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Postpartum characteristics of rectus abdominis on ultrasound imaging

      Abstract

      This cross-sectional and partial longitudinal study aimed to characterize changes in rectus abdominis (RA) and provide reference ranges for the first year postpartum. Ultrasound scanning was used at four stages postnatally to measure cross-sectional area (CSA), thickness, width (indirectly using a shape value) and inter-recti distance (IRD). One hundred and fifteen postnatal women (though some postnatal subjects appeared in more than one postnatal group thus giving a total of 183 data points) and 69 age-matched nulliparous female controls were recruited. Postnatal subjects were studied at Day 1 (PN1; n=63) and at 2 (PN2; n=55), 6 (PN3; n=39) and 12 (PN4; n=26) months postpartum. Longitudinal data were analysed for CSA, thickness, shape (indirect width measurement) (df=67) and IRD (df=62). The mean CSA of the PN1 group was significantly larger (P<0.001) than in controls and decreased (P<0.0021) by 12 months. In all postnatal groups, RA was significantly thinner (P<0.0001, PN1–PN3; P<0.0478, PN4), wider (P<0.0001, PN1–PN3; P=0.0326, PN4) and the IRD was significantly larger (P<0.0001, PN1–PN4) than in controls. Over 2 months postpartum, RA became thicker (P=0.0003) and the width and IRD decreased (P<0.0001 and P=0.0002, respectively) but did not return to control values by 12 months. These results have implications for strength of RA postpartum and anterior abdominal wall stiffness, which together with other muscle characteristics could inform development of effective postnatal exercise programmes.

