Background: Diastasis rectus abdominis (DRA) is a separation of the rectus abdominis during and after pregnancy. Physiotherapy is the first choice of intervention but it is unclear which type of training is the most effective.  Purpose: The aim of the study was twofold. The aim of the first part was to evaluate the effects of training the rectus abdominis in women with DRA postpartum. The aim of the second part was to describe how these women experienced this training program.  Method: Three women were included in the study. Firstly a single subject experimental design with A-B design was implemented. Inter-recti distance (IRD), activity impairment, muscle strength and endurance, pain and aesthetics was measured. Secondly a qualitative design was carried out to describe the participants' experiences. It was implemented with interviews analyzed with qualitative content analysis.  Results: Two of the participants got significantly decreased IRD. One of the participants got significantly improved in the activity impairment ´getting up from lying down with and without a weight´. There was no improvement in the other outcome measures. Two categories comprised by two subcategories each were identified by the qualitative analysis: positive and motivating experiences of the training and experiences of positive results of the training. The categories reveal positive experiences of the training design and exercises as well as becoming stronger and gaining trust to use the body again as the main result after the training period. Conclusion: An individually designed training program focusing on the rectus abdominis muscle could be effective for reducing the IRD and getting stronger when getting up from lying down in women with DRA 2-12 months postpartum. Training the rectus abdominis with regular supervision was experienced positively and motivating after pregnancy. The most important experienced result was becoming stronger and gaining increased trust in the body.

Made available in DSpace on 2015-07-22T20:49:23Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-02-22 / Introdução:Na rotina clínica fisioterapêutica, com freqüência deparamo-nos com pacientes à procura de reabilitação dos desarranjos lombares, e sabe-se que, os músculos abdominais, principalmente o M. rectus abdominis auxiliam na ação de estabilização da pelve. Portanto, o objetivo deste estudo foi analisar através da eletromiografia a atividade elétrica do M. rectus abdominis na retroversão pélvica em decúbito dorsal e em posição ortostática e no abaixamento dos membros inferiores. Material e Método: Participaram deste estudo 30 acadêmicos saudáveis de ambos os sexos, com idade variando entre 17 a 40 anos, divididos em dois grupos, Grupo 1 - 15 voluntários (equilíbrio pélvico) e 15 voluntários do Grupo 2 (desequilíbrio pélvico). A atividade elétrica foi captada do M. rectus abdominis nas porções supraumbilical e infra-umbilical dos lados direito e esquerdo. Para análise da atividade elétrica foi utilizada a média dos valores de RMS (Raiz Quadrada da Média – expressa em microvolts) de três tentativas obtidos dos traçados eletromiográficos. O valor do RMS foi submetido ao processo de normalização. Os dados obtidos foram submetidos ao tratamento estatístico através do Teste de Friedman e análise das médias e desvio padrão, a um nível de significância de 95%. Resultados: Não constatou-se diferença estatisticamente significativa entre a atividade elétrica e o repouso na ação de retroversão pélvica em decúbito dorsal e posição ortostática para o G1 e G2, porém no abaixamento dos membros inferiores a porção inferior no G2 obteve um resultado significativo em relação ao G1. Conclusão: O M. Rectus do Abdominis apresentou baixa atividade elétrica na retroversão pélvica tanto em decúbito dorsal quanto na posição ortostática, porém quando no abaixamento dos membros inferiores a porção inferior D e E no G2 apresentaram atividade elétrica maior que a porção superior D e E. / We often face patients searching for rehabilitation for lower back disorders during the physiotherapeutic routine, and it is known that the abdominal muscle, specially the rectus abdominis muscle, aid the stabilization of the pelvis. Therefore, this paper analyzes the electrical activity of the rectus abdominis muscle in the pelvic retroversion in dorsal decubitus and in orthostatic position and in the lowering of the lower limbs. 30 healthy students, male and female, 17 – 40 yr, divided into two groups – Group 1: 15 volunteers (pelvic balance); Group 2 (pelvic unbalance) took part in this study. The electrical activity of the right and left supra-umbilical and infra-umbilical portions of the rectus abdominis muscle was detected. The mean RMS values from three attempts from the electromyographic traces were used for the analysis of the electrical activity. The RMS value was submitted to the normalization process. The data were submitted to statistic treatment by the Friedman test, and the analyses of the means and standard deviation towards a level of significance of 95%. The results demonstrated that the portions of the rectus abdominis muscle presented low electrical activity for the groups studied for pelvic retroversion either in dorsal decubitus or and orthostatic position. However, the decreasing movement of the lower limbs towards the portions of the rectus abdominis muscle presented more significant electrical activity whereas the lower portions presented higher activity than the higher ones for Group 2. 29 / TEDE

