AN ULTRASOUND STUDY ON

THE EFFECT OF EXERCISE ON POSTPARTUM WOMEN

INTER-RECTUS ABDOMINIS DISTANCE
Ftima Sancho (1), Augusto Gil Pascoal (2), Patricia Mota (2)

1. Superior Health School of Alcoito, Portugal; 2. Technical University of Lisbon,
Faculty of Human Kinetics, Interdisciplinary Centre for the Study of Human
Performance, Neuromechanics Research Group, Portugal.

Introduction
During pregnancy, as the fetus grows the rectus
abdominis muscle (RA), connected by a fascia, the
linea alba, elongates and curves as the abdominal
wall expands, with most separation occurring at the
umbilicus. This gap is known as the inter-recti
distance (IRD). The increased IRD is often referred
as cause of abdominal muscles weakness, pelvic
instability and pelvic floor muscles dysfunction
[Gilleard et al., 1996]. Women are encouraged to
resume abdominal exercises shortly after delivery,
to restore their abdominal figure and fitness,
particularly to reduce de IRD. However, the
abdominal exercise programs are not based on
evidence and is scarce the literature available about
the effect of the abdominal-strengthening exercises
on IRD reduction. Thus, the purpose of this study
was to analyze the effect of three modalities of
abdominal muscles contraction on IRD in women
postpartum.
Methods
An ultrasound scanner (GE Logic-e; 4-12 MHz, 39
mm linear transducer; B-mode) was used to record
images from both RA on 16 postpartum,
primiparous women (vaginal birth: N=8; caesarean
section: N=8) at rest (supine) and on three
abdominal muscles contraction modalities:
abdominal crunch, drawing in e drawing in with
abdominal crunch. The transducer was placed
transversely along the midline of the abdomen 2 cm
above the umbilicus. The IRD was measured
offline by the same investigator blinded to the
result using a customized code (Matlab, Image
Processing Toolbox, Mathworks) assuming each
ultrasound images as a pixel based xy coordinate
system. The contour of both RA was identified by
ultrasound image segmentation using a parabola-
like-curve fit approach. The inflexion point of the
interpolated parabola-like-curve was overlapped on
the original ultrasound image, to guide the
examiner on the identification of the end points of
the linea-alba and improve the accuracy of IRD
measurement. A repeated-measures ANOVA was
used to compare IRD values across the three
modalities of contraction using specific software
(SPSS-v19) and a significant level of P < 0.05.

Figure 1. Inter-rectus distance measured at rest
and at three modalities of abdominal muscles
contraction.
Results
Significantly differences, F (3.42) = 6.24, p = 0.01,
were found on IRD between the rest condition and
the three modalities of abdominal muscles
contraction (Figure 1). No significant differences
were found between IRD and the type of delivery
both in the interaction between rest condition and
contraction (p = 0.936; F = 0.07) as well as isolated
(p = 0.510; F = 0.459).
Discussion
The results showed a significantly reduction on
IRD associated with abdominal muscle contraction.
No differences were found on IRD between the
three modalities of abdominal muscles contraction.
These results suggest that the abdominal-
strengthening exercises should be considered as a
way to reduce the IRD on postpartum women.
Although a significant reduction on IRD that was
found associated to the abdominal crunch exercise,
other parameters such as changes on intra-
abdominal pressure must be considered before
recommendation of this exercise on a postpartum
exercise program.
References
Gilleard, W. L., et al. Phys Ther 76 (7): 750-762,
1996.
Presentation 1614 Topic 34. Muscle biomechanics S493
ESB2012: 18th Congress of the European Society of Biomechanics Journal of Biomechanics 45(S1)