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Specific Musculoskeletal Adaptations in Pregnancy: Pelvic Floor, Abdominal Muscles, Pelvic Girdle, and Lower Back—Implications for Physical Activity and Exercise

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Exercise and Physical Activity During Pregnancy and Postpartum

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Abstract

Pregnancy and childbirth bring along several changes to a woman’s body, especially to the musculoskeletal system. On one hand, pregnancy and childbirth not only represents a window of opportunity for the adoption of an active and healthy lifestyle, but it is also a risk period for the development of musculoskeletal disorders that may negatively affect ability to participate in physical activity both during pregnancy, in the postpartum period and for some, if the conditions are not treated, the rest of their lives. This chapter addresses the most prevalent musculoskeletal complaints related to pregnancy and the postpartum period: pelvic floor dysfunction; urinary incontinence, diastasis recti abdominis, and low back pain and/or pelvic girdle pain.

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References

  1. Healey CH, Borley NR, Mundy A. True pelvis, pelvic floor and perineum. In: Standring S, Ellis H, Healy JC, Johnson D, Williams A, editors. Gray’s anatomy: the anatomical basis of clinical practice. Edinburgh: Elsevier Churchill livingstone; 2005. p. 1357–71.

    Google Scholar 

  2. Delancey JO. Structural aspects of the extrinsic continence mechanism. Obstet Gynecol. 1988;72(3 Pt 1):296–301.

    CAS  PubMed  Google Scholar 

  3. Delancey JO. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol. 1994;170(6):1713–20.

    CAS  PubMed  Google Scholar 

  4. Ashton-Miller JA, Delancey JO. Functional anatomy of the female pelvic floor. Ann N Y Acad Sci. 2007;1101:266–96.

    PubMed  Google Scholar 

  5. Norton PA. Pelvic floor disorders: the role of fascia and ligaments. Clin Obstet Gynecol. 1993;36(4):926–38.

    CAS  PubMed  Google Scholar 

  6. Kegel AH. Stress incontinence and genital relaxation; a nonsurgical method of increasing the tone of sphincters and their supporting structures. Ciba Clin Symp. 1952;4(2):35–51.

    CAS  PubMed  Google Scholar 

  7. Bø K, Lilleas F, Talseth T, Hedland H. Dynamic MRI of the pelvic floor muscles in an upright sitting position. Neurourol Urodyn. 2001;20(2):167–74.

    PubMed  Google Scholar 

  8. Taverner D, Smiddy FG. An electromyographic study of the normal function of the external anal sphincter and pelvic diaphragm. Dis Colon Rectum. 1959;2(2):153–60.

    CAS  PubMed  Google Scholar 

  9. Ashton-Miller JA, Howard D, Delancey JO. The functional anatomy of the female pelvic floor and stress continence control system. Scand J Urol Nephrol Suppl. 2001;207:1–7.

    Google Scholar 

  10. Bø K, Aschehoug A. Pelvic floor and exercise science: strength training. In: Bø K, Berghmans B, Mørkved S, Van Kampen M, editors. Evidence-based physical therapy for the pelvic floor. Edinburgh: Churchill Livingstone Elsevier; 2007. p. 119–32.

    Google Scholar 

  11. Miller JM, Perucchini D, Carchidi LT, DeLancey JO, Ashton-Miller J. Pelvic floor muscle contraction during a cough and decreased vesical neck mobility. Obstet Gynecol. 2001;97(2):255–60.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Miller JM, Ashton-Miller JA, DeLancey JO. A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc. 1998;46(7):870–4.

    CAS  PubMed  Google Scholar 

  13. Miller JM, Sampselle C, Ashton-Miller J, Hong GR, Delancey JO. Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to preempt expected stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(6):773–82.

    PubMed  PubMed Central  Google Scholar 

  14. Bump RC, Norton PA. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin N Am. 1998;25(4):723–46.

    CAS  Google Scholar 

  15. MacLennan AH, Taylor AW, Wilson DH, Wilson D. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG. 2000;107(12):1460–70.

    CAS  PubMed  Google Scholar 

  16. DeLancey JO, Kane LL, Miller JM, Patel DA, Tumbarello JA. Graphic integration of causal factors of pelvic floor disorders: an integrated life span model. Am J Obstet Gynecol. 2008;199(6):610–5.

    PubMed  PubMed Central  Google Scholar 

  17. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49.

    PubMed  Google Scholar 

  18. Milsom I, Altman D, Cartwright R, Lapitan M, Nelson R, Sjöström S, et al. Epidemiology of urinary incontinence [UI] and other lower urinary tract symptoms [LUTS], pelvic organ prolapse [POP] and anal [AI] incontinence. In: Abrams P, Wagg A, Wein A, editors. Incontinence. 6th international consultation on incontinence, Tokyo; 2017.

    Google Scholar 

  19. Thom D. Variation in estimates of urinary incontinence prevalence in the community: effects of differences in definition, population characteristics, and study type. J Am Geriatr Soc. 1998;46(4):473–80.

    CAS  PubMed  Google Scholar 

  20. Botlero R, Urquhart DM, Davis SR, Bell RJ. Prevalence and incidence of urinary incontinence in women: review of the literature and investigation of methodological issues. Int J Urol. 2008;15(3):230–4.

    PubMed  Google Scholar 

  21. Minassian VA, Stewart WF, Wood GC. Urinary incontinence in women: variation in prevalence estimates and risk factors. Obstet Gynecol. 2008;111(2 Pt 1):324–31.