Objective - To assess donor site morbidity and survival of the rectus abdominis muscle with an overlying skin graft after free tissue transfer to a medial femorotibial defect in dogs. Study Design - Experimental study Sample Population: Phase one - six canine cadavers / Phase two - seven adult mixed breed dogs Methods: Phase one - The rectus abdominis muscle was removed from cadavers, muscular and vascular dimensions were recorded and angiography was performed. Phase two - Muscular transfer was performed through anastomosis of the caudal epigastric vasculature to the saphenous vasculature. Transferred tissues were evaluated on postoperative days three, six, 10, and 13. Animals were examined daily until euthanasia between postoperative days 31 and 42. Postmortem angiograms were performed and tissues collected for histopathologic evaluation. Results: Phase one - Appropriate vascular dimensions for microvascular anastomosis were confirmed and surgical technique perfected. Phase two – Muscular excision produced minimal donor site morbidity. All muscles survived after microvascular transfer and angiography confirmed vascular patency. All skin grafts survived with one graft undergoing partial necrosis. Conclusions: The rectus abdominis muscle can be successfully transferred to a medial femorotibial defect and serve as a bed for acute skin grafting. No significant donor site morbidity is associated with its removal. Clinical Relevance: Microvascular free tissue transfer of the canine rectus abdominis muscle has not been previously described. This technique provides an alternative for repair of appropriate wounds. Additional studies are needed to define its utility in clinical patients. / Master of Science

INTRODUCTION: Transverse rectus abdominus muscle flaps (TRAM) can result in significant abdominal wall donor-site morbidity. We present our experience with bilateral pedicle TRAM breast reconstruction using a double-layered polypropylene mesh fold over technique to repair the rectus fascia. METHODS: A retrospective study was performed that included patients with bilateral pedicle TRAM breast reconstruction and abdominal reconstruction using a double-layered polypropylene mesh fold over technique. RESULTS: Thirty-five patients met the study criteria with a mean age of 49 years old and mean follow-up of 7.4 years. There were no instances of abdominal hernia and only 2 cases (5.7%) of abdominal bulge. Other abdominal complications included partial umbilical necrosis (14.3%), seroma (11.4%), partial wound dehiscence (8.6%), abdominal weakness (5.7%), abdominal laxity (2.9%), and hematoma (2.9%). CONCLUSIONS: The TRAM flap is a reliable option for bilateral autologous breast reconstruction. Using the double mesh repair of the abdominal wall can reduce instances of an abdominal bulge and hernia.

INTRODUCTION: Transverse rectus abdominus muscle flaps (TRAM) can result in significant abdominal wall donor-site morbidity. We present our experience with bilateral pedicle TRAM breast reconstruction using a double-layered polypropylene mesh fold over technique to repair the rectus fascia. METHODS: A retrospective study was performed that included patients with bilateral pedicle TRAM breast reconstruction and abdominal reconstruction using a double-layered polypropylene mesh fold over technique. RESULTS: Thirty-five patients met the study criteria with a mean age of 49 years old and mean follow-up of 7.4 years. There were no instances of abdominal hernia and only 2 cases (5.7%) of abdominal bulge. Other abdominal complications included partial umbilical necrosis (14.3%), seroma (11.4%), partial wound dehiscence (8.6%), abdominal weakness (5.7%), abdominal laxity (2.9%), and hematoma (2.9%). CONCLUSIONS: The TRAM flap is a reliable option for bilateral autologous breast reconstruction. Using the double mesh repair of the abdominal wall can reduce instances of an abdominal bulge and hernia.

