The effect of abdominal exercise on diastasis recti abdominal (dra) among postpartum primigravida mother in Kuala Lumpur

Abdominal exercise for diastasis recti abdominal (DRA) during postpartum has yet to be explored in research. Despite general exercise programs in current rehabilitation, strength and conditioning programs, few studies have examined the implementation of gradual and progressions abdominal training, and the benefits therein. The objective of this study was to investigate the effects of a progressive abdominal exercise known as Split Tummy Exercise Program (STEP) on the DRA size, pelvic floor muscle (PFM) strength, endurance and perceived urinary distress symptoms and determine the correlation between these variables. STEP module was developed based on literature review and validated by the experts. A randomized control trial study design was carried out at Obstetric and Gynaecology clinic, University Kebangsaan Malaysia Medical Centre (UKMMC) Kuala Lumpur and 41 pregnant women were selected. Later the participants were randomly assigned to the intervention (21 subjects) and control group (20 subjects). The participants were selected among primigravida diagnosed with DRA at 34-week gestations onward if the gap between the abdominal muscle is more than two-finger width measured with finger palpation at the umbilicus. Those with multiple pregnancies, previous abdominal and urogenital surgery, lower caesarian section delivery, and disease that could interfere with PFM strength such as Ehlan Danlos Syndrome were excluded. The intervention group received STEP module consist of three phases of nine abdominal exercises. The progression from phase one to phase two was administered every three weeks and completed phase three at eight weeks postpartum. DRA size ( using 2D ultrasound) and urinary functions (using Urogenital Distress Inventory questionnaire - UDI-6 and Incontinence Impact questionnaire - IIQ-7) were assessed at baseline and 8-weeks postpartum, whereas the PFM strength and endurance (using perineometer) was evaluated at 8-weeks postpartum for both groups. Out of 41 participants, 87.8% were Malays with the mean age of 28 years old (SD=0.56), and most of them (78%) were working. After 8 weeks, both groups had a reduction of DRA size, but result between the group was not significant whereas within-group analysis, DRA size was reduced up to 27% (mean difference: 6.2; 95% CI: 3.7, 8.7) as compared to 8.2% (mean difference:1.66; 95% CI: -1.3, 4.6) in the control group with significant intervention effect at p<0.001. There is a significant difference in PFM strength with a mean difference of 5.89 mmHg (95% CI: 2.10, 9.68; p=0.003) and PFM endurance with the mean difference of 1.11 second (95% CI: 0.01, 2.22; p=0.049) between groups. On the other hand, for urinary function, there is no significant difference in urinary distress symptoms between-group however, within-group analysis, both groups show significant different (p<0.001). In conclusion, the abdominal exercise using eight weeks STEP module effectively reduce the DRA size and could be implemented for mothers with DRA. The strength and endurance of PFM are higher in the STEP group at 8 weeks postpartum and no significant difference in perceived urinary incontinence symptom between the group. Finally, no relationship was found between DRA size and PFM function and perceived urinary distress symptoms. Further research is warranted to ascertain the efficacy of abdominal exercise among a larger population

Musculoskeletal Models in a Clinical Perspective

This book includes a selection of papers showing the potential of the dynamic modelling approach to treat problems related to the musculoskeletal system. The state-of-the-art is presented in a review article and in a perspective paper, and several examples of application in different clinical problems are provided

Spinal modelling to investigate postural loading and stability

Numerous mathematical models have been developed to investigate the high incidence of low back pain associated with lifting activities. These mainly consider the muscle forces required to support the spine, and few have considered the additional role of curvature. One previous model which represented the spine as an arch (Aspden 1987) indicated the curvature to have a significant effect on both loading and stability of the spine. However this model included collective loading patterns for body weight and muscle forces, and only partial representation of the spine. On the basis that the level of anatomic detail of a model affects the accuracy of its predictions (McGill and Norman, 1987), this thesis describes the development of a model which provides greater detail for investigating spinal stability in the sagittal plane. The curvature of the whole spine, a distributed loading pattern for body weight, and the activity of individual spinal muscle groups have been considered. Comparison with the previous arch model has shown these to be necessary features for determining the loading and stability associated with a given posture. In particular, application of individual muscle forces provide greater control of stability at each vertebral level. By considering the force requirements of the individual muscle groups and the consequent loads at each intervertebral joint, possible areas of tissue over load can be identified