    PubMed  Google Scholar 

  22. Milsom I, Altman D, Lapitan MC, Nelson R, Sillén U, Thom D. Epidemiology of urinary (UI) and faecal (FI) incontinence and pelvic organ prolapse (POP). In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence: 4th International Consultation on Incontinence. 4th ed. Paris: Health Publication Ltd; 2009. p. 35–111.

    Google Scholar 

  23. Dimpfl T, Hesse U, Schussler B. Incidence and cause of postpartum urinary stress incontinence. Eur J Obstet Gynecol Reprod Biol. 1992;43(1):29–33.

    CAS  PubMed  Google Scholar 

  24. Marshall K, Thompson KA, Walsh DM, Baxter GD. Incidence of urinary incontinence and constipation during pregnancy and postpartum: survey of current findings at the Rotunda Lying-In Hospital. Br J Obstet Gynaecol. 1998;105(4):400–2.

    CAS  PubMed  Google Scholar 

  25. Mørkved S, Bo K. Prevalence of urinary incontinence during pregnancy and postpartum. Int Urogynecol J Pelvic Floor Dysfunct. 1999;10(6):394–8.

    PubMed  Google Scholar 

  26. Hvidman L, Hvidman L, Foldspang A, Mommsen S, Bugge NJ. Correlates of urinary incontinence in pregnancy. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(5):278–83.

    CAS  PubMed  Google Scholar 

  27. Wesnes SL, Rortveit G, Bo K, Hunskaar S. Urinary incontinence during pregnancy. Obstet Gynecol. 2007;109(4):922–8.

    PubMed  Google Scholar 

  28. Borello-France D, Burgio KL, Richter HE, Zyczynski H, Fitzgerald MP, Whitehead W, et al. Fecal and urinary incontinence in primiparous women. Obstet Gynecol. 2006;108(4):863–72.

    PubMed  Google Scholar 

  29. Bø K, Nygaard IE. Is Physical activity good or bad for the female pelvic floor? A narrative review. Sports Med. 2020;50:471. https://doi.org/10.1007/s40279-019-01243-1.

    PubMed  Google Scholar 

  30. Koelbl H, Nitti V, Baessler K, Salvatore S, Sultan A, Yamaguchi O. Pathophysiology of urinary incontinence, faecal incontinence and pelvic organ prolapse. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence: 4th International Consultation on Incontinence. 4th ed. Paris: Helarh Publication Ltd; 2009. p. 255–330.

    Google Scholar 

  31. Thorp JM Jr, Norton PA, Wall LL, Kuller JA, Eucker B, Wells E. Urinary incontinence in pregnancy and the puerperium: a prospective study. Am J Obstet Gynecol. 1999;181(2):266–73.

    PubMed  Google Scholar 

  32. Burgio KL, Locher JL, Zyczynski H, Hardin JM, Singh K. Urinary incontinence during pregnancy in a racially mixed sample: characteristics and predisposing factors. Int Urogynecol J Pelvic Floor Dysfunct. 1996;7(2):69–73.

    CAS  PubMed  Google Scholar 

  33. Wilson PD, Herbison RM, Herbison GP. Obstetric practice and the prevalence of urinary incontinence three months after delivery. Br J Obstet Gynaecol. 1996;103(2):154–61.

    CAS  PubMed  Google Scholar 

  34. Rasmussen KL, Krue S, Johansson LE, Knudsen HJ, Agger AO. Obesity as a predictor of postpartum urinary symptoms. Acta Obstet Gynecol Scand. 1997;76(4):359–62.

    CAS  PubMed  Google Scholar 

  35. Viktrup L, Rortveit G, Lose G. Risk of stress urinary incontinence twelve years after the first pregnancy and delivery. Obstet Gynecol. 2006;108(2):248–54.

    PubMed  Google Scholar 

  36. Sugerman H, Windsor A, Bessos M, Wolfe L. Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity. J Intern Med. 1997;241(1):71–9.

    CAS  PubMed  Google Scholar 

  37. Sampselle CM. Changes in pelvic muscle strength and stress urinary incontinence associated with childbirth. J Obstet Gynecol Neonatal Nurs. 1990;19(5):371–7.

    CAS  PubMed  Google Scholar 

  38. Hahn I, Milsom I, Ohlsson BL, Ekelund P, Uhlemann C, Fall M. Comparative assessment of pelvic floor function using vaginal cones, vaginal digital palpation and vaginal pressure measurements. Gynecol Obstet Investig. 1996;41(4):269–74.

    CAS  Google Scholar 

  39. Samuelsson E, Victor A, Svardsudd K. Determinants of urinary incontinence in a population of young and middle-aged women. Acta Obstet Gynecol Scand. 2000;79(3):208–15.

    CAS  PubMed  Google Scholar 

  40. Morin M, Bourbonnais D, Gravel D, Dumoulin C, Lemieux MC. Pelvic floor muscle function in continent and stress urinary incontinent women using dynamometric measurements. Neurourol Urodyn. 2004;23(7):668–74.

    PubMed  Google Scholar 

  41. Mørkved S, Salvesen KA, Bo K, Eik-Nes S. Pelvic floor muscle strength and thickness in continent and incontinent nulliparous pregnant women. Int Urogynecol J Pelvic Floor Dysfunct. 2004;15(6):384–9.