Bakgrund: Rectus abdominis diastas (RAD) är en separation av magmuskler som drabbar två av tre kvinnor (66%) i tredje trimestern och mellan 30-60% av dessa har kvarstående problem efter förlossningen. Detta tillstånd kan leda till försvagad muskelfunktion, ländryggsbesvär, smärta och/eller besvär i abdominis, bäcken-instabilitet samt urogynekologiska symptom. För behandling rekommenderas först fysioterapi dock saknas kliniska riktlinjer. Syfte: Syftet var att sammanställa aktuella randomiserade kontrollerade studier (RCT) för fysioterapeutiska behandlingstekniker vid postpartum rectus abdominis diastas (RAD), samt deras effekt på RAD avstånd. Material och Metod: Litteratursökningen utfördes mellan juni och september 2022 i tre databaser, PubMed (Medline), SPORTDiscus och CINAHL. Sökningen gav 210 träffar varav 6 inkluderades. Kvalitetsbedömning gjordes enligt PEDro skalan. Resultat: De behandlingstekniker som användes var generell träning av bålmuskulaturen, neuromuskulär stimulering, stabiliserande träning av bålmuskulaturen och buk-stabiliserande bälte. Kombination av neuromuskulär stimulering med bålmuskelträning och stabiliserande bålmuskelträning hade en signifikant minskning av RAD. Bålmuskelträning är bättre än ingen behandling. Stabiliserande bälte är inte bättre än ingen behandling. Kvalitet av samtliga artiklarna rankades måttlig till bra kvalitet enligt PEDro skalan. Konklusion: Resultatet visade att majoriteten av de inkluderade studierna rapporterade en minskning av RAD-avståndet. Detta tyder på att fysioterapi är en viktig komponent i rehabiliteringsprocess vid postpartum RAD samt att den kan rekommenderas till kvinnor med RAD efter förlossningen. Behandlingstekniker med signifikant minskning av RAD-avstånd är kombinationen av neuromuskulär stimulering med träning av bålmuskulatur samt träning som fokuserar på stabiliserande bålmuskulaturen. Mer studier med hög bevisvärde efterfrågas.

Bakgrund: Urininkontinens och rektusdiastas är vanliga besvär postpartum och kan kvarstå upp till flera år efter förlossningen. Träning för bäckenbottenmuskulaturen och magmuskulaturen är vanliga rekommendationer för dessa besvär, men evidensen kring om det har positiva effekter är inte samstämmig i olika studier. Fysioterapi ingår i nuläget inte i vårdkedjan efter förlossning. Detta trots att fysioterapeuter kan ha en roll postpartum med råd kring träning och aktivitet.        Syfte: Syftet med denna litteraturöversikt var att undersöka om fysioterapeutiskt ledd träning kan reducera problematik för kvinnor postpartum gällande urinläckage samt rektusdiastas jämfört med sedvanlig vård eller självständig träning. Metod: Detta är en litteraturstudie som granskat totalt 8 stycken artiklar. De har kvalitetsgranskats via PEDro-scale. Sökningar har gjorts i 3 olika databaser. Relevanta artiklar valdes ut via titel och abstract.  Resultat: Övervägande del av artiklarna kring träning för bäckenbottenmuskulaturen för att reducera urininkontinens visar på att träning har en positiv effekt första tiden postpartum men att det inte finns några signifikanta resultat på att träning har en långsiktig effekt. Sammanställning av artiklarna kring träning för rektusdiastas visar inte på en signifikant förbättring av rektusdiastas.  Diskussion: Tidigare forskning visar på ungefär samma resultat som granskas i denna litteraturstudie. Otillräcklig och lågkvalitativ forskning gör att evidensen inte är tillräckligt stark för att dra nya slutsatser.  Konklusion: Det behövs mer forskning kring hur fysioterapeutiskt ledd träning kan reducera problematik för kvinnor postpartum med urininkontinens samt rektusdiastas, kortsiktigt och långsiktigt.

Bakgrund: Rektusdiastas är en delning av musculus rectus abdominis och är vanligt hos kvinnor som fött barn. Det kan ge besvär som instabilitet i bålen samt smärta i ländrygg och bäcken, men även oro och rädsla. Rektusdiastsen påverkar den vardagliga fysiska aktiviteten hos patientgruppen och fysioterapi rekommenderas i första hand som behandling. Evidensen är dock begränsad och svenska kliniska riktlinjer finns inte i dagsläget. Syfte: Syftet är att utforska fysioterapeuters erfarenheter av att arbeta med mödrar som har besvär av rektusdiastas efter förlossning till att få en mer fungerande fysisk aktiv vardag. Metod: En kvalitativ intervjustudie valdes där informanterna rekryterades genom ett ändamålsenligt urval samt snöbollsurval. En semistrukturerad intervjuguide nyttjades och datan analyserades genom en manifest kvalitativ innehållsanalys med en induktiv ansats. Resultat: Behandling för mödrar med besvär av rektusdiastas är främst att ge information och träning. För att hjälpa mödrarna med problematiska vardagsaktiviteter ges råd och strategier för att klara av dessa. Fysioterapeuter önskar kliniska riktlinjer och att kunskapen undervisas om redan på grundutbildningen. Slutsats: Behandling utifrån biopsykosociala faktorer är viktigt för patientgruppen. Fysioterapeuter kan hjälpa patientgruppen och det är viktigt att kunskapen sprids så alla får den vård de har rätt till. / Background: Diastasis recti is a split of the musculus rectus abdominis and is common among women who have given birth. It can lead to problems such as instability in the abdomen and pain in the lumbar region and pelvis, but also anxiety and fear. Diastasis recti affects the daily physical activity among this patient group, and to fix this physiotherapy is recommended. The evidence is limited and there are currently no Swedish clinical guidelines. Purpose: The purpose is to explore physiotherapists experience of working with mothers that are bothered by diastasis recti after childbirth to have a more functional physical activity everyday life. Method: A qualitative interview study where the informants were recruited through a purposive sampling and snowball sampling. The interviews were based on a semi-structured interview guide and analyzed through a manifest qualitative content analysis with an inductive approach. Result: Treatment for mothers with diastasis recti was mainly to provide information and exercises. To help mothers with problematic everyday activities, advice and strategies were given. Physiotherapist’s desire clinical guidelines and that knowledge about diastasis recti is a subject for education at university. Conclusion: Treatment based on biopsychosocial factors is important for this patient group. Physiotherapists can help this patient group and it is important that knowledge about the subject is spread so that everyone can receive the care they are entitled to.

