Выпуск 24-3, 2025

Обзорная статья

Физическая реабилитация для коррекции диастаза у женщин после родов средствами лечебной физической культуры: обзор



Гукасян М.Х.1,2,*, Бакай И.Н.2

1 ООО «ЭКСПРЕСС ФИТНЕС 2», Москва, Россия
2 Российский государственный социальный университет, Москва, Россия


РЕЗЮМЕ

ВВЕДЕНИЕ.  Диастаз прямых мышц живота (ДПМЖ) — патологическое состояние соединительной и мышечной ткани, при котором наблюдается утончение и растяжение белой линии живота. Последние актуальные статистические данные указывают на высокий риск возникновения ДПМЖ у женщин как во время беременности, так и в послеродовый период (ПП). Оптимальным средством коррекции ДПМЖ является лечебная физическая культура.

ОСНОВНОЕ СОДЕРЖАНИЕ ОБЗОРА.  В данном обзоре проведен анализ особенностей коррекции ДПМЖ у женщин в ПП с помощью физических упражнений. Обзор был составлен на основе методологии исследования, разработанной Институтом Джоанны Бриггс (Joanna Briggs Institute — JBI) — международной исследовательской организацией, специализирующейся в области доказательной медицины в сотрудничестве с партнерами, а также на основе рекомендаций по лечению и данных метаанализа Scoping Review. Также изучались рандомизированные контролируемые клинические исследования, описательные исследования, статьи, опубликованные на английском языке и в полнотекстовом виде, без каких-либо ограничений по дате публикации.

ЗАКЛЮЧЕНИЕ.  Полученные данные позволили определить основные направления в использовании средств физической реабилитации в ПП для коррекции ДПМЖ.


КЛЮЧЕВЫЕ СЛОВА: диастаз прямых мышц живота, мышцы живота, физические упражнения, реабилитация, послеродовый период

ДЛЯ ЦИТИРОВАНИЯ:

Гукасян М.Х., Бакай И.Н. Физическая реабилитация для коррекции диастаза у женщин после родов средствами лечебной физической культуры: обзор. Вестник восстановительной медицины. 2025; 24(3):113–122. https://doi.org/10.38025/2078-1962-2025-24-3-113-122 [Ghukasyan M.Kh., Bakay I.N. Physical Rehabilitation for Correction of Diastasis in Postpartum Women through Exercise: a Review. Bulletin of Rehabilitation Medicine. 2025; 24(3):113–122. https://doi.org/10.38025/2078-1962-2025-24-3-113-122 (In Russ.).] 

ДЛЯ КОРРЕСПОНДЕНЦИИ:

Гукасян Марине Хачиковна, Е-mail: marineshka7@icloud.com


Список литературы:

  1. Hernandez-Granados P., Henriksen N.A., Berrevoet F., et al. European Hernia Society guidelines on management of rectus diastasis. British Journal of Surgery. 2021; 108:1189–1191

  2. Chen B., Zhao X., Hu Y. Rehabilitations for maternal diastasis recti abdominis: An update on therapeutic directions. Heliyon. 2023; 9(10): e20956. https://doi.org/10.1016/j.heliyon.2023.e20956

  3. Бернштейн А.Н. Биомеханика для инструкторов. Москва: Издательство «Клинопись», 2023; 220 с. [Bernstein A.N. Biomechanics for instructors. Moscow: Klinopis Publishing House, 2023; 220 p. (In Russ.).]

  4. Liaw L.J., Hsu M.J., Liao C.F., et al. The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study. Journal of Orthopaedics and Sports Physical Therapy. 2011; 41: 435–443. https://doi.org/10.2519/jospt.2011.3507

  5. Temel M., Turkmen A., Berberoglu O. Improvements in vertebral-column angles and psychological metrics after abdominoplasty with rectus plication. Aesthetic Surgery Journal. 2016; 36: 577–587. https://doi.org/10.1093/asj/sjv257

  6. Claus C., Malcher F., Cavazzola L.T., et al. Subcutaneous onlay laparoscopic approach (scola) for ventral hernia and rectus abdominis diastasis repair: technical description and initial results. Arquivos Brasileiros de Cirurgia Digestiva. 2018; 31(4): e1399. https://doi.org/10.1590/0102-672020180001e1399

  7. Systematic Review Resource Package. Method for Systematic Review Research. Quick Reference Guide. Queen’s Joanna Briggs Collaboration Version 4.0. The Joanna Briggs Institute. 2015; Edition / Supplement.

