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

NCT ID: NCT06459752

Last Updated: 2024-06-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-06-30

Study Completion Date

2024-09-30

Brief Summary

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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.

Detailed Description

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A randomized controlled trial will be conducted in DHQ Hospital Toba Tek Singh. A nonprobability convenience sampling technique will be used. There will be 34 participants. Participants will meet with inclusion criteria and be divided into two groups A and B. In Group A 17 participants will receive visceral manipulation technique with noble technique for 30 minutes per session, three sessions per week for 6 weeks. While in Group B 17 participants will just receive noble technique exercises for 15 min per session, three sessions per week for 6 weeks. Participants will be assessed before and after treatment through; Digital nylon calipers for diastasis recti, NPRS for pain, and Quebec Back Pain Disability Scale (QBPDS) to assess LBP-related functional. Data will be analyzed during SPSS software version 21

Conditions

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Diastasis Recti

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Group A

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).

Group Type EXPERIMENTAL

visceral manipulation and noble technique

Intervention Type 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 B

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

Group Type ACTIVE_COMPARATOR

noble technique

Intervention Type 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

Interventions

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visceral manipulation and noble technique

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

Intervention Type OTHER

noble technique

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

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* 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.

Exclusion Criteria

* 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
Minimum Eligible Age

22 Years

Maximum Eligible Age

35 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Riphah International University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Hafiza Neelam

Role: PRINCIPAL_INVESTIGATOR

Riphah International University

Locations

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DHQ Hospital Toba Tek Singh

Toba Tek Singh, Punjab Province, Pakistan

Site Status

Countries

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Pakistan

Central Contacts

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: Imran Amjad, PhD

Role: CONTACT

03324390125

Imran Amjad, PhD

Role: CONTACT

051-5481826

Facility Contacts

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Hafiza Neelam, MS

Role: primary

03204097476

References

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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.

Reference Type BACKGROUND
PMID: 24256310 (View on PubMed)

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

Reference Type BACKGROUND

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

Reference Type 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.

Reference Type BACKGROUND
PMID: 16638461 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 34363190 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 8677279 (View on PubMed)

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/

Reference Type BACKGROUND
PMID: 32491321 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 24268942 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 28946525 (View on PubMed)

Other Identifiers

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REC/RCR & AHS/23/0564

Identifier Type: -

Identifier Source: org_study_id

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