EFFECTIVENESS OF ABDOMINAL MUSCLE STRENGTHENING OF

DIVERCATION OF RECTII IN POST NATAL FEMALES

A project report submitted in partial fulfillment of the requirements for Bachelor

of Physiotherapy of Tilak Maharashtra Vidhyapeeth, Pune.

BACHELOR OF
PHYSIOTHERAPY

BY,
NIDA GULMOHMED SHAIKH
(February 2013)

TILAK MAHARASHTRA VIDHYAPEETH,

PUNE.

ACKNOWLEDGEMENT
Indeed I am very glad to present this dissertation as a part of my Bachelor
program. Also I wish to express my sincere gratitude to all those who really
helped me with it.
I am deeply grateful to the GOD ALMIGHTY and my parents for the inner
strength and guiding light which makes my day bright and my problem solvable.
Am indebted to my project guide Dr.Mamta Bolade (MPT) whose constant
interest in the project keeps me going. Had it not been for her advice and
counseling at every step of this project, this mission would have never taken
such form. During my entire course Bachelor program I was truly blessed by the
constant support of my principal and I am very grateful for this constant support
and shall always cherish his valuable suggestions. My gratitude extends to all
other staff members for their encouragement.
I am also grateful to my friends and my batch mates who were with me
throughout the entire project completion and their easy understanding ways
comforted me all the way.

[NIDA
GULMOHMED SHAIKH]

CERTIFICATE

`This is to certify that the dissertation entitled EFFECTIVENESS OF

ABDOMINAL MUSCLE STRENGTHENING OF DIVERCATION OF RECTII IN POST

NATAL FEMALES has been successfully completed by Ms.Nida Gulmohmed
Shaikh under my supervision and guidance towards the partial fulfillment for the
requirement for the Bachelor of Physiotherapy degree to Tilak Maharashtra
University.

The work has been verified by me from time to time and I am satisfied
regarding the authenticity of the dissertation and confirm to the standards of
Tilak Maharashtra University.

I have great pleasure in forwarding and recommending the work to Tilak

Maharashtra University.

Dr.Mamta Bolade
(MPT in Neuro)
Guide

CERTIFICATE

This is to certify that Ms.Nida Gulmohmed Shaikh has prepared a project entitled
EFFECTIVENESS OF ABDOMINAL MUSCLE STRENGTHENING OF DIVERCATION
OF RECTII IN POST NATAL FEMALES under the supervision and guidance of Dr. Mamta
Bolade ( MPT in Neuro) in partial fulfillment and regulations for awarding her Bachelor of
Physiotherapy degree to my satisfaction.

have a great pleasure in forwarding this work to Tilak Maharashtra

University , Pune411037.

College Seal
Dr. Ujwal Yeole
(MPT.in Neuro)

(Principal)

CONTENTS
1.

INTRODUCTION
a) DEFINATION
b) INCIDENCE AND PREVELANCE
c) ANATOMY, BIOMECHANICS, PATHOPHYSIOLOGY
AND CLINICAL FEATURES
d) NEED OF STUDY

2.

AIMS AND OBJECTIVES

3.

HYPOTHESIS

4.

REVIEW OF LITERATURE

5.

MATERIAL AND METHODOLOGY

a) POPULATION
b) SAMPLE SIZE
c) SAMPLING DESIGN
d) STUDY DESIGN
e) STUDY SETTING
f) SELECTION CRITERIA(inclusion and
criteria)
g) MATERIAL USE
h) OUTCOME MEASURE
i) PROCEDURE

6.

RESULT AND TABLES

7.

DISSCUSSION

8.

CONCLUSION

9.

REFERENCE

10.

ANNEXURE
a) MASTER CHART
b) ASSESMENT FORM
c) SCALE

exclusion

ABSTRACT

ABSTRACT

TITLE : Effect of abdominal muscles strengthening of divercation of rectii in post

natal females.


AIM : To find the effectiveness of abdominal muscles strengthening of divercation
of rectii in post natal females.

STUDY DESIGN : Experimental study.

SET UP : Saifee hospital, Charni Road.

Noor Hospital, Mohammed Ali Road

METHODOLOGY : 30 patients from age group of 28 38 years with diastasis

rectii were selected for the study by scanning for inclusion & exclusion criteria using clinical
attachments and by examining the patients. Once diagnosed for diastasis rectii, patients were
divided into 2 groups , each consisting of 15 patients. Group A were given exercises. Group B
were given abdominal corset. The MMT scale was used before and after the treatment to see
the strength of abdominal muscles.

OUTCOME MEASURES : The MMT scale.

DATA ANALYSIS : Student t test was used ,paired t-test.

RESULTS : Individuals given exercises (group A) were seen with more abdominal
muscle strength as compared to those given only the abdominal corset (group B) .

INTRODUCTION

INTRODUCTION :-

DIVERCATION OF RECTII :-

During pregnancy many women experience a separation of their stomach muscles.

Known as diastasis rectii, this condition occurs when the main abdominal muscles called
the rectus abdominus begin to pull apart. The left and right sides of this muscles separate,
leaving a gap in between. Separated muscles do not tear or rupture so little pain is
involved at least initially. Instead the muscle thin out, creating a space in the abdomen.
This gap can get worse over time and may result in future health complications.

CAUSES :The rectus abdominus is kept in line by your transverse abs and your oblique abs during
pregnancy your abdominal muscles are tend to separate due to the growth of your baby in
your uterus. This growth exerts pressure on the rectus abdominus muscles, causing them
to split. Women who experience rapid growth of their stomachs during pregnancy are
10

more likely to suffer from separated abdominal muscles. Women with particularly weak
abdominal muscles may also end up with a split between the left and right side of the
rectus abdominus.
Separated muscles are actually fairly common during pregnancy. About one third of all
pregnant women experience separated muscles at some point throughout their pregnancy.
Separation of the stomach muscles is more likely to occur during the second trimester of
pregnancy. However, separation also frequently occurs during labor.