  8. Gluppe S., Engh M.E., Bø K. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis. Braz J Phys Ther. 2021; 25(6): 664–675. https://doi.org/10.1016/j.bjpt.2021.06.006

  9. Skoura A., Billis E., Papanikolaou D.T., et al. Diastasis Recti Abdominis Rehabilitation in the Postpartum Period: A Scoping Review of Current Clinical Practice. Int Urogynecol J. 2024; 35(3): 491–520. https://doi.org/10.1007/s00192-024-05727-1

  10. Dudic R., Vaska E. Physiotherapy in a patient with diastasis of the rectus abdominis muscle after childbirth. Ceska Gynekol. 2023; 88: 180–185. https://doi.org/10.48095/cccg2023180

  11. Carlstedt A., Bringman S., Egberth M., et al. Management of diastasis of the rectus abdominis muscles: recommendations for swedish national guidelines. Scand J Surg. 2021; 110(3): 452–459. https://doi.org/10.1177/1457496920961000

  12. Molina B.J., Janis J.E. Diastasis Recti. In Fundamentals of Hernia Radiology. Springer International Publishing. 2023; p. 299–313. https://doi.org/10.1007/978-3-031-21336-6_26

  13. Chen, B., Zhao, X., Hu, Y. Rehabilitations for maternal diastasis recti abdominis: An update on therapeutic directions. Heliyon. Elsevier Ltd. 2023; 9(10): e20956. https://doi.org/10.1016/j.heliyon.2023.e20956

  14. Hanif S.M. Therapeutic exercise in the reduction of diastasis recti: case reports. Pak J Med Res. 2017; 56(3): 104–107

  15. Beer G.M., Schuster A., Seifert B., et al. The normal width of the linea alba in nulliparous women. Clin Anat. 2009; 22(6): 706–711. https://doi.org/10.1002/ca.20836

  16. Depledge J., McNair P., Ellis R. Exercises, Tubigrip and taping: can they reduce rectus abdominis diastasis measured three weeks post-partum? Musculoskelet Sci Pract. 2021; 53: 102381. https://doi.org/10.1016/j.msksp.2021.102381

  17. Djivoh Y.S., De Jaeger D. Acute effect of sit-up versus curl-up on the interrecti distance: a cross-sectional study in parous women. Prog Urol. 2022; 32(11): 776–783. https://doi.org/10.1016/j.purol.2022.07.140

  18. Chiarello C.M., McAuley J.A., Hartigan E.H. Immediate Effect of Active Abdominal Contraction on Inter-recti Distance. J Orthop Sports Phys Ther. 2016; 46(3):1 77–183. https://doi.org/10.2519/jospt.2016.6102

  19. Li Q., Lei S., Liu Y., et al. Effectiveness of yoga on the interrectus distance in early postpartum women: a high-frequency ultrasound study. Biomed Res Int. 2022; 2022(1): 8908095. https://doi.org/10.1155/2022/8908095

  20. Laframboise F.C., Schlaff R.A., Baruth M. Postpartum Exercise Intervention Targeting Diastasis Recti Abdominis. Int J Exerc Sci. 2021; 14(3): 400–409. https://doi.org/10.70252/garz3559

  21. Lee D., Hodges P.W. Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study. J Orthop Sports Phys Ther. 2016; 46(7): 580–589. https://doi.org/10.2519/jospt.2016.6536

  22. Saleem Z., Khan A.A., Farooqui S.I., et al. Effect of exercise on inter-recti distance and associated low back pain among post-partum females: a randomized controlled trial. J Family Reprod Health. 2021; 15(3): 202–209. https://doi.org/10.18502/jfrh.v15i3.7139

  23. Kamel D.M., Yousif A.M. Neuromuscular electrical stimulation and strength recovery of postnatal diastasis recti abdominis muscles. Ann Rehabil Med. 2017; 41(3): 465–474. https://doi.org/10.5535/arm.2017.41.3.465

  24. Liang P., Liang M., Shi S., et al. Rehabilitation programme including EMG-biofeedback-assisted pelvic floor muscle training for rectus diastasis after childbirth: a randomised controlled trial. Physiotherapy. 2022; 117: 16–21. https://doi.org/10.1016/j.physio.2022.05.001

