Muscle elasticity is different in individuals with diastasis recti abdominis than healthy volunteers

Abstract

Objective To determine the value of shear wave elastography (SWE) in assessing abdominal wall muscles, including rectus abdominis (RA), external oblique muscle (EO), internal oblique muscle, and transversus abdominis (TrA) in patients with diastasis recti abdominis (DRA) and healthy controls. Methods From October 2018 to December 2019, 36 postpartum DRA patients and 24 nulliparous healthy women were identified. Inter-rectus distance (IRD) measurements were taken by B-mode ultrasound. Shear wave speed (SWS) values were acquired by one operator at ten specific locations. Clinical and ultrasound variables, including demographics, IRD, muscle thickness, and muscle SWS, were compared between the two groups using Student’s t test or Fisher's exact test. Pearson correlation analyses were conducted for the variables of IRD, muscle thickness, and SWS in the 36 DRA patients. Results The maximum diameter of recti abdominus separation was located at the umbilicus in DRA patients (4.59 ± 1.14 cm). The SWS value was significantly lower in the RA (p = 0.003) and higher in the TrA muscle (p < 0.001) in DRA patients compared with the age-matched controls. However, SWS in both muscles (RA and TrA) showed a statistically positive correlation with IRD (p < 0.05). In addition, the SWS value in EO statistically decreased in DRA patients compared with the healthy controls (1.65 ± 0.15 vs. 1.79 ± 0.14, p = 0.001). Conclusions The application of SWE to abdominal wall muscles in DRA patients is feasible. The correlation between SWS value and IRD in RA should be interpreted with caution.

Multidimensional Ultrasound Evaluation of Diastasis Recti Abdominis During Different Gestational Periods

“…The IRD, thickness, and Young's modulus of rectus abdominis were different at different gestational periods. The two-dimensional morphological changes are inversely related, that is, as IRD widened with the progression of pregnancy, the thickness of the rectus abdominis decreased, and the Young's modulus of the rectus abdominis elasticity decreased accordingly, namely, reduced elasticity of the rectus abdominis, which is similar to the results of He et al, 7 who found that the SWS value of rectus abdominis in patients with DRA decreased significantly. This may be due to the biomechanical and pathological changes in muscle fibers with the increase in the IRD.…”

“…The IRD, thickness and Young's modulus all change during different gestational periods, and the decrease in muscle thickness and fiber volume of gravidas can lead to the slow propagation speed of SWE. 7 Therefore, the correlation analysis in this study showed that the Young's modulus of rectus abdominis had a certain relationship with IRD and thickness of rectus abdominis, but had no significant correlation with neonatal weight or delivery mode.…”

“…Some researchers contend that changes in rectus abdominis muscle tension and flexibility, as opposed to changes in IRD, may be the underlying factor that determines self-healing of DRA and affects clinical efficacy. 6,7 Real-time shear wave ultrasound elastography (SWE) can sensitively and accurately evaluate the elasticity of tissues, 8 and can aid in detecting the functional biomechanics of rectus abdominis. The Young's modulus value of the SWE technical parameter exhibits a positive correlation with muscle strength, which can effectively quantify the elastic function of the rectus abdominis muscle, reflecting its muscle strength and providing insights into its functional biomechanics.…”

Efficacy of electro-acupuncture in postpartum with diastasis recti abdominis: A randomized controlled clinical trial

“…The rectus sheath wraps the rectus abdominal muscles and is divided into two layers: the anterior is formed by the healing of the aponeurosis of the external oblique muscle and the aponeurosis of the internal oblique muscle, and the posterior rectus sheaths are formed by the healing of the aponeurosis of the internal oblique muscle and the aponeurosis of the transverse abdominis. The posterior rectal sheath is functionally more related to transverse abdominis than rectus abdominal muscles, and activation of transverse abdominis plays an important role in the etiology of the DRA ( 34 , 35 ). Physical exercises adopted in this study, such as left and right-side leg rotation, are more effective in activating deep transverse abdominis, external oblique muscle, and internal oblique muscle ( 36 , 37 ), and posterior rectus fascia sheath formed by transverse abdominis tendon sheath has better efficacy in maintaining abdominal wall tension stability.…”

Reliability of offline inter-recti distance measurement on ultrasound images captured by novice examiners

“…In physiotherapy, conventional ultrasound imaging (USI) is commonly used for non-invasive measurement of the inter-recti distance (IRD) [1,2], and pregnancy-related diastasis recti abdominis (DRA) when assessing, for example, the effectiveness of postpartum physical exercises [3,4,5,6]. Desings of these studies usually require IRD measurements with USI in both pregnancy-related DRA subjects and nulliparous controls [7,8,9]. The increasing popularity of this assessment method raises the issue of IRD measurement repeatability and reliability using ultrasonographic imaging, and the importance of the examiner's experience.…”