SYMPTOMS :Separation of the abdominal muscles is typically painless but there are few symptoms that
will help you to identify the condition. A small amount of separation of midline one or
two fingers width is common after most pregnancies and is not a problem. But if the gap
at your midline is:
a. More than 2cm or 2 finger widths
b. Does not shrink as you deepen the work of your abdominals
c. You can see a small mound protruding at your midline

OCCURANCE :Diastasis rectii occurs in pregnancy as a result of hormonal effect on the connective tissue
and the biochemical changes of pregnancy. It causes no discomfort. It can occur above, below
or at the level of umbilicus but it is less common in women with good abdominal tone prior
to pregnancy.
Routine assessment for this condition is highly recommended and easily done in
conjunction with an abdominal strength testing.
Low tone of abdominal musculature is not the sole cause of Diastasis Recti in post
partum women. Most commonly it is the outcome of the overall lack of balance between all
muscles within abdomen as well as the diaphragm and the muscles of pelvic floor. Diastasis
rectii occur in pregnancy possibly as a result of hormonal effect on the connective tissue and
the biomechanical changes of pregnancy. It causes no discomfort, it can occur above, below
11

or at the level of the umbilicus but appears to be less common below the umbilicus. It appears
to be less common in women with good abdominal tone prior to pregnancy.
A small amount of separation of midlineone to two fingers widthis common
after most pregnancies, and is not a problem. A diastasis recti looks like a ridge, which runs
down the middle of the belly area. It stretches from the bottom of the breastbone to the belly
button, and increases with muscle straining. If the gap of more than 2cm or 2 finger width at
the midline indicate Diastasis rectii. The abdomen does not shrink as you deepen the work of
the abdominals. Small mound protruding at the midline is also seen.

INCIDENCE :This condition is not exclusive to childbearing women but is seen frequently in this
population.
Diastasis is commonly found in women ( i.e. 80 % )and occasionally in men ( i.e. 7 -10
%)
This condition is more pronounced in indian population due to multiple pregnancy.

ANATOMY OF ABDOMINAL MUSCLES :-

The abdominals are composed of several muscles: the rectus abdominus, transverse
abdominus, and the external and internal obliques.

12

The abdominal muscles sit on the front and sides of the lower half of the torso, originating
along the rib cage and attaching along the pelvis.

Rectus abdominus When fully developed the rectus abdominus is the most prominent
abs muscle. It runs the length of your abs area, from your pubic bone to the lower chest.
Contraction of this muscle flexes your torso. If your torso is moving towards your hips
(crunches) you are focusing on the upper abs. if your hips are moving towards your torso i.e
reverse crunches, you will focus on the lower section of abs.

.External oblique

Your external oblique runs diagonally down from your lower eight ribs, attaching to the top
half of your hip and your rectus abdominis. The external obliques, along with the internal
obliques twist your body at the waist and straighten your body when its bend to the side.
Some exercises that work your obliques are: crossovers, bicycles and side bends. Some
examples: Baseball, tennis, golf and other racket sports.

13

Internal oblique

The internal obliques lie underneath the external obliques and run in a diagonally opposite
direction. The internal obliques work with the externals to rotate the trunk. Unlike the
external obliques, they are not visible when fully developed.

Transverse Abdominis

14

Of the four muscles of the abdominal muscle group, the transverse abdominis is the one that
does not cause trunk movement. It is the suck in your gut muscle that pulls the abs wall
inwards. It is located deep in your abdomen, underneath your obliques. It holds your organs
in place and forces, expiration when contracted. This muscle is often overlooked, which is a
mistake because training it properly can pull your stomach in, giving you a slimmer profile.

PHYSIOLOGY OF ABDOMINAL MUSCLES :-

The mid-section muscles consist of the rectus abdominis and the internal and external
obliques.
15

The muscle is enclosed in a sheath formed by the aponeurosis (broad, flat and thin connective
tissues) of the other abdominal muscles.
The rectus abdominus flexes the spinal column bringing the rib cage and the towards each
other, and assists in sideward bending. It is also actively involved in stabilizing the trunk
when the head is raised in a supine position.
The external oblique muscles are the most outmost fibres of the trunk, and are located on
each side of the rectus abdominis.
The lower and middle attachments of the external obliques are to the anterior crest of the
pelvis and from the ribs to the crest of the pubis. The external oblique muscle actually
becomes the inguinal ligament. The fibres of this muscle run diagonally forming a V shape
similar to putting your hands into your coat pocket.
Beneath the external muscles running at approximately right angles to them are the internal
oblique muscles which form an inverted V shape.
The deepest layer of abdominal muscles the transversus abdominis is not involved in
movements of the trunk. Instead this respiratory muscle plays an important function in
forceful expiration of air from the lungs as well as compression of the internal organs.
The hip flexors bring the legs and trunk toward each other. Full sit ups involve the hip flexors
which may cause the lower back to arch and unwanted back pain particularly in individuals
with relative weak abdominals.
Traditional sit ups emphasize sitting up rather than merely pulling your sternum down to
meet your pelvis. The action of the psoas muscles which run from the lower back around to
the front of the thighs, is to pull the thighs closer to the torso. This action is the major
component in sitting up. Because of this sit ups primarily engage the psoas making them
inefficient at exercising your abs, because the psoas work best when the legs are close to
straight so for most of the sit ups (as they are when doing sit ups) the psoas are doing most of
the work and the abs are just stabilizing.

16

BIOMECHANICS OF ABDOMINAL MUSCLES:-

Rectus abdominus :Flexes the spine (bringing the rib cage closer to the pelvis). This is seen in the abdominal
crunching movement. When the movement is reversed, the rectus abdominus acts to bring the
pelvis closer to the rib cage (e.g with a leg raising movement).

Transverse abdominus :Acts as a natural weight belt keeping your insides in. this muscle is essential for trunk
stability as well as keeping your waist tight.

Internal And External Obliques :Work to rotate the torso and stabilize the abdomen.

ANATOMY & PHYSIOLOGY OF PREGNANCY :-

Pregnancy (latin graviditas):-

17

It is referred to as carrying of one or more offspring, known as a fetus or embryo, inside the
uterus of a female. In a pregnancy, there can be multiple gestations, as in the case of twins or
triplets. Obstetrics is the surgical field that studies and cares for the high risk pregnancy.

Childbirth :It usually occurs about 38 weeks after conception, i.e approximately 40 weeks from the last
normal menstrual period (LNMP) in humans. The world health organization defines normal
term for delivery as between 37weeks and 42weeks. The calculation of this date involves the
assumption of a regular 28 day period.
One scientific term for the state of pregnancy is gravid, and a pregnant female is sometimes
referred to as a gravida.
Similarly the term parity is used for the number of previous successful live births.
Medically a woman who has never been pregnant is referred to as a nulligravida, and a in
subsequent pregnancies as multigravida or multiparous. Hence during a second
pregnancy women would be described as gravida2,para1 and upon delivery as
gravida2,para2. An in progress pregnancy as well as abortions, miscarriages or stillbirths
count for parity values being less than the gravida number, whereas a multiple birth increase
the parity value. The medical term for a woman who is pregnant for the first time is a
primigravida.
The term embryo is used to describe the developing offspring during the first eight weeks
following conception, and theterm fetus is used from about two months of development until
birth.
In many societies medical or legal definitions, human pregnancy is some what arbitrarily
divided into three trimester periods, as a means to simplify reference to the different stages of
pre natal development. The first trimester carries a highest risk of miscarriages(natural
death of embryo or fetus)

18

During the second trimester, the development of the fetus can be more easily monitored and
diagnosed. The beginning of the third trimester often approximates the point of viability, or
the ability of the fetus to survive, with or without medical help, outside of the uterus.