  25. Keshwani N., Mathur S., McLean L. The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial. Physiother Theory Pract. 2021; 37(9): 1018–1033. https://doi.org/10.1080/09593985.2019.1675207

  26. Walton L.M., Costa A., LaVanture D., et al. The effects of a 6 week dynamic core stability plank exercise program compared to a traditional supine core stability strengthening program on diastasis recti abdominis closure, pain, Oswestry Disability Index (ODI) and Pelvic Floor Disability Index scores (PFDI) Phys Ther Rehabil. 2016; 3(1):3. http://dx.doi.org/10.7243/2055-2386-3-3

  27. Sancho M.F., Pascoal A.G., Mota P., et al. Abdominal exercises affect inter-rectus distance in postpartum women: a two dimensional ultrasound study. Physiotherapy. 2015; 101(3): 286–291. https://doi.org/10.1016/j.physio.2015.04.004

  28. Tuttle L.J., Fasching J., Keller A., et al. Noninvasive treatment of postpartum diastasis recti abdominis: a pilot study. J Womens Health Phys Ther. 2018; 42(2): 65–75. http://dx.doi.org/10.1097/JWH.0000000000000101

  29. Theodorsen N.M., Strand L.I., Bø K. Effect of pelvic floor and transversus abdominis muscle contraction on inter-rectus distance in postpartum women: a cross-sectional experimental study. Physiotherapy. 2019; 105(3): 315–320. https://doi.org/10.1016/j.physio.2018.08.009

  30. Radhakrishnan M., Ramamurthy K. Efficacy and challenges in the treatment of diastasis recti abdominis-A scoping review on the current trends and future perspectives. Diagnostics. 2022; 12(9): 2044. https://doi.org/10.3390/diagnostics12092044

  31. Peters M.D.J., Marnie C., Tricco A.C., et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020; 18(10): 2119–2126. https://doi.org/10.11124/jbies-20-00167

  32. Gluppe S.B., Engh M.E., Bø K. Immediate effect of abdominal and pelvic floor muscle exercises on interrecti distance in women with diastasis recti abdominis who were parous. Phys Ther. 2020; 100(8): 1372–1383. https://doi.org/10.1093/ptj/pzaa070

  33. Dufour S., Bernard S.A., Murray-Davis B., et al. Establishing expert-based recommendations for the conservative management of pregnancy-related diastasis rectus abdominis: a Delphi consensus study. J Womens Health Phys Ther. 2019; 43(2): 1. http://dx.doi.org/10.1097/JWH.0000000000000130

  34. Gluppe S.L., Hilde G., Tennfjord M.K., et al. Effect of a postpartum training program on the prevalence of diastasis recti abdominis in postpartum primiparous women: a randomized controlled trial. Phys Ther. 2018; 98(4): 260–268. https://doi.org/10.1093/ptj/pzy008

  35. Thabet A.A., Alshehri M.A. Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial. J Musculoskelet Neuronal Interact. 2019; 19(1): 62–68

  36. Kim S., Yi D., Yim J. The effect of core exercise using online videoconferencing platform and offline-based intervention in postpartum woman with diastasis recti abdominis. Int J Environ Res Public Health. 2022; 19(12): 7031. https://doi.org/10.3390/ijerph19127031

  37. Ema R., Akagi R., Wakahara T., et al. Training-induced changes in architecture of human skeletal muscles: current evidence and unresolved issues. J Phys Fit Sports Med. 2016; 5(1): 37–46. http://dx.doi.org/10.7600/jpfsm.5.37

  38. Arranz-Martín B., Navarro-Brazález B., Sánchez-Sánchez B., et al. The impact of hypopressive abdominal exercise on linea alba morphology women who are postpartum: a short-term cross-sectional study. Phys Ther. 2022; 102(8): pzac086. https://doi.org/10.1093/ptj/pzac086

  39. Leopold M., Santiago K., Cheng J., et al. Efficacy of a core strengthening program for diastasis rectus abdominis in postpartum women: a prospective observational study. J Womens Health Phys Ther. 2021; 45(4): 147–163. http://dx.doi.org/10.1097/JWH.0000000000000214




Creative Commons License
Контент доступен под лицензией Creative Commons Attribution 4.0 License.

©
Эта статья открытого доступа по лицензии CC BY 4.0. Издательство: ФГБУ «НМИЦ РК» Минздрава России.