The Effects Of External Load And Body Composition On The Sebt In Marching Band Performers

Introduction: Marching band performers are susceptible to a variety of injuries that may have long-term consequences, especially in the lower extremity. The Star Excursion Balance Test (SEBT) dynamic stability assessment tool has been utilized to detect the risk of lower extremity injuries, such as chronic ankle instability. The SEBT may be influenced by internal and external load variations amongst individuals; however, the interactions between these factors and the impact on specific populations, such as marching band performers, have not been studied. Therefore, the purpose of this study is to determine how performance on the SEBT differs when taking external load from instruments and body composition into account in marching band performers. Methods: Height, weight, leg length, and body composition via DEXA Scan were obtained during each initial visit. During the second visit, the subject completed the SEBT with and without carrying various musical instruments bilaterally. Results: There were 31 participants in the study, 3 participated solely in the body composition portion of the study, 1 only participated on the SEBT, and 27 participated in the entire study. The participant\u27s age (19.67±1.74 years), height (169.72±10.46 cm), weight (81.73±19.96 kg), total mass (80.75±20.51 kg), fat mass (29.59±12.47 kg), lean mass (48.58±10.50 kg), fat-free mass (51.16±10.95 kg), bone mineral density (1.23±0.12 g/cm2), bone mineral content (2.58±0.49 kg), and relative skeletal muscle mass (7.62±1.46 kg/m2) were all measured. Total mass had the most amount of significant correlation with lower reach scores. The tenor drums were found to significantly lower reach distances compared to all other conditions in each reach direction and stance limb (p≤0.05). There were no significant symmetrical differences in reach scores when loaded (p≥0.05). Conclusion: Wearing the tenor drum significantly decreases performance on the SEBT. Future investigations should look at the prevalence of lower extremity injuries in tenor drum players in relation to the SEBT to help determine at-risk performers. External load did not reveal significant asymmetrical differences in reach scores when compared to unloaded scores. All variables of body composition, especially total mass, have correlations with lower reach scores

Evaluating web-based pelvic floor muscle education for pregnant women

Background: Guidelines recommend that when pregnant women attend antenatal education they gain adequate knowledge about pregnancy-related topics, including the function of pelvic floor muscles and how to undertake a pelvic floor muscle exercise programme. Evidence is limited about how this information can be optimally delivered to pregnant women such that they gain knowledge, confidence and motivation to engage in a pelvic floor muscle exercise programme during the antenatal period. The primary objectives of the research were to evaluate the effect of delivering a web-based pelvic floor muscle education intervention in addition to usual antenatal care on primiparae women’s awareness; knowledge; confidence in and beliefs about engaging in and adhering to a pelvic floor muscle exercise programme compared to provision of usual antenatal care alone. Secondary objectives were to investigate pregnant women’s attendance at antenatal education; self-reported urinary incontinence; and usage of the Internet for pregnancy-related information. Methods: The research was conducted in two phases. Phase 1 consisted of surveying and auditing physiotherapists who provided antenatal education at public hospitals in 2012 in Western Australia. Phase 2 surveyed pregnant women about their knowledge; confidence in and beliefs about pelvic floor muscle function and exercises; attendance at antenatal education; self-reported urinary incontinence; and usage of the Internet for pregnancy-related information. Subsequently in Phase 2, a pilot randomised controlled trial of primiparae women was conducted to evaluate the effect of providing a novel web-based pelvic floor muscle education programme delivered in addition to usual antenatal care on knowledge, confidence in and beliefs about engaging in and adhering to a pelvic floor muscle exercise programme. Results: Antenatal education facilitated by physiotherapists (n=31) was provided at 25 (83.3%) hospitals. While all classes provided information about pelvic floor muscle function, there was a wide variation in pelvic floor muscle exercise prescription. Of the pregnant women surveyed (n = 633), English speaking respondents (82%) were significantly more knowledgeable about pelvic floor muscles; significantly more likely to practise pelvic floor muscle exercises; significantly more likely to attend antenatal education compared to respondents who spoke languages other than English (18%). A total of 49% of respondents reported urinary incontinence. Fewer than 50% of primiparae women in Western Australia attended antenatal education. Participants (n=70) enrolled in the RCT were randomised into two groups. There were 47 (67.1 %) participants who provided full follow-up data (n = 25 intervention; n = 22 control). Participants in the intervention group had significantly increased knowledge about pelvic floor muscles and significantly increased belief about engaging in pelvic floor muscle exercises at follow-up compared to the control group. Intervention group participants also showed significantly increased adherence to a pelvic floor muscle exercise programme compared to the control group [Odds ratio 19.1; 95% Confidence Interval (1.8, 196), p =.013]. Conclusions: Surveying physiotherapists and pregnant women identified that large numbers of primiparae women do not attend antenatal education. Furthermore, these women reported low levels of engagement in pelvic floor muscle exercises and a high frequency of urinary incontinence. Providing web-based antenatal education was a feasible and effective method of increasing knowledge, confidence in and adherence to pelvic floor muscle exercises. Future research should evaluate this promising intervention as a means of providing more pregnant women with education about pelvic floor muscles and pelvic floor muscle exercises