Progression :-

Initiation:Pregnancy occurs as the result of the female gamete or oocyte being penetrated by the male
gamete spermatozoon in a process referred to in medicine as fertilization, or more
commonly known as conception. After the point of fertilization it is referred to as an egg.
The fusion or male and female gametes usually occurs through the act of sexual intercourse.
However the advent of artificial insemination and in vitro fertilization have also made
achieving pregnancy possible in cases where sexual intercourse does not result in fertilization

Perinatal period:-

Perinatal defines the period occurring around the time of birth, specifically from 22
completed weeks (154days) of gestation(the time when birth weight is normally 500gm) to
seven completed days after birth.
Legal regulations in different countries include gestation age beginning from 16-22
weeks(5months)before birth.

Postnatal period:-

Duration :19

The expected date of delivery (EDD) is 40 weeks counting from the last menstrual period and
birth usually occurs between 37 and 42 weeks, the actual pregnancy duration is typically
38weeks after conception. Though pregnancy begins at conception, it is more convenient to
date from the first day of a womans last menstrual period, or from the date of conception if
known. Starting from one of these dates the expected date of delivery can be calculated. 40
weeks is nine month and six days, which forms the basis of Naegeles rule of estimating date
of delivery.
Pregnancy is considered at term when gestation attains 37 complete weeks but is less than
42(between 259 and 294 days since LMP). Events before completion of 37 weeks(259 days )
are considered pre term, from week 42(294 days ) events are considered post term. When a
pregnancy exceeds 42 weeks the risk of complications for women and the fetus increases
significantly. As such, obstetricians usually prefer to induce labour, in an uncomplicated
pregnancy , at some stage between 41 and 42 weeks..
Fewer than 5% of births occur on the due date; 50% of births are within a week of the due
date and almost 90% within two weeks. It is much more useful, therefore to consider a range
of due dates, rather than one specific day with some online date calculators providing this
information.

PHYSIOLOGY OF PREGNANCY :a) CHANGES OF THE REPRODUCTIVE SYSTEM DURING

PREGNANCY :20

Approximate height of the fundus at various weeks of pregnancy.

Changes in the body during pregnancy are most obvious in the organs of the reproductive
system.

Uterus :Changes in the uterus are phenomenal. By the time the pregnancy has reached term, the
uterus will have increased five times its normal size:

length from 6.5 to 32 cm.

In depth from 2.5 to 22 cm

In width from 4 to 24 cm

In weight from 50 to 1000 grams

In thickness of the walls from 1 to 0.5com

21

The capacity of the uterus must expand to normally accommodate a seven pound fetus
and the placenta, the umbilical cord, 500 ml to 1000 ml of amniotic fluid, and the fetal
membranes.

The abdominal contents are displaced to the sides as the uterus grows in size which
allows for ample space for the uterus within the abdominal cavity.

1. Growth of the uterus occurs at a steady, predictable pace.

2. Measurement of the fundal height during pregnancy is an important factor that is
noted and recorded.
3. Growth that occurs too fast or too slow could be an indication of problems.
4. The size of the uterus usually reaches its peak at the 38 week gestation. The uterus
may drop slightly as the fetal head settles into the pelvis, preparing for delivery. This
dropping is referred to as lightening. This is more noticeable in a primigravida than a
multigravida.

CHANGES OF THE SKIN DURING PREGNANCY :-

Alterations in hormonal balance and mechanical stretching are responsible for several
changes in the integumentary system. The following changes occur during pregnancy:
(a) Linea Nigra :- This is a dark line that runs from the umbilicus to the symphysis pubis
and may extend as high as the sternum. It is a hormone- induced pigmentation. After
delivery, the line begins to fade, though it may not ever completely disappear.

(b) Mask of pregnancy (chloasma) :- This is the brownish hyper pigmentation of the
skin over the face and forehead. It gives a bronze look, especially in dark
complexioned women. It begins about the 16th week of pregnancy and gradually
increases, then it usually fades after delivery.

22

(c) Striae Gravidarum (stretch marks) :- This may be due to the action of the
adrenocorticosteroids. It reflects a separation within underlying connective tissue of
the skin. This occurs over areas of maximal stretch the abdomen, thighs and breasts.
It usually fades after delivery although they never completely disappear
(d) Sweat glands :- Activity of the sweat glands throughout the body usually increases
which causes the woman to perspire more profusely during pregnancy.

BIOMECHANICAL ALTERATION DURING

PREGNANCY :-

There is a realignment of the spinal curvatures during pregnancy to maintain

balance. It is due to the increase in size of the uterine and pressure on the
abdominal wall. The patient with head and shoulders thrust backward and
chest protruding outward to compensate. This gives the patient a wadding
gait.

There is a slight relaxation and increased mobility of the pelvic joints,

which allows stretching at the time of delivery of the infant.

Postural changes during pregnancy :-

23

 SYSTEMIC CHANGES DURING PREGNANCY :-

PREGNANCY WEIGHT GAIN :The total weight gain in pregnancy is about 10 to 15 kgs
a. Fetus 3 to 4 kgs
b. Placenta 1 to 1 1 kgs
c. Amniotic fluid th 1 kg
d. Uterus and breast 2 to 3 kgs
e. Blood and other fluids 1 to 4 kgs
f. Muscles and fat to 3 kgs

PELVIC VISCERA, FASCIAE AND LIGAMENTS :24

The uterus increases from a pre-pregnant size of 5 to 10 cm (2 by 4 inches) to 25 cm by 36

cm (10 by 14 inches). It increases five to six times in size. 3000 to 4000 times in capacity. 20
times in weight by the end of pregnancy. Each muscle cell in the uterus has increased
approximately 10 times its length prior to pregnancy. Once the uterus expands upward and
leaves the pelvis, it becomes an abdominal organ than a pelvic organ.
Ligaments connected to the pelvic organs are more fibro elastic than ligaments supporting
joint structures.

