Document Type : Research Article

Authors

1 Faculty of Sport Science, Shomal University, Amol, Iran

2 Department of Motor Behavior and Biomechanics, Faculty of sports sciences, University of Mazandaran, Babolsar, Iran

Abstract

Background: Diastasis of Rectus Abdominis (DRA) is a frequent problem that affects women during pregnancy and postpartum. The study aimed to investigate the effectiveness of static and dynamic plank exercise on Inter-Recti Distance (IRD) in postpartum women.
Methods: This semi-experimental study included 30 postpartum women with DRA who were randomly divided into static plank (N=10), dynamic plank (N=10) and control group (n=10). Exercise groups implemented the plank exercise three times weekly for six weeks in Sari, Iran from April to May 2023. Ultrasound imaging was recorded to measure IRD in three locations, center of umbilicus (reference point), three cm above and three cm below umbilicus. The analysis of covariance (ANCOVA) was used to compare the effect of static and dynamic plank exercise on IRD.
Results: IRD significantly decreased in static (29 mm vs 27/4 mm, P=0.001) and dynamic (30.1 mm vs 27 mm, P=0.001) plank groups after exercise. IRD did not significantly differ between static and dynamic groups at post-test (P=0.420). However, the percentage of the change was greater in dynamic (10.33%) compared with the static (5.51%) group. A significant difference was observed between the dynamic and control groups (P=0.001).
Conclusion: The findings revealed that both types of plank exercise could cause narrowing of IRD in postpartum women. However, based on the percentage of change, incorporating additional movements such as abduction and rotation in dynamic plank, which could produce more muscle activity, yielded greater reduction in IRD compared with static plank.

Highlights

How to Cite: Khademi M, Ghaffari R, Dashti Rostami K. Effectiveness of Dynamic and Static Plank Exercise on Inter-Recti Distance in Postpartum Women. Women. Health. Bull. 2024;11(4):222-230. doi: 10.30476/whb.2024.102632.1293.

 

Komeil Dashti Rostami: (Google Scholar), (PubMed)