    PubMed  Google Scholar 

  42. Thompson JA, O’Sullivan PB, Briffa NK, Neumann P. Assessment of voluntary pelvic floor muscle contraction in continent and incontinent women using transperineal ultrasound, manual muscle testing and vaginal squeeze pressure measurements. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(6):624–30.

    PubMed  Google Scholar 

  43. Shishido K, Peng Q, Jones R, Omata S, Constantinou CE. Influence of pelvic floor muscle contraction on the profile of vaginal closure pressure in continent and stress urinary incontinent women. J Urol. 2008;179(5):1917–22.

    PubMed  Google Scholar 

  44. Hilde G, Staer-Jensen J, Ellstrom EM, Braekken IH, Bo K. Continence and pelvic floor status in nulliparous women at midterm pregnancy. Int Urogynecol J. 2012;23(9):1257–63.

    PubMed  Google Scholar 

  45. Bø K, Stien R, Kulseng-Hanssen S, Kristofferson M. Clinical and urodynamic assessment of nulliparous young women with and without stress incontinence symptoms: a case-control study. Obstet Gynecol. 1994;84(6):1028–32.

    PubMed  Google Scholar 

  46. Sartore A, Pregazzi R, Bortoli P, Grimaldi E, Ricci G, Guaschino S. Assessment of pelvic floor muscle function after vaginal delivery. Clinical value of different tests. J Reprod Med. 2003;48(3):171–4.

    PubMed  Google Scholar 

  47. Hvidman L, Foldspang A, Mommsen S, Nielsen JB. Postpartum urinary incontinence. Acta Obstet Gynecol Scand. 2003;82(6):556–63.

    PubMed  Google Scholar 

  48. Foldspang A, Hvidman L, Mommsen S, Nielsen JB. Risk of postpartum urinary incontinence associated with pregnancy and mode of delivery. Acta Obstet Gynecol Scand. 2004;83(10):923–7.

    CAS  PubMed  Google Scholar 

  49. Altman D, Ekstrom A, Gustafsson C, Lopez A, Falconer C, Zetterstrom J. Risk of urinary incontinence after childbirth: a 10-year prospective cohort study. Obstet Gynecol. 2006;108(4):873–8.

    PubMed  Google Scholar 

  50. Groutz A, Gordon D, Keidar R, Lessing JB, Wolman I, David MP, et al. Stress urinary incontinence: prevalence among nulliparous compared with primiparous and grand multiparous premenopausal women. Neurourol Urodyn. 1999;18(5):419–25.

    CAS  PubMed  Google Scholar 

  51. Rortveit G, Hannestad YS, Daltveit AK, Hunskaar S. Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study. Obstet Gynecol. 2001;98(6):1004–10.

    CAS  PubMed  Google Scholar 

  52. Lukacz ES, Lawrence JM, Contreras R, Nager CW, Luber KM. Parity, mode of delivery, and pelvic floor disorders. Obstet Gynecol. 2006;107(6):1253–60.

    PubMed  Google Scholar 

  53. Press JZ, Klein MC, Kaczorowski J, Liston RM, von DP. Does cesarean section reduce postpartum urinary incontinence? A systematic review. Birth. 2007;34(3):228–37.

    PubMed  Google Scholar 

  54. Peschers U, Schaer G, Anthuber C, Delancey JO, Schuessler B. Changes in vesical neck mobility following vaginal delivery. Obstet Gynecol. 1996;88(6):1001–6.

    CAS  PubMed  Google Scholar 

  55. Meyer S, Schreyer A, De GP, Hohlfeld P. The effects of birth on urinary continence mechanisms and other pelvic-floor characteristics. Obstet Gynecol. 1998;92(4 Pt 1):613–8.

    CAS  PubMed  Google Scholar 

  56. Dietz HP, Clarke B, Vancaillie TG. Vaginal childbirth and bladder neck mobility. Aust N Z J Obstet Gynaecol. 2002;42(5):522–5.

    CAS  PubMed  Google Scholar 

  57. Meyer S, De GP, Schreyer A, Caccia G. The assessment of bladder neck position and mobility in continent nullipara, mulitpara, forceps-delivered and incontinent women using perineal ultrasound: a future office procedure? Int Urogynecol J Pelvic Floor Dysfunct. 1996;7(3):138–46.

    CAS  PubMed  Google Scholar 

  58. King JK, Freeman RM. Is antenatal bladder neck mobility a risk factor for postpartum stress incontinence? Br J Obstet Gynaecol. 1998;105(12):1300–7.

    CAS  PubMed  Google Scholar 

  59. Lavin JM, Smith ARB, Anderson J, Grant M, Buckley H, Critchley H, et al. The effect of the first pregnancy on the connective tissue of the rectus sheath. Neurourol Urodyn. 1997;16:381–2.

    Google Scholar 

  60. Howard D, Miller JM, DeLancey JO, Ashton-Miller JA. Differential effects of cough, valsalva, and continence status on vesical neck movement. Obstet Gynecol. 2000;95(4):535–40.

    CAS  PubMed  PubMed Central  Google Scholar 

  61. Smith AR, Hosker GL, Warrell DW. The role of pudendal nerve damage in the aetiology of genuine stress incontinence in women. Br J Obstet Gynaecol. 1989;96(1):29–32.

    CAS  PubMed  Google Scholar 

  62. Snooks SJ, Setchell M, Swash M, Henry MM. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet. 1984;2(8402):546–50.