MUSKULOSKELETAL SYSTEM :Abdominal muscles are stretched to the point of their elastic limit by the end of pregnancy.
This greatly decreases the muscles ability to generate a strong contraction and thus decreases
their efficiency of contraction. The shift in the center of gravity also decreases the mechanical
advantage of the abdominal muscles.
Hormonal influence on the ligaments is profound, tensile strength. This change is primarily a
result of change in relaxin and progesterone levels. Joint hyper mobility occurs as a result of
ligaments laxity and ligaments injury, especially in the weight bearing joints of the back,
pelvis and lower extremities.
The pelvic floor muscles must withstand the weight of the uterus, the pelvic floor drops as
much as 2.5cm (1 inch). The pelvic floor may be stretched, torn or injured during the birth
process. Stretch and compression of the pudental nerve occurs as the babys head travels
through the birth canal. This compromise to the pudental nerve is most intense during
pushing. As a result the pelvic floor is vulnerable from both a muscular and neurologic
perspective during labor and vaginal delivery.
As the musculoskeletal changes occur during pregnancy, along with other muscles abdominal
muscles also become weak and at the same time size of the uterus increases 5-6 times
because of which linea alba splits and the is known as diastasis recti.

POSTURE AND BALANCE CHANGES:The center of gravity shifts upward and forward because of the enlargement of the uterus and
breasts. This requires postural compensations for balance and stability. The shoulder girdle
25

and upper back become rounded with scapular protraction and upper intremity internal
rotation because of breast enlargement and postpartum positioning for infant care. Tightness
of the pectorial stabilizers also contributes to this postural changes. Cervical spine and
forward head posture develops to compensate for the shoulder alignment.
Lumbar lordosis increases to compensate for the knees hyperextend probably because of
changes in the line of gravity. Weight shifts towards the heels to bring the center of gravity to
a more posterior position. Changes in posture do not usually correct spontaneously after
childbirth and the pregnant posture may be maintained as a learned posture.

During pregnancy a women develops postural changes that are necessary for her to maintain
balance in the upright posture.
As the abdominal muscles are stretched and tone is diminished, they lose their ability to
contribute effectively to the maintenance of neutral posture with the biomechanical changes it
was thought that lumbar lordosis increases.
As pregnancy continues, production of the hormone relaxin increases & reaches peak
between 38 to 48 weeks.
Relaxin creates joint laxity which is necessarily the enlarging uterus. Joint laxity is more
pronounced in multi-parous as compare to nulli-parous women.
In the lumbar spine joint laxity is most notable in the anterior and posterior longitudinal
ligaments. This weakens the ability of static supports in the lumbar spine to withstand the
shearing forces.
As a result there may be an increase in discogenic symptoms and on pain coming from, the
facet joints in the pelvis, it laxity is the most prominent in the symphysis pubis and the SI
joints.

Complications associated with separated muscles :-

If you are suffering from separated muscles during pregnancy or in the postpartum period,
it is important to take steps to encourage your muscles to reattach on their own and they may
26

actually continue to separate after you have given birth. If left untreated, separated muscles
can cause health complications, including:
(1) Chronic lower back pain (due to the fact that the abdominal muscles help to
support your back and spinal column)
(2) Altered posture due to weak abdominal muscles (which is in turn weakens
your back muscles, leading to back pain).

TREATMENT FOR DIVERCATION OF RECTII :There are some easy ways to help treat separated muscles after you have given birth.
Abdominal exercises, bracing the abdomen by using abdominal corset, and Incase of tearing
surgery is recommended.

STRENGTENING OF ABDOMINAL MUSCLES :Simple abdominal exercises can help to bring the left and right sides of your rectus
abdominus back together. These abdominal exercises are designed to help target weak
muscles and will not cause extra stress to your stomach or back.
Work to perform three sets of ten repetitions each.
Before you begin any type of exercise, though be sure to consult with your health care
provider. These stomach exercises are suitable if you have undergone a cesarian section as
long as your stitches have been removed and your scars have healed.

(a) Head Lift Exercise 1 :-

27

Lie on your back with your knees bent and feet flat on the floor. Work to bring
your navel as close as possible to your spine, so it looks as if your stomach is
caving in. Hold this for a minute or two, while continuing to relax and breathe.

(b) Head Lift Exercise 2 :Lie on your back with your knees bent and feet flat on the floor. Place both of your
hands on your abdomen, fingers pointing towards your pelvis. Exhale and lift your
head off of the floor, while pressing down with your fingers.

(c) Head Lift With Pelvic Tilt :Lie on your back with knees bent and feet flat on the floor. Press your buttocks
down or contract gluteus ,this causes posterior tilting of pelvis. Then exhale & lift
your head & maintain the pelvic tilt.

(d) Leg Sliding :Lie on your back with your knees bent and feet flat on the floor. Exhale and extend
one leg out in front of you. Wait for your abdomen to contract and then inhale and
place your leg back on the floor. Alternate legs.

(e) Head Lift With Towel :Wrap a long towel around your stomach with the ends in front of your abdomen.
Do a crunch. As u raise your shoulders and head off of the ground, pull the ends of
the towel towards one another.

NEED OF THE STUDY :28

Diastasis rectii may produce musculo-skeletal complaints such as low back pain as a
result of a decreased ability of the abdominal muscle to control the pelvis and lumbar spine.
Functional limitation can also occur such as inability to perform independent supine to sitting
transitions. Severe cases of Diastasis rectii may progress to herniation of the abdominal
viscera.
Abdominal exercise is very important not because they help in shaping abs but
because they help in strengthening your spine in order to reduce the backaches. They are also
meant for promoting good posture.
As this condition is very common in post natal women there is a need to correct the
condition in females among the age group of 28 to 38 years.

29

AIMS & OBJECTIVES

AIMS AND OBJECTIVES:-

30

 AIM:TO DETERMINE THE EFFECT OF ABDOMINAL MUSCLE STRENGTHENING IN

DIVERCATION OF RECTII IN POST NATAL FEMALES.

OBJECTIVE :-

TO DETERMINE THE EFFECT OF STRENGTHENING ABDOMINAL MUSCLES IN

DIASTASIS RECTII IN POST NATAL FEMALES IN THE AGE GROUP OF 28-38
YEARS.

31

HYPOTHESIS

HYPOTHESIS : RESEARCH HYPOTHESIS :32

There is a significant effect of abdominal muscle strengthening exercises against the control
group in divercation of rectii in the age group of 28 to 38 years old postnatal females.

NULL HYPOTHESIS :There is no significant effect of abdominal muscle strengthening exercises against the control
group in divercation of rectii in the age group of 28 to 38 years old postnatal females.

