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Effects of 4-week PNF Exercise Program on Activity, Posture, and Muscle Strength in a Patient with Abdominalis Weakness after Cesarean Section: A Single-Subject Study

  • Beom-Ryong Kim (Department of Physical Therapy, Design Hospital) ;
  • Tae-Woo Kang (Department of Physical Therapy, College of Health and Welfare, Woosuk University) ;
  • Seo-Yoon Park (Department of Physical Therapy, College of Health and Welfare, Woosuk University)
  • Received : 2024.01.15
  • Accepted : 2024.02.27
  • Published : 2024.02.28

Abstract

Purpose: The purpose of this study was to determine the effect of proprioceptive neuromuscular facilitation (PNF) abdominal muscle strengthening exercise on the activity, posture, and body function of clients with abdominal muscle weakness after cesarean section. Methods: PNF abdominal muscle strengthening exercise was applied to one patient with abdominal muscle weakness after cesarean section. PNF abdominal muscle strengthening exercise was applied five times a week for four weeks. The 5-time supine-to-long sitting test (5-TSLST) and supine-to-stand test (SST) were used to measure activity, and the pelvis tilt angle test (PTAT) and anterior head translation test (AHTT) were used to measure posture. Body function was assessed using the transverse abdominis muscle strength test (TAMST), the internal oblique and external oblique muscle strength test (IOEOMST), and the rectus abdominis muscle strength test (RAMST). Results: Activity, posture, and body function were improved post-intervention. Conclusion: The study verified that PNF abdominal muscle strengthening exercises are effective when applied to patients with abdominal muscle weakness after cesarean section. The findings of this study provide useful data for future interventions in patients with abdominal muscle weakness after cesarean section.