Keywords

  1. Benjamin DR, Frawley HC, Shields N, van de Water AT, Taylor NF. Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy. 2019;105(1):24-34. doi: 10.1016/j.physio.2018.07.002. PubMed PMID: 30217494 2. ##
  2. Cavalli M, Aiolfi A, Bruni P, Manfredini L, Lombardo F, Bonfanti M, et al. Prevalence and risk factors for diastasis recti abdominis: a review and proposal of a new anatomical variation. Hernia. 2021;25(4):883-890. doi: 10.1007/s10029-021-02468-8. PubMed PMID: 34363190; PubMed Central PMCID: PMC8370915. ##
  3. Mota P, Pascoal AG, Carita AI, Bø K. Normal width of the inter-recti distance in pregnant and postpartum primiparous women. Musculoskelet Sci Pract. 2018;35:34-37. doi: 10.1016/j.msksp.2018.02.004. PubMed PMID: 29494833. ##
  4. Kim S, Yi D, Yim J. The effect of core exercise using online videoconferencing platform and offline-based intervention in postpartum woman with diastasis recti abdominis. Int J Environ Res Public Health. 2022;19(12):7031. doi: 10.3390/ijerph19127031. PubMed PMID: 35742279; PubMed Central PMCID: PMC9222342. ##
  5. Da Mota PGF, Pascoal AGBA, Carita AIAD, Bø K. 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(1):200-5. doi: 10.1016/j.math.2014.09.002. PubMed PMID: 25282439. ##
  6. Köckerling F, Botsinis MD, Rohde C, Reinpold W. Endoscopic-assisted linea alba reconstruction plus mesh augmentation for treatment of umbilical and/or epigastric hernias and rectus abdominis diastasis–early results. Front Surg. 2016;3:27. doi: 10.3389/fsurg.2016.00027. PubMed PMID: 27243016; PubMed Central PMCID: PMC4865488. ##
  7. Opala-Berdzik A, Rudek-Zeprzałka M, Niesporek J, Cebula M, Baron J, Gruszczyńska K, et al. Technical aspects of inter-recti distance measurement with ultrasonographic imaging for physiotherapy purposes: the scoping review. Insights Imaging. 2023;14(1):92. doi: 10.1186/s13244-023-01443-4. PubMed PMID: 37202551; PubMed Central PMCID: PMC10195962. ##
  8. Van de Water A, Benjamin DR. Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): a systematic review of their measurement properties and meta-analytic reliability generalisation. Man Ther. 2016;21:41-53. doi: 10.1016/j.math.2015.09.013. PubMed PMID: 26474542. ##
  9. Jiang Q, Gao Y, Xia S, Gu Y, Gu J, Guo J, et al. Intra‐and Interimage reliability of inter‐rectus distance measurements determined via ultrasound imaging by the same or different testers in women in the early postpartum period. J Ultrasound Med. 2024;43(6):1037-1044. doi: 10.1002/jum.16430. PubMed PMID: 38380860. ##
  10. Carlstedt A, Bringman S, Egberth M, Emanuelsson P, Olsson A, Petersson U, et al. Management of diastasis of the rectus abdominis muscles: recommendations for Swedish national guidelines. Scand J Surg. 2021;110(3):452-459. doi: 10.1177/1457496920961000. PubMed PMID: 32988320; PubMed Central PMCID: PMC8551433. ##
  11. Benjamin DR, Frawley HJ, Shields N, Peiris C, van de Water AT, Bruder AM, et al. Conservative interventions may have little effect on reducing diastasis of the rectus abdominis in postnatal women–A systematic review and meta-analysis: A systematic review and meta-analysis. Physiotherapy. 2023;119:54-71. doi: 10.1016/j.physio.2023.02.002. PubMed PMID: 36934466. ##
  12. Gluppe S, Engh ME, Bø K. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis. Braz J Phys Ther. 2021;25(6):664-675. doi: 10.1016/j.bjpt.2021.06.006. PubMed PMID: 34391661; PubMed Central PMCID: PMC8721086. ##
  13. Vaishnavi G, Mohan Kumar G, Jayson C, Kirupa K, Tharani G, Kamatchi K, et al. Effectiveness of exercise in treating rectus abdominis diastasis. Biomed. 2018;38(4):147-151. ##
  14. Lisnaini L. Effect Of Plank Exercise On Diastasis Recti Abdominis Below Umbilicus In Postpartum Women. International Journal Of Medical and Exercise Science. 2022;8(1):1219-27. doi: 10.36678/IJMAES.2022.V08I01.007. ##
  15. Saleem Z, Khan AA, Farooqui SI, Yasmeen R, Rizvi J. Effect of exercise on inter-recti distance and associated low back pain among post-partum females: a randomized controlled trial. J Family Reprod Health. 2021;15(3):202-209. doi: 10.18502/jfrh.v15i3.7139. PubMed PMID: 34721612; PubMed Central PMCID: PMC8536823. ##
  16. Mota P, Pascoal AG, Carita AI, Bø K. Normal width of the inter-recti distance in pregnant and postpartum primiparous women. Musculoskelet Sci Pract. 2018;35:34-37. doi: 10.1016/j.msksp.2018.02.004. PubMed PMID: 29494833. ##
  17. Acharry N, Kutty RK. Abdominal exercise with bracing, a therapeutic efficacy in reducing diastasis-recti among postpartal females. Int J Physiother Res. 2015;3(2):999-1005. doi: 10.16965/ijpr.2015.122. ##
  18. Radhakrishnan M, Ramamurthy K. Efficacy and challenges in the treatment of diastasis recti abdominis—a scoping review on the current trends and future perspectives. Diagnostics. 2022;12(9):2044. doi: 10.3390/diagnostics12092044. PubMed PMID: 36140446; PubMed Central PMCID: PMC9498119. ##
