Lee Diane, Hodges Paul W
J Orthop Sports Phys Ther. 2016 Jul;46(7):580-9. doi: 10.2519/jospt.2016.6536.
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. J Orthop Sports Phys Ther 2016;46(7):580-589. doi:10.2519/jospt.2016.6536.
横断面重复测量。背景：腹直肌分离（DRA）的康复通常旨在减小腹直肌间距（IRD）。我们检验了这样一个假设，即在仰卧起坐前激活腹横肌（TrA）会减少IRD变窄，同时白线（LA）的扭曲/变形更小，这可能会使腹壁两侧之间的力传递更好。目的：本研究调查了在自然进行仰卧起坐以及TrA预激活的情况下LA和IRD的行为。方法：26名患有DRA的女性和17名健康对照参与者进行仰卧起坐，采用自然策略（自动仰卧起坐）和TrA预激活（TrA仰卧起坐）。在脐上2个点（U点和UX点）记录超声图像。比较了3项任务（休息、自动仰卧起坐、TrA仰卧起坐）之间、组间以及测量点之间IRD的超声测量值和LA扭曲的一项新测量指标（扭曲指数：LA与腹直肌之间最短路径的平均偏差）（方差分析）。结果：患有DRA的女性进行自动仰卧起坐会使IRD从休息值变窄（平均U点任务间差异为 -1.19 cm；95%置信区间[CI]：-1.45，-0.93；P<.001，平均UX点任务间差异为 -0.51 cm；95% CI：-0.69，-0.34；P<.001），但LA扭曲增加（平均U点任务间差异为0.018；95% CI：0.0003，0.041；P = .046，平均UX点任务间差异为0.025；95% CI：0.004，0.045；P = .02）。虽然TrA仰卧起坐导致的IRD变窄不明显或比自动仰卧起坐更小（TrA仰卧起坐与休息之间的平均U点差异为 -0.56 cm；95% CI：-0.82，-0.31；P<.001，平均UX点任务间差异为0.02 cm；95% CI：-0.22，0.19；P = .86），但LA扭曲更小（平均U点任务间差异为 -0.025；95% CI：-0.037，-0.012；P<.001，平均UX点任务间差异为 -0.021；95% CI：-0.038，-0.005；P = .01）。对照组的腹直肌间距和扭曲指数在休息时没有变化，任务间也没有差异（P≥.55）。结论：DRA患者在自动仰卧起坐过程中IRD变窄会使LA扭曲。扭曲指数需要进一步验证，但研究结果表明，TrA预激活时IRD变窄更小可能会改善腹部两侧之间的力传递。临床意义在于，一直不被提倡的通过TrA收缩减少IRD变窄可能会对腹部力学产生积极影响。《矫形与运动物理治疗杂志》2016年；46(7):580 - 589。doi:10.2519/jospt.2016.6536。
