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Physiotherapy. 2019 Mar;105(1):24-34. doi: 10.1016/j.physio.2018.07.002. Epub 2018 Jul 24.

Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review.

Author information

1
Department of Rehabilitation, Nutrition & Sport, School of Allied Health, La Trobe University, Victoria, Australia. Electronic address: d.benjamin@latrobe.edu.au.
2
School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia; Centre of Allied Health Research & Education, Cabrini Hospital, Victoria Australia. Electronic address: helena.frawley@monash.edu.
3
Department of Rehabilitation, Nutrition & Sport, School of Allied Health, La Trobe University, Victoria, Australia. Electronic address: N.Shields@latrobe.edu.au.
4
Department of Physiotherapy and Lectorate of Health and Movement, Academy of Health Sciences, Saxion University of Applied Sciences, Netherlands. Electronic address: a.vandewater@latrobe.edu.au.
5
Department of Rehabilitation, Nutrition & Sport, School of Allied Health, La Trobe University, Victoria, Australia; School of Allied Health, Allied Health Clinical Research Office, Eastern Health, Victoria, Australia. Electronic address: N.Taylor@latrobe.edu.au.

Abstract

BACKGROUND:

Diastasis of the rectus abdominis muscle (DRAM) is common during and after pregnancy.

OBJECTIVES:

To determine the association between: the presence of DRAM and low back pain, lumbo-pelvic pain, incontinence, pelvic organ prolapse, abdominal muscle performance or health-related quality of life; and between DRAM width and severity of these outcomes.

DATA SOURCES:

Six electronic databases (EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro).

STUDY SELECTION:

Included studies of all designs with adults with DRAM that assessed low back pain, lumbo-pelvic pain incontinence, pelvic organ prolapse, abdominal performance or health-related quality of life.

STUDY APPRAISAL & SYNTHESIS METHODS:

Methodological quality was assessed using the Effective Public Health Practice Project tool. A narrative summary was completed for DRAM presence and presence of the various musculoskeletal dysfunctions, and DRAM width and the severity of these dysfunctions.

RESULTS:

Twelve studies involving 2242 participants were included. There was no significant association between the presence of DRAM and lumbo-pelvic pain or incontinence. There was a small association between the presence of DRAM and pelvic organ prolapse. DRAM width may be associated with health-related quality of life, abdominal muscle strength and severity of low back pain.

LIMITATIONS:

Quality of studies was weak. There was variability in the methods used to assess DRAM.

CONCLUSION:

There is weak evidence that DRAM presence may be associated with pelvic organ prolapse, and DRAM severity with impaired health-related quality of life, impaired abdominal muscle strength and low back pain severity. Systematic Review Registration Number: PROSPERO CRD42017058089.

KEYWORDS:

Abdominal muscles; Diastasis; Low back pain; Pelvic organ prolapse; Pelvic pain; Rectus abdominis; Urinary incontinence

PMID:
30217494
DOI:
10.1016/j.physio.2018.07.002
[Indexed for MEDLINE]

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