33

REVIEW OF LITERATURE

Review of literature:1) The Effects of an Exercise Program on Diastasis Recti Abdominis in

Pregnant Women
34

Chiarello, Cynthia M.; Falzone, Laura A.; McCaslin, Kristin E.; Patel, Mita N.; Ulery, Kristen
R.
Journal of Womens Health Physical Therapy. 29(1):11-16, Spring 2005.
Abstract:
The purpose of this project was to determine the effect of an abdominal strengthening
exercise program on the presence and size of DRA in pregnant women.
Subjects were comprised of 8 pregnant women participating in an abdominal exercise
program and 10 non-exercising pregnant women. Diastis recti abdominis was measured using
a digital caliper at 3 marked sites along the midline of each subject's abdomen: 4.5 cm above
the umbilicus, at the umbilicus, and 4.5 cm below the umbilicus. Two measurements were
taken at each site, and the average was used for statistical analyses. Descriptive statistics were
generated, and independent t-tests were performed on each subject characteristic. An analysis
of covariance was computed with the number of previous pregnancies as the covariate to
control for the difference between the subject groups.
90% of non-exercising pregnant women exhibited DRA while only 12.5% of exercising
women had the condition. The mean DRA located 4.5 cm above the umbilicus was 9.6 mm
(+/- 6.6) for the exercise group and 38.9 mm (+/- 17.8) for the non-exercise group. The mean
DRA located at the umbilicus was 11.4 mm (+/- 3.82) for the exercise group and 59.5 mm
(+/- 23.6) for the non-exercise group. The mean DRA located 4.5 cm below the umbilicus
was 8.2 mm (+/- 7.4) for the exercise group and 60.4 (+/- 29.0) for the non-exercise group.
Thus occurrence and size of DRA is much greater in non-exercising pregnant women
than in exercising pregnant women.

2) Diastasis Rectus Abdominis and Lumbo-Pelvic Pain and DysfunctionAre They Related?
Parker, Meredy A. PT, DPT1; Millar, Lynn A. PT, PhD, FACSM2; Dugan, Sheila A. MD3

Abstract
The purpose of this study was to examine the clinical assumption that the presence of
diastasis recti abdominis (DRA) causes lumbopelvic pain (LPP) or dysfunction.
Subjects (n=39; PG) included women seeking medical care for lumbar or pelvic area
diagnoses (>18 years old) who had delivered at least one child. A control group (n=53; CON)
of women were included, as well as a third group (n=8; LAP) with a history of a laparoscopy.
Subjects completed the Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire,
and the Modified Oswestry Low Back Pain Disability Questionnaire, as well as 2 Visual
Analog Scales (VAS) for pain. A dial caliper was used to measure the distance between the
rectus bellies. Differences between groups were analyzed using ANOVAs.

35

The incidence for the DRA was 74.4% for the PG, 50.9% in the CON, and 100% in the
LAP groups. There was a significant difference between groups for all pain and dysfunction
scales. There was also a significant difference between those with and without DRA for the
VAS scores for abdominal and pelvic area pain. Otherwise, there was not a significant
difference between those with and without DRA for any other LPP or function scales.
Thus Women with a DRA tend to have a higher degree of abdominal or pelvic region
pain.

3) The Relationships Between Inter-recti Distance Measured by Ultrasound

Imaging and Abdominal Muscle Function in Postpartum Women: A 6month Follow-up Study
Lih-Jiun Liaw, Miao-Ju Hsu, Chien-Fen Liao, Mei-Fang Liu, Ar-Tyan Hsu
DOI: 10.2519/jospt.2011.3507
Abstract
This study was done to investigate the natural recovery of IRD and abdominal muscle
strength and endurance in women between 7 weeks and 6 months postpartum, and to examine
the relationship between IRD and abdominal muscle function.
40 postpartum (25-37 years of age) and 20 age-matched, nulliparous females
participated. IRD was measured at 4 locations (upper and lower margin of the umbilical ring,
and 2.5 cm above and below the umbilical ring) with a 7.5-MHz linear ultrasound transducer.
Trunk flexion and rotation strength and endurance were measured with manual muscle testing
and curl-ups. Evaluation was conducted at 4 to 8 weeks and 6 to 8 months after childbirth in
postpartum women, and only once for the nulliparous female controls.
During follow-up, the IRD at 2.5 cm above the umbilical ring and at the upper margin
of the umbilical ring decreased (P = .013 and P = .002, respectively). The strength and static
endurance of the abdominal muscles improved over time (P<.05). A negative correlation
between IRD and abdominal muscle function at 7 weeks and 6 months postpartum was found
(r = 0.34 to 0.51; P<.05, except for trunk flexion strength at 6 months postpartum [P = .064]).
In addition, IRD changes between 7 weeks and 6 months postpartum were correlated with
improvement in trunk flexion strength (Spearman rho = 0.38, P = .040). At 6 months after
childbirth, postpartum women had greater mean ? SD IRDs at all 4 locations (from cranial to
caudal: 1.80 0.72, 2.13 0.65, 1.81 0.62, and 1.16 0.58 cm) than those of nulliparous
females (0.85 0.26, 0.99 0.31, 0.65 0.23, and 0.43 0.17 cm) (all P<.001). All
abdominal strength and endurance measurements were less than those of nulliparous females
(all P<.001).
The IRD and abdominal muscle function of postpartum women improved but had not
returned to normal values at 6 months after childbirth. Future research is essential to explore
36

the need for intervention and, if needed, the effectiveness of specific intervention to reduce
the size of IRD in postpartum women.
J Orthop Sports Phys Ther 2011;41(6):435-443, Epub 2 February 2011.
doi:10.2519/jospt.2011.3507

4) Incidence of diastasis recti abdominis during the childbearing year.

by J S Boissonnault, M J Blaschak
Physical Therapy (1988) Volume: 68, Issue: 7, Pages: 1082-1086
Abstract
This study was conducted to determine :1) the incidence of diastasis recti abdominis among women during the childbearing year
2) the location of the condition along the linea alba.
Clinicians have long noted its presence, prenatally and postnatally, but the magnitude of the
problem is currently unknown. A cross-sectional design was used to test 71 primiparous
women placed in one of five groups, based on placement within the childbearing year. A
commonly accepted test for diastasis recti abdominis was performed. Palpation for diastasis
recti abdominis at the linea alba was performed 4.5 cm above, 4.5 cm below, and at the
umbilicus. Diastases were observed at all three places, but most often at the umbilicus. A
significant relationship (p less than .05) was found between a woman's placement in her
childbearing year and the presence or absence of the condition. Diastasis recti abdominis was
observed initially in the women in the second trimester group. Its incidence peaked in the
third trimester group; remained high in the women in the immediate postpartum group; and
declined, but did not disappear, in the later postpartum group. These findings demonstrate the
importance of testing for diastasis recti abdominis above, below, and at the umbilicus
throughout and after the childbearing year

5) Physical therapy treatment for diastasis rectii (case report)

by Michelle E Collie, Bette Ann Harris
Medicine Miscellaneous Papers

Abstract
The purpose of this case report is to illustrate the use of specific abdominal exercises for the
management of unresolved diastasis recti in a woman 6 years postpartum.
37

This case describes a 34-year-old woman referred for physical therapy with a
diagnosis of diastasis recti and report of increasing abdominal pain and swelling over the last
4 years . She was 6 years postpartum and 5 years posthysterectomy. A diastasis recti of 4
fingerbreadths was noted during physical therapy examination as well as impairments of
decreased abdominal muscle performance and motor control. Limited physical function was
reported with the patient unable to perform activities other than light household duties and
had reportedly adopted a sedentary lifestyle.
An abdominal muscle pelvic CT scan confirmed the clinical findings of diastasis of
the rectus muscle with images obtained in spinal flex- ion. Physical therapy treatment
consisted of a 3- month program that emphasized specific exercises for transversus abdominis
strength. Treatment was initially carried out 3 times a week and was decreased to once every
other week by the time of discharge. A daily home exercise program was included as a
component of the physical therapy program and it was recom- mended to be continued
indefinitely and at the time of discharge.
Following the 3- month physical therapy program, the pain complaints resolved
completely and the previous level of function was restored.