    CAS  PubMed  Google Scholar 

  63. Smith AR, Hosker GL, Warrell DW. The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine. A neurophysiological study. Br J Obstet Gynaecol. 1989;96(1):24–8.

    CAS  PubMed  Google Scholar 

  64. Allen RE, Hosker GL, Smith AR, Warrell DW. Pelvic floor damage and childbirth: a neurophysiological study. Br J Obstet Gynaecol. 1990;97(9):770–9.

    CAS  PubMed  Google Scholar 

  65. Snooks SJ, Swash M, Mathers SE, Henry MM. Effect of vaginal delivery on the pelvic floor: a 5-year follow-up. Br J Surg. 1990;77(12):1358–60.

    CAS  PubMed  Google Scholar 

  66. Lien KC, Morgan DM, Delancey JO, Ashton-Miller JA. Pudendal nerve stretch during vaginal birth: a 3D computer simulation. Am J Obstet Gynecol. 2005;192(5):1669–76.

    PubMed  Google Scholar 

  67. Snooks SJ, Swash M, Henry MM, Setchell M. Risk factors in childbirth causing damage to the pelvic floor innervation. Int J Color Dis. 1986;1(1):20–4.

    CAS  Google Scholar 

  68. Sultan AH, Kamm MA, Hudson CN. Pudendal nerve damage during labour: prospective study before and after childbirth. Br J Obstet Gynaecol. 1994;101(1):22–8.

    CAS  PubMed  Google Scholar 

  69. Gilpin SA, Gosling JA, Smith AR, Warrell DW. The pathogenesis of genitourinary prolapse and stress incontinence of urine. A histological and histochemical study. Br J Obstet Gynaecol. 1989;96(1):15–23.

    CAS  PubMed  Google Scholar 

  70. Delancey JO, Kearney R, Chou Q, Speights S, Binno S. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol. 2003;101(1):46–53.

    PubMed  PubMed Central  Google Scholar 

  71. Kearney R, Miller JM, Ashton-Miller JA, Delancey JO. Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol. 2006;107(1):144–9.

    PubMed  PubMed Central  Google Scholar 

  72. Dietz HP. Pelvic floor trauma following vaginal delivery. Curr Opin Obstet Gynecol. 2006;18(5):528–37.

    PubMed  Google Scholar 

  73. DeLancey JO, Ashton-Miller JA. Measurement of pelvic floor muscle function and strength and pelvic organ prolapse: MRI of intact and injured female pelvic floor muscles. In: Bø K, Berghmans B, Mørkved S, Van Kampen M, editors. Evidence-based physical therapy for the pelvic floor. Edinburgh: Churchill Livingstone Elsevier; 2007. p. 93–105.

    Google Scholar 

  74. Ashton-Miller JA, Delancey JO. On the biomechanics of vaginal birth and common sequelae. Annu Rev Biomed Eng. 2009;11:163–76.

    CAS  PubMed  PubMed Central  Google Scholar 

  75. Turner CE, Young JM, Solomon MJ, Ludlow J, Benness C. Incidence and etiology of pelvic floor dysfunction and mode of delivery: an overview. Dis Colon Rectum. 2009;52(6):1186–95.

    PubMed  Google Scholar 

  76. Peschers UM, Schaer GN, Delancey JO, Schuessler B. Levator ani function before and after childbirth. Br J Obstet Gynaecol. 1997;104(9):1004–8.

    CAS  PubMed  Google Scholar 

  77. Botelho S, Riccetto C, Herrmann V, Pereira LC, Amorim C, Palma P. Impact of delivery mode on electromyographic activity of pelvic floor: comparative prospective study. Neurourol Urodyn. 2010;29(7):1258–61.

    PubMed  Google Scholar 

  78. Caroci AS, Riesco ML, Sousa WS, Cotrim AC, Sena EM, Rocha NL, et al. Analysis of pelvic floor musculature function during pregnancy and postpartum: a cohort study: (a prospective cohort study to assess the PFMS by perineometry and digital vaginal palpation during pregnancy and following vaginal or caesarean childbirth). J Clin Nurs. 2010;19(17–18):2424–33.

    Google Scholar 

  79. Sigurdardottir T, Steingrimsdottir T, Arnason A, Bo K. Pelvic floor muscle function before and after first childbirth. Int Urogynecol J. 2011;22:1497.

    PubMed  Google Scholar 

  80. Hilde G, Staer-Jensen J, Siafarikas F, Engh ME, Braekken IH, Bo K. Impact of childbirth and mode of delivery on vaginal resting pressure and on pelvic floor muscle strength and endurance. Am J Obstet Gynecol. 2013;208(1):50–7.

    PubMed  Google Scholar 

  81. Lien KC, Mooney B, Delancey JO, Ashton-Miller JA. Levator ani muscle stretch induced by simulated vaginal birth. Obstet Gynecol. 2004;103(1):31–40.

    PubMed  PubMed Central  Google Scholar 

  82. Hoyte L, Damaser MS, Warfield SK, Chukkapalli G, Majumdar A, Choi DJ, et al. Quantity and distribution of levator ani stretch during simulated vaginal childbirth. Am J Obstet Gynecol. 2008;199(2):198–5.

    PubMed  Google Scholar 

  83. Parente MP, Jorge RM, Mascarenhas T, Fernandes AA, Martins JA. Deformation of the pelvic floor muscles during a vaginal delivery. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(1):65–71.