Keywords

References

  1. Jensen R, Doucet S, Treitz T. Changes in segment mass and mass distribution during pregnancy. J Biomech. 1996;29(2):251-6.  https://doi.org/10.1016/0021-9290(95)00042-9
  2. Opala-Berdzik A, Bacik A, Cieslinska-Swider J et al. The influence of pregnancy on the location of the center of gravity in standing position. J Hum Kinet. 2010;26(1). 
  3. Opala-Berdzik A, Blaszczyk JW, Bacik B et al. Static postural stability in women during and after pregnancy: a prospective longitudinal study. PloS one. 2015;10(6):e0124207. 
  4. Bullock JE, Jull GA, Bullock MI. The relationship of low back pain to postural changes during pregnancy. Aust J Physiother. 1987;33(1):10-7.  https://doi.org/10.1016/S0004-9514(14)60580-8
  5. Lippold C, Danesh G, Schilgen M et al. Relationship between thoracic, lordotic, and pelvic inclination and craniofacial morphology in adults. Angle Orthod. 2006;76(5):779-85. 
  6. Takaki S, Kaneoka K, Okubo Y et al. Analysis of muscle activity during active pelvic tilting in sagittal plane. Phys Ther Res. 2016;19(1):50-7.  https://doi.org/10.1298/ptr.E9900
  7. Yoo Wg. Effect of the individual strengthening exercises for posterior pelvic tilt muscles on back pain, pelvic angle, and lumbar ROM of a LBP patient with excessive lordosis: a case study. J Phys Ther Sci. 2014;26(2):319-20.  https://doi.org/10.1589/jpts.26.319
  8. McGill SM, Grenier SM, kavcic N et al. Coordination of muscle activity to assure stability of the lumbar spine. J Electromyogr Kinesiol. 2003;13(4):353-9.  https://doi.org/10.1016/S1050-6411(03)00043-9
  9. Fujita T, Sato A, Togashi Y et al. Contribution of abdominal muscle strength to various activities of daily living of stroke patients with mild paralysis. J Phys Ther Sci. 2015;27(3):815-8.  https://doi.org/10.1589/jpts.27.815
  10. Gilleard WL, Brown JMM. Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period. Phys Ther. 1996;76(7):750-62.  https://doi.org/10.1093/ptj/76.7.750
  11. Coldron Y, Stokes MJ, Newham DJ et al. Postpartum characteristics of rectus abdominis on ultrasound imaging. Man Ther. 2008;13(2):112-21.  https://doi.org/10.1016/j.math.2006.10.001
  12. Richardson CA, Snijders CJ, Hides JA et al. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine. 2002;27(4):399-405.  https://doi.org/10.1097/00007632-200202150-00015
  13. Kainu JP, Sarvela J, Tiippana E et al. Persistent pain after caesarean section and vaginal birth: a cohort study. Int J Obstet Anesth. 2010;19(1):4-9.  https://doi.org/10.1016/j.ijoa.2009.03.013
  14. Pool-Goudzwaard AL, Slieker MC, Vierhout ME et al. Relations between pregnancy related low back pain, pelvic floor activity and pelvic floor dysfunction. Int urogynecology J. 2005;16(6):468-74.  https://doi.org/10.1007/s00192-005-1292-7
  15. Hildenbrand K, Noble L. Abdominal muscle activity while performing trunk-flexion exercises using the Ab roller, AB slide, Fit Ball, and conventionally performed trunk curls. J Athl Train. 2004;39(1):37-43. 
  16. Ralston SH, Urquhart GD, Brzeski M et al. Prevalence of vertebral compression fractures due to osteoporosis in ankylosing spondylitis. Br Med J. 1990;300(6724):563-5.  https://doi.org/10.1136/bmj.300.6724.563
  17. Nachemson AL. Disc pressure measurements. Spine. 1981;6(1):93-7.  https://doi.org/10.1097/00007632-198101000-00020
  18. Boissonnault JS, Mary JB. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther. 1998;68(7):1082-6.  https://doi.org/10.1093/ptj/68.7.1082
  19. Kofotolis N, Kellis E. Proprioceptive neuromuscular facilitation versus isokinetic training for strength, endurance and jumping performance. J Hum Mov Stud. 2002;42(2):155-65. 
  20. Kim GD, Lee YJ, Choi WS et al. Effects of lumbar stabilization exercise using PNF techniques on thickness of lumbar deep muscle and functional activity in chronic low back pain patients. The Journal of the Korea Contents Association. 2012;12(3):233-43.  https://doi.org/10.5392/JKCA.2012.12.03.233
  21. Bong SY, Kim YJ, Kang MG et al. Effects of proprioceptive neuromuscular facilitation exercise on forced expiratory volume at one second, pain, and functional disability index of chronic low back pain patients. PNF & Mov. 2016;14(3):185-93.  https://doi.org/10.21598/JKPNFA.2016.14.3.185
  22. Abe T, Kusuhara N, Yoshimura N et al. Differential respiratory activity of four abdominal muscles in humans. J Appl Physiol. 1996;80(4):1379-89.  https://doi.org/10.1152/jappl.1996.80.4.1379
  23. Whitney SL, Wrisley DM, Marchetti GF et al. Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the Five-Times-Sit-to-Stand Test. Phys Ther. 2015;85(10):1034-45.  https://doi.org/10.1093/ptj/85.10.1034
  24. Slezynska M, Miesok G, Miesok K. Responsiveness of people with moderate and significant intellectual disability to physical stimulation. Ann Agric Environ Med. 2018;25(1). 
  25. Cattuzzo MT, Santana de FS, Safons MP et al. Assessment in the supine-to-stand task and functional health from youth to old age: a systematic review. Int J Environ Res Public Health. 2020;17(16):5794. 
  26. Joshi S, Kamboj R, Pawalia A. Effect of interferential therapy and elastic band exercises on subjects with round shoulder and forward head posture: a randomized trial. J Dow Univ Health Sci. 2022;16(2):59-65.  https://doi.org/10.36570/jduhs.2022.2.1639
  27. Kang TW, Kim BR. The effects of stretching and strengthening exercise on the pain, pelvic tilt, functional disability index, and balance ability of patients with chronic lower back pain. J Kor Phys Ther. 2019;31(1):7-12.  https://doi.org/10.18857/jkpt.2019.31.1.7
  28. Harman K, Hubley-Kozey CL, Butler H. Effectiveness of an exercise program to improve forward head posture in normal adults: a randomized, controlled 10-week trial. J Man Manip Ther. 2005;13(3):163-76.  https://doi.org/10.1179/106698105790824888
  29. Grenier SG, McGill SM. Quantification of lumbar stability by using 2 different abdominal activation strategies. Arch Phys Med Rehabil. 2007;88:54-62.  https://doi.org/10.1016/j.apmr.2006.10.014
  30. Conroy VM, Murray BN Jr, Alexopulos QT et al. Kendall's muscles: testing and function with posture and pain. Lippincott Williams & Wilkins, Philadelphia. 2022:5-95. 
  31. Hislop H, Avers D, Brown M et al. Daniels and Worthingham's muscle testing-e-book: techniques of manual examination and performance testing. 9th ed, St Louis, Elsevier Health Sciences, 2014:41-62. 
  32. Rortveit G, Daltveit AK, Hannestad YS et al. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med. 2003;348(10):900-7.  https://doi.org/10.1056/NEJMoa021788
  33. O'Sullivan P, Twomey L, Allison G et al. Altered patterns of abdominal muscle activation in patients with chronic low back pain. Aust J Physiother. 1997;43(2):91-8.  https://doi.org/10.1016/S0004-9514(14)60403-7
  34. Hodges PW, Richardson CA. Contraction of the abdominal muscles associated with movement of the lower limb. Phys Ther. 1997;77(2):132-42.  https://doi.org/10.1093/ptj/77.2.132
  35. Nesbitt D, Molina S, Sacko R et al. Examining the feasibility of supine-to-stand as a measure of functional motor competence. J Mot Learn Dev. 2018;6(2):267-86.  https://doi.org/10.1123/jmld.2017-0016
  36. Kang MH, Yoon JY, Yang JL et al. The effect of visual biofeedback on EMG activity of trunk muscles and endurance holding time for correct position during whole-body tilt exercise. Phys Ther Korea. 2011;18(1):9-17. 
  37. Kim KH, Youn HJ, Park SH et al. The effects of PNF patterns on trunk muscle activity according to position changes. PNF & Mov. 2016;14(1):1-6. 
  38. Lee H, Kim H, Kim H et al. The effects of trunk stability education in pelvic stabilization. Journal of the Korean Society of Integrative Medicine. 2013;1(4):57-66.  https://doi.org/10.15268/KSIM.2013.1.4.057
  39. Lee DK, Kang MH, Kim JW et al. Effects of non-paretic arm exercises using a tubing band on abdominal muscle activity in stroke patients. NeuroRehabilitation. 2013;33(4):605-10.  https://doi.org/10.3233/NRE-131003
  40. Kang TW. The effects of the upper extremity and lower extremity patterns of PNF on abdominal muscle activity in healthy subjects and abdominal muscle strength and respiratory functions in stroke patients. Silla University. Dissertation of Master's Degree. 2019.