38

MATERIAL METHODOLOGY

MATERIAL AND METHOD

METHOD OF COLLECTION:1) STUDY DESIGN AND SETTING :a) STUDY DESIGN
39

Randomised controlled trial.

2) SOURCE OF DATA:
a) METHODOLOGY :i) POPULATION
Females between 28 - 38 years of age.
ii) SELECTION CRITERIA :a) INCLUSION CRITERIA:

Age: 28-38 years.

Sex: females

Post delivery : within 1 week

Type of Delivery : normal

History of : splitting of abdominal muscles

b) EXCLUSION CRITERIA:

Cessarian delivery

Trauma at abdomen

Any abdominal surgery

Un co-operative patients.

Subject who is not able to understand the procedure

3) SAMPLING METHOD AND SAMPLE SIZE :a) SAMPLING METHOD

Simple random sampling method.
b) SAMPLE SIZE.
30 subjects
40

4) PROCEDURE :30 subjects females satisfying the inclusion criteria will be selected, written
consent will be taken from the selected subjects and randomly assigned as follows.
Experimental Group - 15 subjects
Control Group - 15 subjects
Separation of rectus abdominis is assessed in both experimental and control group
using finger test & MMT for rectus abdominis.
Experimental group will receive abdominal strengthening exercises for a period
of 1 week. Exercises are performed for 15 20 mins for two sessions per day. The duration
of the exercises can be gradually increased to 30 mins.

TREATMENT :-

(a) Head Lift Exercise 1

(b) Head Lift Exercise 2
(c) Head Lift With Pelvic Tilt
(d) Leg Sliding
(e) Head Lift With Towel

The control group will be using only abdominal corset for 1week.
After a week post treatment evaluation is done in both groups using MMT scale
and the scores will be recorded.

a) DURATION OF STUDY :Duration 1 week.

b) MATERIALS USED :1.

MMT scale.

2.

Abdominal corset

5) OUTCOME MEASURES AND STATISTICAL ANALYSIS :41

1) OUTCOME MEASURES :MMT scale for abdominals

2) STATISTICAL ANALYSIS :Student T- test

CONSENT FORM

Investigator: Ms NIDA .G. SHAIKH

Purpose of research
I.

have been informed that this study is carried to know the effect of

abdominal muscle strengthening exercises.

Procedure
I understand that my Pain will be assessed by Ms.Nida .G . Shaikh with MMT
scale. And I have to undergo 7days of treatment (experimental group) /
abdominal corset (control group). I am aware that I have to follow the
researchers instruction as has been told to me.
Risk and comfort

42

I understand that there is no potential risk associated with this study and this
study will not produce any harm to me by participating. I understand that there
wont be any discomfort throughout the study. I am aware that Ms. Nida .G.
Shaikh will help me for better understanding of the procedure.
Benefits
I understand that this study helps to know the efficiency of abdominal muscle
strengthening exercises in divercation of rectii.

Alternatives
I understand the procedure being studied is the standard way than compared to
other studies which can be conducted by using other tools.
Confidentiality
All the data recorded will be kept in strictest confidence. Apart from the
researcher no one will ever access to the data without your permission. If the
data is used for publication in the medical literature or for the teaching purpose,
no names will be used
Photograph consent
Ms. Nida .G. Shaikh has explained to me that photographs are required in order
to illustrate various aspects of the study for the thesis and other articles, and at
presentations or conferences. These images may also be converted to electronic
formats for use in multimedia presentations and documents accessible to others
by computers for promoting this research. By giving my consent I authorise Ms.
Nida .G. Shaikh to use any of the photographs taken of me in printed format, in
slides for presentation, and in electronic format.
Request for more information
I understand that I may ask any questions of the study at any time, Ms. Nida .G.
Shaikh is available to answer my questions, and copy of this consent form will be
given to me for my careful reading.
Refusal or withdrawal of participation.
I understand that my participation is voluntary and may refuse to withdraw
consent and discontinue participation at any time. I also understand that she may
not include my participation in the study at any time after she has explained the
reason for doing so.
Injury statement
I understand that in the unlikely event of the injury resulting directly/indirectly from
my participation in this study, medical treatment will be available but no further
43

compensation will be provided. I understand that my agreement to participation in

this study and I am not waiver any kind of my legal right, I explained to.
. the
purpose of the best of my ability.

Investigator: Ms. Nida .G. Shaikh

Investigator signature:

date:

I confirm that Ms. Nida .G. Shaikh has explained me the purpose of research
study, the procedure and the possible risk and benefits that I may experience, I
have read and I have understood this consent to participate as a subject in this
research project.

Candidates signature:

date:

Witness signature:

date:

APPENDIX III

PROFORMA

Name

Group

Age

serial no:

Sex

date of assessment:

Address

Phone no:

Mobile:

Inclusion criteria:

Is the subject between 28-38 yrs of age?

(Y/N)

Is the subject female ?

(Y/N)
44

Does the subject has a history of split of abdominal muscles? (Y/N)

Is the subject undergone normal delivery ?

(Y/N)

Exclusion criteria:

Does the subject have any other condition such as

(Y/N)

infective condition of abdomen like tumor,etc.. ?

Is the subject undergone cessarian delivery ?

(Y/N)

Does the subject has any trauma at abdomen ?

(Y/N)

Has the subject undergone any abdominal surgery?

(Y/N)

Is the subject un co-operative ?

(Y/N)

Is the subject not able to understand the procedure ?

(Y/N)

Chart for experimental group

Outcom
MMT
Scale

Pre training score

Chart for control group

Outcom Pre training score

e
measure
MMT
scale
Signature of the subject.

Signature of the witness.