    CAS  PubMed  Google Scholar 

  84. Dietz HP. Quantification of major morphological abnormalities of the levator ani. Ultrasound Obstet Gynecol. 2007;29(3):329–34.

    CAS  PubMed  Google Scholar 

  85. Dietz HP, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol. 2005;106(4):707–12.

    PubMed  Google Scholar 

  86. Valsky DV, Lipschuetz M, Bord A, Eldar I, Messing B, Hochner-Celnikier D, et al. Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women. Am J Obstet Gynecol. 2009;201(1):91–7.

    PubMed  Google Scholar 

  87. Krofta L, Otcenasek M, Kasikova E, Feyereisl J. Pubococcygeus-puborectalis trauma after forceps delivery: evaluation of the levator ani muscle with 3D/4D ultrasound. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(10):1175–81.

    PubMed  Google Scholar 

  88. Jarvinen TA, Jarvinen TL, Kaariainen M, Aarimaa V, Vaittinen S, Kalimo H, et al. Muscle injuries: optimising recovery. Best Pract Res Clin Rheumatol. 2007;21(2):317–31.

    PubMed  Google Scholar 

  89. Delancey JO, Morgan DM, Fenner DE, Kearney R, Guire K, Miller JM, et al. Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol. 2007;109(2 Pt 1):295–302.

    PubMed  Google Scholar 

  90. Dietz HP, Shek C. Levator avulsion and grading of pelvic floor muscle strength. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(5):633–6.

    CAS  PubMed  Google Scholar 

  91. Steensma AB, Konstantinovic ML, Burger CW, de Timmerman RD, Deprest J. Prevalence of major levator abnormalities in symptomatic patients with an underactive pelvic floor contraction. Int Urogynecol J. 2010;21(7):861–7.

    PubMed  PubMed Central  Google Scholar 

  92. Brincat CA, Delancey JO, Miller JM. Urethral closure pressures among primiparous women with and without levator ani muscle defects. Int Urogynecol J. 2011;22(12):1491–5.

    PubMed  PubMed Central  Google Scholar 

  93. Hilde G, Staer-Jensen J, Siafarikas F, Gjestland K, Ellstrom EM, Bo K. How well can pelvic floor muscles with major defects contract? A cross-sectional comparative study 6 weeks after delivery using transperineal 3D/4D ultrasound and manometer. BJOG. 2013;120(11):1423–9.

    CAS  PubMed  Google Scholar 

  94. Shek KL, Dietz HP. The effect of childbirth on hiatal dimensions. Obstet Gynecol. 2009;113(6):1272–8.

    PubMed  Google Scholar 

  95. Majida M, Braekken IH, Bo K, Engh ME. Levator hiatus dimensions and pelvic floor function in women with and without major defects of the pubovisceral muscle. Int Urogynecol J. 2012;23:707.

    PubMed  Google Scholar 

  96. Morgan DM, Larson K, Lewicky-Gaupp C, Fenner DE, Delancey JO. Vaginal support as determined by levator ani defect status 6 weeks after primary surgery for pelvic organ prolapse. Int J Gynaecol Obstet. 2011;114(2):141–4.

    PubMed  PubMed Central  Google Scholar 

  97. Dietz HP, Steensma AB. The prevalence of major abnormalities of the levator ani in urogynaecological patients. BJOG. 2006;113(2):225–30.

    CAS  PubMed  Google Scholar 

  98. Dietz HP, Simpson JM. Levator trauma is associated with pelvic organ prolapse. BJOG. 2008;115(8):979–84.

    CAS  PubMed  Google Scholar 

  99. Tunn R, Goldammer K, Neymeyer J, Gauruder-Burmester A, Hamm B, Beyersdorff D. MRI morphology of the levator ani muscle, endopelvic fascia, and urethra in women with stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol. 2006;126(2):239–45.

    PubMed  Google Scholar 

  100. Dietz HP, Kirby A, Shek KL, Bedwell PJ. Does avulsion of the puborectalis muscle affect bladder function? Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(8):967–72.

    CAS  PubMed  Google Scholar 

  101. Bodine-Fowler S. Skeletal muscle regeneration after injury: an overview. J Voice. 1994;8(1):53–62.

    CAS  PubMed  Google Scholar 

  102. Jarvinen TA, Jarvinen TL, Kaariainen M, Kalimo H, Jarvinen M. Muscle injuries: biology and treatment. Am J Sports Med. 2005;33(5):745–64.

    PubMed  Google Scholar 

  103. Orchard JW, Best TM, Mueller-Wohlfahrt HW, Hunter G, Hamilton BH, Webborn N, et al. The early management of muscle strains in the elite athlete: best practice in a world with a limited evidence basis. Br J Sports Med. 2008;42(3):158–9.

    PubMed  Google Scholar 

  104. Lovering R. Physical therapy and related interventions. In: Tiidus PM, editor. Skeletal muscle damage and repair. Champaign, IL: Human Kinetics; 2007. p. 219–30.

    Google Scholar 

  105. Bø K, Artal R, Barakat R, Brown W, Davies GA, Dooley M, et al. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1-exercise in women planning pregnancy and those who are pregnant. Br J Sports Med. 2016;50(10):571–89. https://doi.org/10.1136/bjsports-2016-096218.