An investigation into the mechanisms of acute effects of dynamic stretching on ankle joint mechanics and running economy

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonWarm-up routines commonly include stretching to increase flexibility (joint range of motion - ROM), optimise performance, and reduce the risk of injury. Literature suggests that static stretching as part of the warm-up routines decreases force and power production compared to an active warm-up or a warm-up including dynamic stretching, and therefore could be detrimental to performance. This has led to an increased interest in the use of dynamic stretching by many athletes while the benefits of such interventions and their potential mechanisms of action are not well understood. Studies presented in this thesis were conducted to examine the effects of acute dynamic stretching on aspects of performance (e.g. torque production capacity of the plantarflexors and running economy) and to identify possible neuromechanical mechanisms underpinning any potential changes. Furthermore, we attempted to examine whether altered pain tolerance/perception to stretch may be a contributing factor to the increased ROM using adaptations in the neural substrates involved by using functional magnetic resonance imaging (fMRI) technique. In the first study, both slow dynamic stretching and fast dynamic stretching increased ROM, and this was due to an increased tendon elongation. Importantly, dynamic stretching was not detrimental to the torque producing capacity of the ankle plantarflexors. Effects of dynamic stretching on the sensorimotor performance remained mainly unclear. Employment of shear wave elastography technique in the second study suggested an increase in muscle stiffness, a decrease in fascicle strain, and showed an increase in muscle thickness after dynamic stretching, supporting an increase in tendon compliance as a contributing factor to increased flexibility after dynamic stretching. In the third study, the improved running economy by dynamic stretching may be attributable to the decreased dynamic joint ankle and vertical stiffness. The fMRI study was not conclusive due to methodological issues. Present findings have practical implications for the use of dynamic stretching in sporting contexts

Musculoskeletal Diseases 2021-2024

This open access book focuses on imaging of the musculoskeletal diseases. Over the last few years, there have been considerable advances in this area, driven by clinical as well as technological developments. The authors are all internationally renowned experts in their field. They are also excellent teachers, and provide didactically outstanding chapters. The book is disease-oriented and covers all relevant imaging modalities, with particular emphasis on magnetic resonance imaging. Important aspects of pediatric imaging are also included. IDKD books are completely re-written every four years. As a result, they offer a comprehensive review of the state of the art in imaging. The book is clearly structured with learning objectives, abstracts, subheadings, tables and take-home points, supported by design elements to help readers easily navigate through the text. As an IDKD book, it is particularly valuable for general radiologists, radiology residents, and interventional radiologists who want to update their diagnostic knowledge, and for clinicians interested in imaging as it relates to their specialty