Signature of the investigator.45

Date

Post training score

Post training score

APPENDIX IV

Two Finger Test :Hook lying position

Slowly actively raise the head and shoulders off the floor, reaching her hands
towards the knees, until the spine of the scapulae leaves the floor

Place fingers of one hand horizontally across the midline of the abdomen at the
umbilicus

If separation exists, fingers will sink into the gap

The number of fingers that can be placed between the rectus muscle bellies
measures diastasis

Less than 2 fingers or 2 cms is normal; more than 2 fingers or 2 cms is abnormal

Instruct client to performed a self-diastasis test

46

MMT Scale :-

ABDOMINALS MMT (MANUAL MUSCLE TESTING)

GRADE 1:- :- Place the hand below L5 spine and ask to press the hand that is there
is a flicker of contraction.
GRADE 2:- Hook the finger and tell her to see the toes ie. head and cervical spine
are off the bed.
GRADE 3:- Hook the finger and try to sit ie. Scapula off the bed & patient is able to
sit.
GRADE 4:- Hands across the chest and the patient is able to sit.
GRADE 5:- Both the hands clasped behind the head and the patient is able to sit.
APPENDIX V

Abdominal Strengthening Exercises:-

1) Head Lift Exercise 1 :Hold for 30 seconds then relax - repeat 10 times for 15-20mins
two session/day

2) Head Lift Exercise 2 :Hold for 30 seconds then relax - repeat 10 times for 15-20mins
two session/day

3) Head Lift With Pelvic Tilt :Hold for 30 seconds then relax - repeat 10 times for 15-20mins
two session/day
47

4) Leg Sliding :Hold for 30 seconds then relax - repeat 10 times for 15-20mins
two session/day

5) Head Lift With Towel :Hold for 30 seconds then relax - repeat 10 times for 1520mins two session/day

48

RESULT AND TABLE

RESULT AND TABLES:GROUP A

TABLE 1

Treatment

Mean

St Dev

SE Mean

PRETreatment

15

1.000

0.000

0.000

POSTTreatment

15

2.200

0.775

0.200

Difference

15

-1.200

0.775

0.200

95% CI for mean difference: (-1.629, -0.771)

T-Test of mean difference = 0 (vs not = 0): T-Value = -6.00

49

P-Value

= 0.000

The treatment given showed improvement from the pre-treatment mean 1.000
and post-treatment mean 2.200 with T- Value= -6.00 and P-Value=0.000 and the
above graph also represent the increase in range post-treatment.

GROUP B
TABLE 2

Treatment

Mean

St Dev

SE Mean

PRETreatment

15

1.000

0.000

0.000

POSTTreatment

15

1.667

0.488

0.126

Difference

15

-0.667

0.488

0.126

95% CI for mean difference : (-0.937, -0.396)

T-Test of mean difference = 0 (vs not = 0) : T-Value = -5.29
0.000

50

P-Value =

The treatment given showed improvement from the pre-treatment mean 1.000
and post-treatment mean 1.667 with T- Value=-5.29 and P-Value=0.000 and the
above graph also represent the increase in range post-treatment.

GROUP A AND GROUP B POST TREATMENT:TABLE 3

Treatment

Mean

St Dev

SE Mean

PostTreatment

15

2.200

0.775

0.200

15

1.667

0.488

0.126

15

0.533

0.990

0.256

Group A
(experimental
group)
PostTreatment
Group B
(control
group)
Difference

51

95% CI for mean difference: (-0.015, 1.082)

T-Test of mean difference = 0 (vs not = 0): T-Value = 2.09 P-Value = 0.000

The Group A (experimental group) and Group B (control group) showed

improvement from the post-treatment mean 2.200 and 1.667 with T- Value= 2.09
and P-Value=0.000 and the above graph also represent the increase in range
post-treatment of Group A then Group B.

DISCUSSION
52

DISCUSSION:During pregnancy many women experience a separation of their stomach muscles. Known as
diastasis rectii, this condition occurs when the main abdominal muscles called the rectus
abdominus begins to pull apart. The left and right sides of this muscles separate, leaving a
gap in between.
As the musculoskeletal changes occur during pregnancy, along with other muscles abdominal
muscles also become weak and at the same time size of the uterus increases 5-6 times
because of which linea alba splits and this is known as diastasis recti.
In the study of Divercation of rectii in postnatal care 30 subjects were selected according
to inclusive and exclusive criteria which include Multigravid women among the age group of
28 to 38 years within first week after delivery.
The females were assessed for Divercation of rectii by placing the Patient is in hook lying
position. The Divercation is measured by the number of fingers that can be placed between
53

the rectus muscle belly. Any separation larger than 2 cm or two finger widths is considered
significant. Since a Divercation of rectii can occur above, below or at the level of the
umbilicus, test for it at all three areas.
After checking the presence of divercation, MMT(manual muscle testing) of Rectus
Abdominis muscle was checked. Almost, all the subjects demonstrate grade 1 MMT.
And finally the strengthening of Rectus Abdominis was given for a week and the results
noted. Before treatment the mean MMT was 1 and after treatment the mean MMT recorded
was 2 or 3.
Hence, the study is highly significant. This means that strengthening of Rectus abdominis is
effective in divercation of rectii.
Our observation indicates strengthening of rectus abdominus more in group A as compared to
group B.
Group A has a pre test mean value 1.000 to post test mean value 2.200 with T value -6.00 and
P value 0.000.while in group B pre test mean value 1.000 to post test mean value was 1.667
with T value -5.29 ands P value 0.000

The report supported the hypothesis that there is a significant effect of abdominal muscle
strengthening exercises (Group A) in divercation of rectii in the age group of 28 to 38 years
old postnatal females.

54

CONCLUSION

55

CONCLUSION:From the above study performed and data collected it is concluded that
strengthening of abdominal muscle is effective in divercation of rectii in postnatal
females.

56

57

SUGGESTIONS AND LIMITATIONS

SUGGESTIONS AND LIMITATIONS:-

The study was short term study result did not show much significant changes
between the two groups of patients, each group being treated with different
techniques.
Sample size was very small, so further study using a large sample size could be
better to compare the effectiveness of treatment.

