Neuromuscular Electrical Stimulation and Strength Recovery of Postnatal Diastasis Recti Abdominis Muscles

Abstract

Objective: To assess the effect of neuromuscular electrical stimulation (NMES) on the recovery of abdominal muscle strength in postnatal women with diastasis of recti abdominis muscles (DRAM).

Methods: Sixty women, 2 months postnatal, participated in this study. They were divided randomly into two equal groups. Group A received NMES in addition to abdominal exercises; group B received only abdominal exercises. The intervention in both groups was for three times per week for 8 weeks. The outcome measures were body mass index (BMI), waist/hip ratio, inter recti distance (IRD), and abdominal muscle strength in terms of peak torque, maximum repetition total work, and average power.

Results: Both groups showed highly significant (p<0.05) improvement in all outcomes. Further, intergroup comparisons showed significant improvement (p<0.05) in all parameters in favor of group A, except for the BMI.

Conclusion: NMES helps reduce DRAM in postnatal women; if combined with abdominal exercises, it can augment the effects.

Keywords: Abdominal muscles; Diastasis recti; Electrical stimulation therapy; Exercise; Postnatal care.

Fig. 1. Flow diagram of patients included in this study by NMES and abdominal exercises versus abdominal exercises only groups. BMI, waist/hip ratio, IRD, and abdominal muscle strength in terms of peak torque, maximum repetition total work, and average power were the outcome measures. NMES, neuromuscular electrical stimulation; BMI, body mass index; IRD, inter recti distance.

Fig. 2. The inter recti distance (IRD) measurement by ultrasonography in the study group is shown as a dotted line between the two bellies of the rectus abdominis. (A) Pre-IRD measurement showed a distance of 3.59 cm and (B) post-IRD measurement showed a distance of 2.58 cm. IRD measurement in control group. (C) pre-IRD measurement showed a distance of 2.74 cm and (D) post-IRD measurement showed a distance of 1.98 cm.

Fig. 3. The neuromuscular electrical stimulation (NMES) application for the study group. (A) Sites of electrode placement for the NMES of the rectus abdominis muscles on each side. The lower electrode is applied on the rectus abdominis muscle's origin; the upper electrode is applied on the muscle insertion. (B) Phyaction E NMES unit.

Fig. 4. The abdominal exercises that were performed by both groups. (A) Sit-up exercise, (B) reverse sit-up exercise, (C) reverse trunk twist exercise, and (D) U-seat exercise.