Combined Effects of Visceral Manipulation and Noble Technique on Post-partum Females With Diastasis Recti

NCT06459752 | Not Yet Recruiting

• 1 other identifier: REC/RCR & AHS/23/0564
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 1

Brief Summary

Diastasis recti is characterized by an abnormal expansion of the gap between the medial sides of the rectus abdominis muscle and a lengthening of the linea alba (increased inter-recti distance). It is mainly caused by excessive intra-abdominal pressure. The abdominal muscles and connective structures expand from the growing uterus during pregnancy. Low back pain is a prevalent complaint that can result from various factors, including weakened core muscles and functional disability. The aim of the study would assess of combined effect of visceral manipulation and noble technique on Inter-rectal distance, low back pain and functional disability in post-partum females with diastasis recti.

Conditions

Diastasis Recti

Keywords

Diastasis recti; Low back pain; Post partum females; Visceral manipulation

Outcome Measures

Primary Outcomes (3)

• Pain: NPRS

  The Numerical Pain Rating Scale (NPRS) is a subjective measure in which individuals rate their pain on an eleven-point numerical scale. The scale is composed of 0 (no pain at all) to 10 (worst imaginable pain). Cronbach's alpha value of NPRS is 0.88

  6th week

• disability: Quebec Back Pain Disability Scale (QBPDS)

  The Quebec Back Pain Disability Scale (QBPDS) measures the extent to which people with low back pain have difficulty with everyday activities. The questionnaire is composed of 20 items on daily activities. The items were selected from 6 relevant subdomains of functional skills for patients with low back pain.

  6th week

• Muscle separation: Digital nylon calipers

  The Digital nylon calipers are a valid tool for measuring IRD above the umbilicus. For the caliper measurements with the abdominal muscles at rest, the participant was positioned in hook-lying, arms down by the side, with 1 pillow placed beneath the head. The examiner palpated the medial borders of the right and left rectus abdominis muscle bellies at the marked locations. The inside measurement jaws of the digital nylon calipers were positioned at the locations of the palpating fingers. The intra-class correlation coefficient values exceeded 0.75 for the digital calipers.

  6th week

Study Arms (2)

Group A

EXPERIMENTAL

This group received three sessions a week for six weeks, with 30 minutes per session given to visceral manipulation and noble technique (15 minutes each technique).

Other: visceral manipulation and noble technique

Group B

ACTIVE COMPARATOR

This group receives three sessions a week for six weeks, with 15 minutes per session in which noble technique is applied.

Other: noble technique

Interventions

visceral manipulation and noble technique OTHER

First, the patient will lie face-up on a massage or exam table. Physiotherapists feel viscera, major internal organs located in the abdomen by lightly pressing through abdominal muscles. Physiotherapist manual poking, pressing, and massage actions do three things: 1. Reveals visceral adhesions. 2. Find tender spots. 3. Breaks up adhesions. Massaging and pressing stretch the collagen fibers that makeup fascia, which loosens tightly bound fibers to break up adhesions. This releases the organs and allows them to move more freely. Minor adhesions may resolve after one session. Tough, stubborn adhesions may require several sessions plus self-manipulation between sessions

Group A

noble technique OTHER

The patient is positioned in supine with both knees bent and feet flat on a firm surface. The patient then places her crossed hands over her abdomen to support and pull the rectus abdominis muscles towards the midline. Finally, the patient is asked to slowly raise her head until a slight contraction is felt in the abdomen, holding for 20 seconds and repeating the exercise up to 20 times a day

Group B

Eligibility Criteria

• Age: 22 Years - 35 Years
• Gender Eligibility Details: participant eligibility is based on self-representation of gender identity.
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age between 22 to 35.
• Primiparous women with vaginal delivery and an IRD of \>2 cm.
• Three to six months postpartum with the presence of diastasis rectus abdominis.
• Patients having moderate low back pain in NPRS.

You may not qualify if:

• Acute Malignancy
• Recent Abdominal or Pelvic surgery
• Having undergone spinal surgery in the previous six months
• Serious spinal pathology
• Serious cardiovascular or metabolic disease Pregnancy
• Herniation pain

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

DHQ Hospital Toba Tek Singh

Toba Tek Singh, Punjab Province, 36050, Pakistan

Location

Related Publications (9)

• Akram J, Matzen SH. Rectus abdominis diastasis. J Plast Surg Hand Surg. 2014 Jun;48(3):163-9. doi: 10.3109/2000656X.2013.859145. Epub 2013 Nov 21.

  PMID: 24256310 BACKGROUND

• Arslan OE. Anatomy of the abdominal wall. Aesthetic surgery of the abdominal wall: Springer; 2005. p. 1-28.

  BACKGROUND

• Flament JB, Avisse C, Delattre JFJAwhp, management. Anatomy of the abdominal wall. 2001:39-63.

  BACKGROUND

• Grevious MA, Cohen M, Shah SR, Rodriguez P. Structural and functional anatomy of the abdominal wall. Clin Plast Surg. 2006 Apr;33(2):169-79, v. doi: 10.1016/j.cps.2005.12.005.

  PMID: 16638461 BACKGROUND

• Cavalli M, Aiolfi A, Bruni PG, Manfredini L, Lombardo F, Bonfanti MT, Bona D, Campanelli G. Prevalence and risk factors for diastasis recti abdominis: a review and proposal of a new anatomical variation. Hernia. 2021 Aug;25(4):883-890. doi: 10.1007/s10029-021-02468-8. Epub 2021 Aug 6.

  PMID: 34363190 BACKGROUND

• Gilleard WL, Brown JM. Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period. Phys Ther. 1996 Jul;76(7):750-62. doi: 10.1093/ptj/76.7.750.

  PMID: 8677279 BACKGROUND

• Brahmandam G, Lipsett BJ. Anatomy, Abdomen and Pelvis: Umbilical Cord. 2025 Jul 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK557389/

  PMID: 32491321 BACKGROUND

• Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014 Mar;100(1):1-8. doi: 10.1016/j.physio.2013.08.005. Epub 2013 Oct 5.

  PMID: 24268942 BACKGROUND

• Doubkova L, Andel R, Palascakova-Springrova I, Kolar P, Kriz J, Kobesova A. Diastasis of rectus abdominis muscles in low back pain patients. J Back Musculoskelet Rehabil. 2018 Feb 6;31(1):107-112. doi: 10.3233/BMR-169687.

  PMID: 28946525 BACKGROUND

MeSH Terms

Conditions

Low Back Pain

Condition Hierarchy (Ancestors)

Back Pain; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Hafiza Neelam

  Riphah International University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

: Imran Amjad, PhD

CONTACT

03324390125; imran.amjad@riphah.edu.pk

Imran Amjad, PhD

CONTACT

051-5481826; imran.amjad@riphah.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 11, 2024
• First Posted: June 14, 2024
• Study Start: June 1, 2024
• Primary Completion: August 1, 2024
• Study Completion: September 1, 2024
• Last Updated: June 14, 2024

Record last verified: 2024-06

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)