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      References

        • Boissonnault J.S.
        • Blaschak M.J.
        Incidence of diastasis recti abdominis during the childbearing year.
        Physical Therapy. 1988; 68: 1082-1086
        • Bottinelli R.
        • Pellegrino M.A.
        • Canepari M.
        • Rossi R.
        • Reggiani C.
        Specific contributions of various muscle fibre types to human muscle performance: an in vitro study.
        Journal of Electromyography and Kinesiology. 1999; 9: 87-95
        • Bursch S.G.
        Interrater reliability of diastasis recti abdominis measurement.
        Physical Therapy. 1987; 67: 1077-1079
        • Caix M.
        • Outrequin G.
        • Descottes B.
        • Kalfon M.
        • Pouget X.
        The muscles of the abdominal wall: a new functional approach with anatomoclinical deductions.
        Anatomia Clinica. 1984; 6: 101-108
        • Candido G.
        • Lo T.
        • Janssen P.A.
        Risk factors for diastasis of the recti abdominis.
        Journal of the Association of Chartered Physiotherapists in Women's Health. 2005; 97: 49-54
        • Chi-Fishman G.
        • Hicks J.E.
        • Cintas H.M.
        • Sonies B.C.
        • Gerber L.H.
        Ultrasound imaging distinguishes between normal and weak muscle.
        Archives of Physical Medicine and Rehabilitation. 2004; 85: 980-986
        • Clark K.M.
        • Holt L.E.
        • Sinyard J.
        Electromyographic comparison of the upper and lower rectus abdominis during abdominal exercises.
        Journal of Strength and Conditioning Research. 2003; 17: 475-483
        • Dix D.J.
        • Eisenberg B.R.
        Myosin mRNA accumulation and myofibrillogenesis at the myotendinous junction of stretched muscle fibers.
        Journal of Cell Biology. 1990; 111: 1885-1894
        • Elliott J.M.
        • Galloway G.J.
        • Jull G.A.
        • et al.
        Magnetic resonance imaging analysis of the upper cervical spine extensor musculature in an asymptomatic cohort: an index of fat within muscle.
        Clinical Radiology. 2005; 60: 355-363
        • Fast A.
        • Weiss L.
        • Ducommun E.J.
        • Medina E.
        • Butler J.G.
        Low-back pain in pregnancy: abdominal muscles, sit-up performance, and back pain.
        Spine. 1990; 15: 28-30
        • Gilleard W.L.
        • Brown J.M.
        Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period.
        Physical Therapy. 1996; 76: 750-762
        • Goldspink G.
        Impairment of IGF-I gene splicing and MGF expression associated with muscle wasting.
        The International Journal of Biochemistry and Cell Biology. 2006; 38: 481-489
        • Goldspink G.
        • Scutt A.
        • Martindale J.
        • Jaenicke T.
        • Turay L.
        • Gerlach G.F.
        Stretch and force generation induce rapid hypertrophy and myosin isoform gene switching in adult skeletal muscle.
        Biochemistry Society Transactions. 1991; 19: 368-373
        • Graziotti G.H.
        • Rios C.M.
        • Rivero J.L.
        Evidence for three fast myosin heavy chain isoforms in type II skeletal muscle fibers in the adult llama (Lama glama).
        Journal of Histochemistry and Cytochemistry. 2001; 49: 1033-1044
        • Gunreben G.
        • Bogdahn U.
        Real-time sonography of acute and chronic muscle denervation.
        Muscle Nerve. 1991; 14: 654-664
        • Haggmark T.
        • Thorstensson A.
        Fibre types in human abdominal muscles.
        Acta Physiologica Scandanavica. 1979; 107: 319-325
        • Kendall F.P.
        • McCreary E.
        • Provance D.
        Muscles: testing and function.
        4th ed. Williams & Wilkins, Baltimore, USA1993 (pp. 131–176 [Chapter 6])
        • Lalatta C.G.
        • Barazzoni A.M.
        • Lucchi M.L.
        • Bortolami R.
        Histochemical types and sizes of fibers in the rectus abdominis muscle of guinea pig: adaptive response to pregnancy.
        Anatomy Record. 1987; 217: 23-29
        • Lalatta C.G.
        • Barazzoni A.M.
        • Lucchi M.L.
        • Bortolami R.
        Fiber sizes and histochemical characteristics of the rectus abdominis muscle of the rabbit under conditions of pregnancy and mechanically induced stress.
        Anatomy Record. 1988; 222: 136-144
        • Lamminen A.
        Low field magnetic resonance imaging and ultrasonography in muscle diseases.
        Acta Radiologica Supplement. 1991; 377: 42-45
        • Lo T.
        • Candido G.
        • Janssen P.
        Diastasis of the recti abdominis in pregnancy: risk factors and treatment.
        Physiotherapy Canada. 1999; 44: 32-37
        • Mantle M.J.
        • Greenwood R.M.
        • Currey H.L.
        Backache in pregnancy.
        Rheumatology and Rehabilitation. 1977; 16: 95-101
        • Martin W.D.
        A study of the effect of pregnancy on muscle fibers of the rectus abdominis muscle of the rat.
        Anatomical Record. 1979; 195: 455-462
        • Maurits N.M.
        • Bollen A.E.
        • Windhausen A.
        • De Jager A.E.
        • Van Der Hoeven J.H.
        Muscle ultrasound analysis: normal values and differentiation between myopathies and neuropathies.
        Ultrasound in Medicine and Biology. 2003; 29: 215-225
        • Nahas F.X.
        • Ferreira L.M.
        • Augusto S.M.
        • Ghelfond C.
        Long-term follow-up of correction of rectus diastasis.
        Plastic and Reconstructive Surgery. 2005; 115: 1736-1741
        • Negrao Filho R.F.
        • Berzin F.
        • Souza G.C.
        Electromyography study of the portions of the abdominal rectus muscle.
        Electromyography and Clinical Neurophysiology. 1997; 37: 491-501
        • Negrao Filho R.F.
        • Berzin F.
        • Souza G.C.
        Quantitative end qualitative analysis of the electrical activity of rectus abdominis muscle portions.
        Electromyography and Clinical Neurophysiology. 2003; 43: 305-314
        • Noren L.
        • Ostgaard S.
        • Johansson G.
        • Ostgaard H.C.
        Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up.
        European Spine Journal. 2002; 11: 267-271
        • Ostgaard H.C.
        Lumbar and pelvic pain in pregnancy.
        in: Vleeming A. Mooney V. Dorman T. Snijders C. Stoeckart R. Movement, stability and low back pain. Churchill Livingstone, Edinburgh1997: 411-420 ([Chapter 33])
        • Ostgaard H.C.
        • Andersson G.B.
        Postpartum low-back pain.
        Spine. 1992; 17: 53-55
        • Ostgaard H.C.
        • Andersson G.B.
        • Karlsson K.
        Prevalence of back pain in pregnancy.
        Spine. 1991; 16: 549-552
        • Ostgaard H.C.
        • Roos-Hansson E.
        • Zetherstrom G.
        Regression of back and posterior pelvic pain after pregnancy.
        Spine. 1996; 21: 2777-2780
        • Ostgaard H.C.
        • Zetherstrom G.
        • Roos-Hansson E.
        Back pain in relation to pregnancy: a 6-year follow-up.
        Spine. 1997; 22: 2945-2950
        • Polden M.
        • Mantle J.
        Physiotherapy in obstetrics and gynaecology.
        Butterworth Heinemann, Oxford1990 (p. 222–80 [Chapter 7])
      1. Potter HM, Downey JL, Jones ST. Effect of an Intense training programme for the deep antero-lateral abdominal muscles on rectus abdominis diastasis: a single case study. In: Proceedings of the 10 Biennial Conference of the Manipulative Physiotherapists Association of Australia (MPAA). Victoria, Australia: MPAA; 1997a. p. 153–5.