    PubMed  Google Scholar 

  106. Benjamin DR, van der Water ATM, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014;100:1–8.

    CAS  PubMed  Google Scholar 

  107. Vleeming A, Albert HB, Ostgaard HC, et al. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;17:794–819.

    PubMed  PubMed Central  Google Scholar 

  108. Koelbl H, Igawa TY, Salvatore S, et al. Pathophysiology of urinary incontinence, faecal incontinence and pelvic organ prolapse. In: Abrams P, Cardozo L, Khouy S, Wein A, editors. Incontinence. 5th ed. Cardiff: Health publication Ltd; 2013. p. 261–359. Committee 4.

    Google Scholar 

  109. Lee D, Hodges PW. Behavior of the linea alba during a curl-up task in diastasis rectus abdominis; An Observational Study. J Orthop Sports Phys Ther. 2016;46:580–9.

    PubMed  Google Scholar 

  110. Venes D, Taber CW. Taber’s cyclopedic medical dictionary 20, 2005, Philadelphia, PA: Davis

    Google Scholar 

  111. Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther. 1988;68(7):1082–6.

    CAS  PubMed  Google Scholar 

  112. Mota PGF, Pascoal AG, Carita AI, Bo K. The immediate effects on inter-rectus distance of abdominal crunch and drawing in exercises during pregnancy and the postpartum period. J Orthop Sports Phys Ther. 2015;45:781–8.

    PubMed  Google Scholar 

  113. Rett MT, Braga MD, Bernardes NO, Andrade SC. Prevalence of diastasis of the rectus abdominis muscles immediately postpartum: comparison between primiparae and multiparae. Revista Brasileira De Fisioterapia. 2009;13(4):275–80.

    Google Scholar 

  114. Turan V, Colluoglu C, Turkyilmaz E, Korucuoglu U. Prevalence of diastasis recti abdominis in the population of young multiparous adults in Turkey. Ginekol Pol. 2011;82(11):817–82.

    PubMed  Google Scholar 

  115. Sperstad JB, Tennfjord MT, Hilde G, Engh ME, Bø K. Diastasis recti abdominis and risk of low back and pelvic girdle pain. Br J Sports Med. 2016;50:1092–6.

    PubMed  Google Scholar 

  116. Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J. 2007;18:321–8.

    Google Scholar 

  117. Lockwood T. Rectus muscle diastasis in males: primary indication for endoscopically assisted abdominoplasty. Plast Reconstr Surg. 1998;101:1685–91; discussion 1692–1684.

    CAS  PubMed  Google Scholar 

  118. van de Water AT, Benjamin DR. Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): a systematic review of their measurement properties and meta-analytic reliability generalisation. Man Ther. 2016;21:41–53.

    PubMed  Google Scholar 

  119. Keeler J, Albrecht M, Eberhardt L, Horn L, Donelly C, Lowe D. Diastasis recti abdominis; a survey of women’s health specialists for current physical therapy clinical practice for postpartum women. J Womens Health Phys Ther. 2012;36:131–42.

    Google Scholar 

  120. Mota P, Pascoal AG, Sancho F, Carita AI, Bo K. Reliability of the inter-rectus distance measured by palpation. Comparison of palpation and ultrasound measurements. Man Ther. 2013;18(4):294–8.

    PubMed  Google Scholar 

  121. Mota P, Pascoal AG, Sancho F, Bø K. Test-retest and intrarater reliability of 2-dimensional ultrasound measurements of distance between rectus abdominis in women. J Orthop Sports Phys Ther. 2012;42(11):940–6.

    PubMed  Google Scholar 

  122. Candido G, Lo T, Janssen PA. Risk factors for diastasis of the recti abdominis. J Assoc Chart Physiother Women’s Health. 2005;97:49–54.

    Google Scholar 

  123. Mota P, Pascoal AG, Carita AI, Bø K. Normal width of the inter-recti distance in pregnant and postpartum primiparous women. Musculoskelet Sci Pract. 2018;35:34–7. https://doi.org/10.1016/j.msksp.2018.02.004.

    PubMed  Google Scholar 

  124. Lo T, Candido G, Janssen P. Diastasis of the Recti abdominis in pregnancy: risk factors and treatment. Physiother Can. 1999;51:32.

    Google Scholar 

  125. Fernandes da Mota PG, Pascoal AG, Carita AI, Bo K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther. 2015;20(1):200–5.

    PubMed  Google Scholar 

  126. Lee DG, Lee LJ, McLaughlin L. Stability, continence and breathing: the role of fascia following pregnancy and delivery. J Bodyw Mov Ther. 2008;12:333–48.

    CAS  PubMed  Google Scholar 

  127. Gilleard WL, Brown JM. Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period. Phys Ther. 1996;76:750–62.

    CAS  PubMed  Google Scholar 

  128. Liaw LJ, Hsu MJ, Liao CF, Liu MF, Hsu AT. The Relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study. J Orthop Sports Phys Ther. 2011;41(6):435–43.

    PubMed  Google Scholar 

  129. Benjamin DR, Frawley HC, Shields N, van de Water ATM, Taylor NF. Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy. 2019;105(1):24–34.

    PubMed  Google Scholar 

  130. Gluppe S, Engh ME, Bø K. Women with diastasis recti abdominis might have weaker abdominal muscles and more abdominal pain, but no higher prevalence of pelvic floor disorders, low back and pelvic girdle pain than women without diastasis recti abdominis. Physiotherapy. 2021;111:57. https://doi.org/10.1016/j.physio.2021.01.008.