58

59

REFRENCES

LIST OF REFERENCES :-

1. Coulter ID. Chiropractic: a philosophy for alternative health care. Oxford:

Butterworth-Heinemann; 1999.
2. Strang V. Essential principles of chiropractic. Davenport, IA: Palmer College
of Chiropractic; 1984.
3. Green BN, Gin RH. George Goodheart, Jr., D.C., and a history of applied
kinesiology. J Manipulative Physiol Ther. 1997;20:331337. [PubMed]
4. Walther DS. Applied Kinesiology, Synopsis. 2. Pueblo, CO: Systems DC;
2000.
5. Walther DS. Applied Kinesiology, Chapter 6. In: Coughlin P, editor. Principles
and Practice of Manual Therapeutics: Medical Guides to Complementary &
Alternative Medicine. Philadelphia: Churchill-Livingstone: Elsevier Science;
2002.
6. Goodheart GJ. Applied Kinesiology Research Manuals. Detroit, MI: Privately
published yearly; 1964.
7. Frost R. Applied Kinesiology: A training manual and reference book of basic
principals and practices. Berkeley, CA: North Atlantic Books, Berkeley; 2002.
8. Leaf D. Applied Kinesiology Flowchart Manual, III. Plymouth, MA: Privately
published; 1995.
60

9. Maffetone P. Complementary Sports Medicine: Balancing traditional and

nontraditional treatments. Champaign, IL: Human Kinetics; 1999.
10. Christensen MG, Delle Morgan DR. National Board of Chiropractic
Examiners. Greeley, CO; 1993. Job analysis of chiropractic: a project report,
survey analysis, and summary of the practice of chiropractic within the United
States; p. 78.
11. Christensen MG, Delle Morgan DR. National Board of Chiropractic
Examiners. Vol. 92. Greeley, CO; 1994. Job analysis of chiropractic in
Australia and New Zealand: a project report, survey analysis, and summary of
the practice of chiropractic within Australia and New Zealand; p. 152.
12. American Chiropractic Association
Database http://www.amerchiro.org/techniques Accessed February 15, 2007.
13. LeBoeuf C. A Survey of Registered Chiropractors Practicing in South
Australia in 1986. J Aust Chiro Assoc. 1988. pp. 10510.
14. Touch for Health
Database http://www.touch4health.com/books.htm Accessed February 15,
2007 See also: A moment of silence for Dr. John Thie, Dynamic
Chiropractic 2005;23(19).http://www.chiroweb.com/archives/23/19/11.html.
15. Swinkels RA, Bouter LM, Oostendorp RA, Swinkels-Meewisse IJ, Dijkstra
PU, de Vet HC. Construct validity of instruments measuring impairments in
body structures and function in rheumatic disorders: which constructs are
selected for validation? A systematic review. Clin Exp
Rheumatol. 2006;24:93102. [PubMed]
16. Kaminski M, Boal R, Gillette RG, Peterson DH, Vilinave TJ. A model for the
evaluation of chiropractic methods. J Manipulative Physiol Ther. 1987;10:61
4. [PubMed]
17. Fletcher RH, Fletcher SW, Wagner EH. Clinical epidemiology: the
essentials. 3. Philadelphia, PA: Williams & Wilkins; 1988.
18. Janda V. PhD thesis. Charles University, Prague; 1964. Movement patterns in
the pelvic and hip region with special reference to pathogenesis of
vertebrogenic disturbances.
19. Bohannon RW. Manual muscle testing: does it meet the standards of an
adequate screening test?Clin Rehabil. 2005;19:6627. doi:
10.1191/0269215505cr873oa. [PubMed] [Cross Ref]
20. Karin Harms-Ringdahl. Muscle Strength. Edinburgh: Churchill Livingstone;
1993.
21. Kendall FP, McCreary EK, Provance PG. Muscles: Testing and
Function. Baltimore, MD: Williams & Wilkins; 1993.
22. Daniels L, Worthingham K. Muscle Testing Techniques of Manual
Examination. 7. Philadelphia, PA: W.B. Saunders Co; 2002.
23. Walther DS. Applied Kinesiology, Synopsis. 2. Pueblo, CO: Systems DC;
2000.
24. Barbano RL. Handbook of Manual Muscle Testing Neurology. 2000. p. 1211.
61

25. Martin EG, Lovett RW. A method of testing muscular strength in infantile
Paralysis. JAMA. pp. 15123. 1915 Oct 30.

ANNEXURE

62

INFORMED CONSENT DOCUMENT

I __________________________________________________ hereby give

my consent to include me as the subject in the clinical study. I have been
informed to my satisfaction by the attending physiotherapist, the purpose
of this clinical study. I am aware that I may choose to stop being a part of
this study at any time without having to give the reason for doing so.
____________________________
Signature of attending Physiotherapist
___________
Date
__________________
Signature of Patient
63

___________
Date

ASSESSMENT FORM

64

NAME:AGE:ADDRESS:TEL NO.:OCCUPATION:DATE OF PRESENT DELIVERY:CHIEF COMPLAIN:PAST SURGICAL HISTORY:HISTORY OF PRESENT PREGNANCY:Planned-

Accidental65

OBSTETRIC HISTORY:- NO.OF DELIVERY________

ON OBSERVATION:1. POSTURE AND ATTITUDE:2. SWELLING:ON EXAMINATION:1. MMT (MANUAL MUSCLE TESTING) :UPPER ABDOMEN - GRADE_______
LOWER ABDOMEN- GRADE_______

2.TEST FOR DIASTASIS RECTII:

PRESENT_____ ABSENT_______

INCLUSIVE CRITERIA :
1. AGE: 28-38
2. POST DELIVERY: WITH IN 1 WEEK
3. HOUSE WIVES.
4. MULTIGRAVID.

EXCLUSIVE CRITERIA:1. ANY ABDOMINAL SURGERY:

2. CESSARIAN DELIVERY:3. TRAUMA AT ABDOMEN:-

66

SCALE
67

ABDOMINAL MMT (MANUAL MUSCLE TESTING)

GRADE 1:- Place the hand below L5 spine and ask to press the hand that is there is a
flicker of contraction.
GRADE 2:- Hook the finger and tell her to see the toes ie. head and cervical spine are off the
bed.
GRADE 3:- Hook the finger and try to sit ie. Scapula off the bed & patient is able to sit.
GRADE 4:- Hands across the chest and the patient is able to sit.
GRADE 5:- Both the hands clasped behind the head and the patient is able to sit.

68

MASTER CHART
69

GROUP A
MASTER CHART
SR.NO AGE GENDER
GROUP A
(EXPERIMENTAL
GROUP)

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

29
28
32
30
28
35
29
33
30
29
29
36
29
30
34

F
F
F
F
F
F
F
F
F
F
F
F
F
F
F

70

PRE-

POST-

TREATMENT
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

TREATMENT
2
3
1
2
3
2
3
1
2
3
1
3
3
2
2

GROUP B
MASTER CHART
SR.NO
GROUP B
(CONTROL
GROUP)

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

AGE

GENDER

PRE-

POST-

28
31
28
28
30
29
30
28
36
30
37
34
29
28
30

F
F
F
F
F
F
F
F
F
F
F
F
F
F
F

TREATMENT
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

TREATMENT
1
2
2
2
1
2
2
2
2
2
2
2
1
1
1

71