby LN. Therapeutic Exercise – Foundations and Techniques. F. A. Davis; Sixth edition; pg 938-939.
[14]. Chou L, Sharmayne R.E. et al. The association between obesity and low back pain and disability is affected by mood disorders. Medicine April 2016;95(15).
[15]. Ewald et al. The effect of obesity on treatment outcomes for low back pain. Chiropractic & Manual Therapies 2016;24:48.
[16]. Samartzis D, Karppinen J, Mok F, Fong D, Luk K, Cheung K. A population- based study of juvenile disc degeneration and its association with overweight and obesity, low back pain, and diminished functional status. J Bone Joint Surg. 2011;93(7):662–70.
[17]. WHO Waist Circumference and Waist-Hip ratio-report of a WHO Expert consultation. December 2008.
[18]. Mattew K G, Aggarwal P. Medicine-Prep manual for undergraduates. Elsevier; Third edition; pg 586-587.
[19]. WHO World Health Organization. The Asia Pacific Perspective: redefining obesity and its treatment. Melbourne. Health Communications Australia; 2000.
[20]. Aziz N, Kallur S, Nirmalan P. Implications of the Revised Consensus Body Mass Indices for Asian Indians on Clinical Obstetric Practice. Journal of Clinical and Diagnostic Research. 2014 May;8(5):OC01-OC03.
[21]. Boissonnault JS, Kotarinos RK. Diastasis Recti. In: Wilder E, ed. Obstetric and Gynaecology Physical Therapy. Edinburgh: Churchill Livingstone; 1988;63-82.
[22]. Boxer S, Jones S. Intra-rater reliability of rectus abdominis diastasis measurement using dial calipers. Aust Physio- ther. 1997;43(2):109-114.
[23]. Jones S. Interrater reliability of rectus abdominis measurement using dial calipers, Abstracted presented at: Proceedings. Australian Physiotherapy Association; May 1998; Melbourne.
[24]. Issac, Hill. How to figure out Sample size for pilot study. 1995:1998 retrieved from https://www.researchgate.net/post/How_to_figure_out_an_appropriate_sample_for_the_pilot_study.
[25]. Whitehead AL, Julious SA, Cooper CL, et al. Estimating the sample size for a pilot randomized trial to minimize the overall trial sample size for a continuous outcome variable. Statistical Methods in Medical research .2016;25(3):1057-1073.
[26]. Qu E, Zhang X. Study on the correlation between diastasis recti and pelvic floor dysfunction using ultrasound. Ultrasound in Obstetrics & Gynecology 2018;52(Suppl. 1):126–127.
[27]. Cheesborough JE, Dumanian GA. Simultaneous prosthetic mesh abdominal wall reconstruction with abdominoplasty for ventral hernia and severe rectus diastasis repairs. Plast Reconstr Surg. 2015 Jan;135(1):268-276. doi: 10.1097/PRS.0000000000000840. PMID: 25539311; PMCID: PMC4280273.
[28]. Dalal K, Kaur A, Mitra M. Correlation between diastasis rectus abdominis and lumbopelvic pain and dysfunction. Indian J Physiother Occup Ther 2014;8:210–14.
[29]. Chiarello CM, Falzone LA, McCaslin KE, et al. The effects of an exercise program on diastasis recti abdominis in pregnant women. J Womens Health Phys Ther 2005;29:11–16.
[30]. Grotle M, Garratt AM, Krogstad Jenssen H, Stuge B. Reliability and construct validity of self-report questionnaires for patients with pelvic girdle pain. Phys Ther 2012 Jan;92(1):111-23.
[31]. Candido G, Lo T, Janssen PA. Risk factors for diastasis of the recti abdominis. J Assoc Chart Physiother Womens Health 2005;97:49–54.
[32]. Palanivelu C, Rangarajan M, Jategaonkar PA, et al. Laparoscopic repair of diastasis recti using the ‘Venetian blinds’ technique of plication with prosthetic reinforcement: a retrospective study. Hernia 2009;13:287–92.
[33]. Doubkova L, Andel R, Palascakova-Springrova I et al. Diastasis of rectus abdominis muscles in low back pain patients. Journal of Back and Musculoskeletal Rehabilitation 2018; 31:107–112.