      2. Potter HM, Randall HF, Strauss GR. Effect of pregnancy and motherhood on trunk muscle strength: an examination of isokinetic trunk strength at 24 weeks postpartum. In: Proceedings of the 10 Biennial Conference of the Manipulative Physiotherapists Association of Australia (MPAA). Victoria, Australia: MPAA; 1997b. p. 151–2.

        • Rath A.M.
        • Attali P.
        • Dumas J.L.
        • Goldlust D.
        • Zhang J.
        • Chevrel J.P.
        The abdominal linea alba: an anatomo-radiologic and biomechanical study.
        Surgical and Radiological Anatomy. 1996; 18: 281-288
        • Reimers K.
        • Reimers C.D.
        • Wagner S.
        • Paetzke I.
        • Pongratz D.E.
        Skeletal muscle sonography: a correlative study of echogenicity and morphology.
        Journal of Ultrasound Medicine. 1993; 12: 73-77
        • Sarti M.A.
        • Monfort M.
        • Fuster M.A.
        • Villaplana L.A.
        Muscle activity in upper and lower rectus abdominus during abdominal exercises.
        Archives of Physical Medicine and Rehabilitation. 1996; 77: 1293-1297
        • Sheppard S.
        The role of transversus abdominis in postpartum correction of gross divarication recti.
        Manual Therapy. 1996; 1: 214-216
        • Spence M.
        Postnatal survey.
        Australian Journal of Physiotherapy. 1978; 34: 151-160
        • Stelzner F.
        • Beyenburg S.
        • Hahn N.
        [Acquired disorders of peritoneal cavity muscles. Abdominal wall denervation in pregnancy, denervation incontinence, and continent and incontinent constipation].
        Langenbecks Archiv fuer Chirugie. 1993; 378: 49-59
      3. Stokes MJ, Hides JA, Nassiri DK. Musculoskeletal ultrasound imaging; diagnostic and trreatment aid in rehabilitation. Physical Therapy Reviews 1997;2:73–92.

        • Udd B.
        • Lamminen A.
        • Somer H.
        Imaging methods reveal unexpected patchy lesions in late onset distal myopathy.
        Neuromuscular Disorders. 1991; 1: 279-285
        • van Uchelen J.H.
        • Kon M.
        • Werker P.M.
        The long-term durability of plication of the anterior rectus sheath assessed by ultrasonography.
        Plastic and Reconstructive Surgery. 2001; 107: 1578-1584
        • Williams P.E.
        • Goldspink G.
        Changes in sarcomere length and physiological properties in immobilized muscle.
        Journal of Anatomy. 1978; 127: 459-468
        • Williams P.L.
        • Warwick R.
        • Dyson M.
        • Bannister L.H.
        Gray's anatomy.
        37th ed. Churchill Livingstone, Edinburgh1989 (p. 546–69 [Chapter 5])
        • Williams P.
        • Kyberd P.
        • Simpson H.
        • Kenwright J.
        • Goldspink G.
        The morphological basis of increased stiffness of rabbit tibialis anterior muscles during surgical limb-lengthening.
        Journal of Anatomy. 1998; 193: 131-138
        • Zuberi S.M.
        • Matta N.
        • Nawaz S.
        • Stephenson J.B.
        • McWilliam R.C.
        • Hollman A.
        Muscle ultrasound in the assessment of suspected neuromuscular disease in childhood.
        Neuromuscular Disorders. 1999; 9: 203-207