Made available in DSpace on 2014-06-11T19:22:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-04-07Bitstream added on 2014-06-13T18:48:40Z : No. of bitstreams: 1 strang_r_me_botfm.pdf: 1503065 bytes, checksum: c600d4becf4eafb0269428ce7cb268b7 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Foi realizado estudo experimental em ratos, visando avaliar o efeito da ablação cirúrgica dos músculos retos abdominais (MRA), nos padrões utilizados nos retalhos TRAM, sobre a resistência da parede abdominal. Utilizou-se 60 ratos machos da linhagem Wistar, divididos aleatoriamente em três grupos de 20 animais. No primeiro grupo removeu-se um dos músculos, no segundo, ambos e o terceiro grupo, controle, não foi submetido à cirurgia. Após 180 dias os animais foram sacrificados e submetidos a dois tipos de avaliação: aumento progressivo da pressão intracavitária, com o auxílio de um balão de silicone, para a observação do surgimento de abaulamentos ou hérnias, e teste de tração em dinamômetro, para quantificar a resistência da parede abdominal à tração. O segmento operado das paredes abdominais foi submetido à análise histológica. Constatou-se no primeiro teste não haver diferença significativa entre os três grupos. No teste da tração, as paredes abdominais submetidas à cirurgia apresentaram resistência significativamente maior do que as do grupo controle. A histologia evidenciou fibrose cicatricial madura, uniformemente distribuída, e fibras musculares em posição anatômica. Na análise estatística, para comparar os valores da pressão de ruptura (mmHg) e da Tração-Força Máxima (N) dos três grupos foi utilizada Análise de Variância de um fator. Quando o resultado do teste F foi estatisticamente significante, aplicou-se o Post-Hoc de Tukey para se identificar as diferenças. Concluiu-se que, no modelo utilizado, a remoção cirúrgica dos MRA não provoca redução na resistência da parede abdominal. / This experimental study was carried out in rats, with the purpose to evaluate the effect of the surgical ablation of the rectus abdominis muscles (RAM), in the patterns of the TRAM flap, on the resistance of the abdominal wall. Sixty male Wistar rats were used, divided randomly in three groups of twenty animals. In the first group, one of the muscles was removed, in the second, both and the third group, the control group, was not submitted to the surgery. After 180 days the animals were killed and submitted to two types of evaluation: an increase in the intracavitary pressure, with the help of a silicone balloon, to observe the emergence of bulge or hernia, and a test in a dynamometer to quantify the resistance of the abdominal wall to traction. The operated segment of the abdominal walls was submitted to histological analysis. In the first test, it was testified that there was no significant difference between the three groups. In the traction test, the abdominal walls submitted to the surgery showed a resistance significantly greater than the ones on the control group. Histology evidenced mature cicatricial fibrosis, evenly distributed, and muscular fibers in anatomical position. In the statistical analysis, to compare the values of rupture pressure (mmHg) and the Maximum Traction-Force (N) of the three groups it was used one-way Analysis of Variance. When the F test result showed to be statistically significant, the Tuckey test was applied to identify the differences. It was concluded that, in the used model, the surgical removal of the RAM didn’t cause a reduction in the abdominal wall resistance.

Freie Universiẗat, Diss., 2005--Berlin. / Dateiformat: zip, Dateien im PDF-Format. ERscheinungsjahr an der Haupttitelstelle: 2005.