    PubMed  Google Scholar 

  131. Parker MA, Millar LA, Dugan SA. Diastasis rectus abdominis and lumbo-pelvic pain and dysfunction-are they related? J Women’s Health Phys Therapy. 2009;33:15–22.

    Google Scholar 

  132. Braga A, Caccia G, Nasi I, Ruggeri G, Di Dedda MC, Lamberti G, et al. Diastasis recti abdominis after childbirth: is it a predictor of stress urinary incontinence? J Gynecol Obstet Hum Reprod. 2019:101657.

    Google Scholar 

  133. Wang Q, Yu X, Chen G, Sun X, Wang J. Does diastasis recti abdominis weaken pelvic floor function? A cross-sectional study. Int Urogynecol J. 2020;31(2):277–83.

    CAS  PubMed  Google Scholar 

  134. Bjorklund K, Bergstrom S. Is pelvic pain in pregnancy a welfare complaint? Acta Obstet Gynecol Scand. 2000;79:24–30.

    CAS  PubMed  Google Scholar 

  135. Charpentier K, Leboucher J, Lawani M, et al. Back pain during pregnancy and living conditions: a comparison between Beninese and Canadian women. Ann Phys Rehabil Med. 2012;55:148–59.

    CAS  PubMed  Google Scholar 

  136. Mousavi SJ, Parnianpour M, Vleeming A. Pregnancy related pelvic girdle pain and low back pain in an Iranian population. Spine. 2007;32:E100–4.

    PubMed  Google Scholar 

  137. Gutke A, Boissonnault J, Brook G, et al. The severity and impact of pelvic girdle pain and low-back pain in pregnancy: a multinational study. J Women’s Health (Larchmt). 2017;27:510.

    Google Scholar 

  138. Gashaw M, Gedlu S, Janakiraman B, Gashaw M, et al. Burden of pelvic girdle pain during pregnancy among women attending ante-natal clinic, Ethiopia: a cross-sectional study. BMC Pregnan Childb. 2020;20(1):494.

    Google Scholar 

  139. Wormslev M, Juul AM, Marques B, et al. Clinical examination of pelvic insufficiency during pregnancy. An evaluation of the interobserver variation, the relation between clinical signs and pain and the relation between clinical signs and physical disability. Scand J Rheumatol. 1994;23:96–102.

    CAS  PubMed  Google Scholar 

  140. Olsson C, Nilsson-Wikmar L. Health-related quality of life and physical ability among pregnant women with and without back pain in late pregnancy. Acta Obstet Gynecol Scand. 2004;83:351–7.

    PubMed  Google Scholar 

  141. Stuge B, Veierød MB, Lærum E, et al. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy. A two-year follow-up of a randomized clinical trial. Spine. 2004;29:E197–203.

    PubMed  Google Scholar 

  142. Persson M, Winkvist A, Dahlgren L, et al. “Struggling with daily life and enduring pain”: a qualitative study of the experiences of pregnant women living with pelvic girdle pain. BMC Pregnan Childb. 2013;13:111.

    Google Scholar 

  143. Pierce H, Homer CS, Dahlen HG, et al. Pregnancy-related lumbopelvic pain: listening to Australian women. Nurs Res Pract. 2012;2012:387428.

    PubMed  PubMed Central  Google Scholar 

  144. Gutke A, Bullington J, Lund M, et al. Adaptation to a changed body. Experiences of living with long-term pelvic girdle pain after childbirth. Disabil Rehabil. 2017;40:1–7.

    Google Scholar 

  145. Fredriksen EH, Moland KM, Sundby J. “Listen to your body”. A qualitative text analysis of internet discussions related to pregnancy health and pelvic girdle pain in pregnancy. Patient Educ Couns. 2008;73:294–9.

    PubMed  Google Scholar 

  146. Engeset J, Stuge B, Fegran L. Pelvic girdle pain affects the whole life--a qualitative interview study in Norway on women’s experiences with pelvic girdle pain after delivery. BMC Res Notes. 2014;7:686.

    PubMed  PubMed Central  Google Scholar 

  147. Wu WH, Meijer OG, Uegaki K, et al. Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. Eur Spine J. 2004;13:575–89.

    CAS  PubMed  PubMed Central  Google Scholar 

  148. Ostgaard HC, Zetherstrom G, Roos-Hansson E, et al. Reduction of back and posterior pelvic pain in pregnancy. Spine. 1994;19:894–900.

    CAS  PubMed  Google Scholar 

  149. Gutke A, Ostgaard HC, Oberg B. Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning. Spine. 2006;31:E149–55.

    PubMed  Google Scholar 

  150. Robinson HS, Mengshoel AM, Bjelland EK, et al. Pelvic girdle pain, clinical tests and disability in late pregnancy. Man Ther. 2010;15:280–5.

    PubMed  Google Scholar 

  151. Kristiansson P, Svardsudd K, von Schoultz B. Back pain during pregnancy: a prospective study. Spine. 1996;21:702–9.

    CAS  PubMed  Google Scholar 

  152. Ostgaard HC, Andersson GB. Previous back pain and risk of developing back pain in a future pregnancy. Spine. 1991;16:432–6.

    CAS  PubMed  Google Scholar 

  153. Ostgaard HC, Andersson GB, Karlsson K. Prevalence of back pain in pregnancy. Spine. 1991;16:549–52.

    CAS  PubMed  Google Scholar 

  154. Bjelland EK, Stuge B, Engdahl B, et al. The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study. BJOG. 2013;120:32–40.

