08/09/2024
Celebrating Diastasis Awareness Month the only way I know how- nerding out on new research. I am IN LOVE with this study from Woxnerud
et al (2023)! They looked at baseline abdominal wall (Ab Wall) measures in those that have never had babies- one of my fave DRA topics! This is another article out of the surgical space and offers us all better communication across the continuum of care.
The authors sought to look beyond the cosmetic result of DRA closure, but also how surgery restores postpartum abdominal wall (Ab Wall) function. FUNCTION!! That is really where we need to focus to understand the clinical meaning of DRA. However, we can’t eval postpartum rehab or post-surgical function if we don’t understand prepartum Ab Wall function.
What really makes this article standout is not only did they use ultrasound to measure at inter-recti distance (IRD) at rest on their back, but also measured in standing and on one leg to represent functional demands on the Ab Wall. Be still my nerdy heart- such awesome insight for me as someone who treats runners who need Ab Wall function on one leg over and over again.
So what did they find? A range of values at each measurement point.
- [ ] IRD at rest on back(supine):
- [ ] 3 cm above navel (mean 9 mm, range 4-20 mm)
- [ ] Sup border of navel (mean 10 mm, 3-24 mm)
- [ ] 2 cm below navel (mean 2 mm, -5-10mm)
- [ ] IRD Upright (sup border of navel):
- [ ] Standing (mean 12 mm, 3–26 mm)
- [ ] Standing on one leg (mean 13 mm, 6-37mm)
Though there was a shift to a larger mean and range for upright values vs supine, authors noted that 25% of participants standing on two legs and 19% standing on one-leg demonstrated an IRD that was ≥1 mm less than supine values. So what does that mean? Participants demonstrated variability in HOW they used their abdominal wall to accomplish the task. For some the IRD was wider, for some it was smaller in upright. Our job is to sort out HOW each patient uses their abdomen, and if that supports their goals. This new insight, gives us better ideas how to assess function, tailor programs, and measure improvement.
This only scratches the surface of this study! Hoping to blog and post more. But for now sharing some DRA research love as we keep moving our conversations forward beyond IRD and LA to looking at abdominal wall function as a big component of the clinical meaning of DRA.
Woxnerud K, Sandblom G, Hedbeck C and Olsson A (2023) Reference Data on the Normal Abdominal Wall Anatomy and Baseline Characteristics in Seventy-One Nulliparous Women. J. Abdom. Wall Surg. 2:10940. doi: 10.3389/jaws.2023.10940 (open access)