  19. Park SK, Lee KS, Heo SJ, Jee YS. Effects of High Intensity Plank Exercise on Physical Fitness and Immunocyte Function in a Middle-Aged Man: A Case Report. Medicina (Kaunas). 2021;57(8):845. doi: 10.3390/medicina57080845. PubMed PMID: 34441051; PubMed Central PMCID: PMC8399219. ##
  20. Park D-J, Park S-Y. Which trunk exercise most effectively activates abdominal muscles? A comparative study of plank and isometric bilateral leg raise exercises. J Back Musculoskelet Rehabil. 2019;32(5):797-802. doi: 10.3233/BMR-181122. PubMed PMID: 30856100. ##
  21. Park S, Choi B-H, Jee Y-S. Effects of plank exercise on respiratory capacity, physical fitness, and immunocytes in older adults. J Exerc Rehabil. 2023;19(6):332-338. doi: 10.12965/jer.2346536.268. PubMed PMID: 38188128; PubMed Central PMCID: PMC10766451. ##
  22. Gupta G, Alok M. Effectiveness of plank exercise in low back pain. International Journal of Science and Research. 2020;9(10):1182-1186. doi: 10.21275/SR201011145832. ##
  23. Sun M, Min L, Xu N, Huang L, Li X. The effect of exercise intervention on reducing the fall risk in older adults: a meta-analysis of randomized controlled trials. Int J Environ Res Public Health. 2021;18(23):12562. doi: 10.3390/ijerph182312562. PubMed PMID: 34886293; PubMed Central PMCID: PMC8657315. ##
  24. Do YC, Yoo WG. Comparison of the thicknesses of the transversus abdominis and internal abdominal obliques during plank exercises on different support surfaces. J Phys Ther Sci. 2015;27(1):169-170. doi: 10.1589/jpts.27.169. PubMed PMID: 25642065; PubMed Central PMCID: PMC4305553. ##
  25. Örgün E, Kurt C, Özsu İ. The effect of static and dynamic core exercises on dynamic balance, spinal stability, and hip mobility in female office workers. Turk J Phys Med Rehabil. 2019;66(3):271-280. doi: 10.5606/tftrd.2020.4317. PubMed PMID: 33089083; PubMed Central PMCID: PMC7557618. ##
  26. Sever O. Comparison of static and dynamic core exercises’ effects on stork balance test in soccer players. Journal of Human Sciences. 2017;14(2):1781-91. doi: 10.14687/jhs.v14i2.4440. ##
  27. Cho N, Kim H. Comparison of Effects of Static Core Training and Additional Dynamic Core Training in Young Adults: An Experimental Study. Physical Therapy Rehabilitation Science. 2023;12(1):56-61. doi: 10.14474/ptrs.2023.12.1.56. ##
  28. Awad E, Mobark A, Zidan AA, Hamada HA, Shousha TM. Effect of progressive prone plank exercise program on diastasis of rectus abdominis muscle in postpartum women: a randomized controlled trial. 2021;16(2proc):S395-S403. doi: 10.14198/jhse.2021.16.Proc2.24. ##
  29. Reito A, Raittio L, Helminen O. Revisiting the sample size and statistical power of randomized controlled trials in orthopaedics after 2 decades. JBJS Rev. 2020;8(2):e0079. doi: 10.2106/JBJS.RVW.19.00079. PubMed PMID: 32224628. ##
  30. Thabet AA, Alshehri MA. Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial. J Musculoskelet Neuronal Interact. 2019;19(1):62-68. PubMed PMID: 30839304; PubMed Central PMCID: PMC6454249. ##
  31. Mota P, Pascoal AG, Carita AI, Bø K. The Immediate Effects on Inter-rectus Distance of Abdominal Crunch and Drawing-in Exercises During Pregnancy and the Postpartum Period. J Orthop Sports Phys Ther. 2015;45(10):781-8. doi: 10.2519/jospt.2015.5459. PubMed PMID: 26304639. ##
  32. Kumar R, Zemková E. The effect of 12-week core strengthening and weight training on muscle strength, endurance and flexibility in school-aged athletes. Appl Sci. 2022;12(24):12550. doi: 10.3390/app122412550. ##
  33. Lee J, Jeong K-h, Lee H-, Shin J-y, Choi J-l, Kang S-b, et al. Comparison of three different surface plank exercises on core muscle activity. Phys Ther Rehabil Sci. 2016;5(1):29-33. doi: 10.14474/ptrs.2016.5.1.29. ##
  34. Mueller J, Hadzic M, Mugele H, Stoll J, Mueller S, Mayer F. Effect of high-intensity perturbations during core-specific sensorimotor exercises on trunk muscle activation. J Biomech. 2018;70:212-218. doi: 10.1016/j.jbiomech.2017.12.013. PubMed PMID: 29290418. ##
  35. Kim SY, Kang MH, Kim ER, Jung IG, Seo EY, Oh JS. Comparison of EMG activity on abdominal muscles during plank exercise with unilateral and bilateral additional isometric hip adduction. J Electromyogr Kinesiol. 2016;30:9-14. doi: 10.1016/j.jelekin.2016.05.003. PubMed PMID: 27213781. ##
  36. Yoon J-O, Kang M-H, Kim J-S, Oh J-S. Effect of modified bridge exercise on trunk muscle activity in healthy adults: a cross sectional study. Braz J Phys Ther. 2018;22(2):161-167. doi: 10.1016/j.bjpt.2017.09.005. PubMed PMID: 28943402; PubMed Central PMCID: PMC5883971. ##
  37. Jung K-S, Cho H-Y, In T-S. Trunk exercises performed on an unstable surface improve trunk muscle activation, postural control, and gait speed in patients with stroke. J Phys Ther Sci. 2016;28(3):940-944. doi: 10.1589/jpts.28.940. PubMed PMID: 27134389; PubMed Central PMCID: PMC4842470. ##