    CAS  PubMed  Google Scholar 

  155. Bø K, Backe-Hansen KL. Do elite athletes experience low back, pelvic girdle and pelvic floor complaints during and after pregnancy? Scand J Med Sci Sports. 2007;17:480–7.

    PubMed  Google Scholar 

  156. O’Sullivan PB, Beales DJ. Diagnosis and classification of pelvic girdle pain disorders, Part 2: illustration of the utility of a classification system via case studies. Man Ther. 2007;12:e1–12.

    PubMed  Google Scholar 

  157. Aldabe D, Ribeiro DC, Milosavljevic S, et al. Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. Eur Spine J. 2012;21:1769–76.

    PubMed  PubMed Central  Google Scholar 

  158. Nielsen LL. Clinical findings, pain descriptions and physical complaints reported by women with post-natal pregnancy-related pelvic girdle pain. Acta Obstet Gynecol Scand. 2010;89:1187–91.

    PubMed  Google Scholar 

  159. Goode A, Hegedus EJ, Sizer P, et al. Three-dimensional movements of the sacroiliac joint: a systematic review of the literature and assessment of clinical utility. J Man Manip Ther. 2008;16:25–38.

    PubMed  PubMed Central  Google Scholar 

  160. Mens JM, Vleeming A, Snijders CJ, et al. The active straight leg raising test and mobility of the pelvic joints. Eur Spine J. 1999;8:468–74.

    CAS  PubMed  PubMed Central  Google Scholar 

  161. Kibsgard TJ, Roise O, Sturesson B, et al. Radiosteriometric analysis of movement in the sacroiliac joint during a single-leg stance in patients with long-lasting pelvic girdle pain. Clin Biomech. 2014;29:406–11.

    Google Scholar 

  162. Snijders CJ, Vleeming A, Stoeckart R, et al. Biomechanics of the interface between spine and pelvis in different postures. In: Vleeming A, Mooney V, Dorman T, et al., editors. Movement, stability & low back pain. The essential role of the pelvis. Edinburgh: Churchill Livingstone; 1997. p. 103–14.

    Google Scholar 

  163. Hungerford B, Gilleard W, Hodges P. Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine. 2003;28:1593–600.

    PubMed  Google Scholar 

  164. Hungerford B, Gilleard W, Lee D. Altered patterns of pelvic bone motion determined in subjects with posterior pelvic pain using skin markers. Clin Biomech. 2004;19:456–64.

    Google Scholar 

  165. Damen L, Buyruk HM, Guler-Uysal F, et al. Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints. Acta Obstet Gynecol Scand. 2001;80:1019–24.

    CAS  PubMed  Google Scholar 

  166. Palsson TS, Graven-Nielsen T. Experimental pelvic pain facilitates pain provocation tests and causes regional hyperalgesia. Pain. 2012;153:2233–40.

    PubMed  Google Scholar 

  167. Palsson TS, Hirata RP, Graven-Nielsen T. Experimental pelvic pain impairs the performance during the active straight leg raise test and causes excessive muscle stabilization. Clin J Pain. 2015;31:642.

    PubMed  Google Scholar 

  168. Torstensson T, Lindgren A, Kristiansson P. Corticosteroid injection treatment to the ischiadic spine reduced pain in women with long-lasting sacral low back pain with onset during pregnancy: a randomized, double blind, controlled trial. Spine. 2009;34:2254–8.

    PubMed  Google Scholar 

  169. Torstensson T, Lindgren A, Kristiansson P. Improved function in women with persistent pregnancy-related pelvic pain after a single corticosteroid injection to the ischiadic spine: a randomized double-blind controlled trial. Physiother Theory Pract. 2013;29:371–8.

    PubMed  Google Scholar 

  170. Eichenseer PH, Sybert DR, Cotton JR. A finite element analysis of sacroiliac joint ligaments in response to different loading conditions, vol. 36. Spine; 2011. p. E1446–52.

    Google Scholar 

  171. Snijders CJ, Vleeming A, Stoeckart R. Transfer of lumbosacral load to iliac bones and legs. 1. Biomechanics of Self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clin Biomech. 1993;8:285–94.

    CAS  Google Scholar 

  172. Franklin ME, Conner-Kerr T. An analysis of posture and back pain in the first and third trimesters of pregnancy. J Orthop Sports Phys Ther. 1998;28:133–8.

    CAS  PubMed  Google Scholar 

  173. Moore K, Dumas GA, Reid JG. Postural changes associated with pregnancy and their relationship with low-back pain. Clin Biomech. 1990;5:169–74.

    CAS  Google Scholar 

  174. Okanishi N, Kito N, Akiyama M, et al. Spinal curvature and characteristics of postural change in pregnant women. Acta Obstet Gynecol Scand. 2012;91:856–61.

    PubMed  Google Scholar 

  175. Aldabe D, Milosavljevic S, Bussey MD. Is pregnancy related pelvic girdle pain associated with altered kinematic, kinetic and motor control of the pelvis? A systematic review. Eur Spine J. 2012;21:1777–87.

    PubMed  PubMed Central  Google Scholar 

  176. Beales DJ, O’Sullivan PB, Briffa NK. Motor control patterns during an active straight leg raise in chronic pelvic girdle pain subjects. Spine. 2009;34:861–70.

    PubMed  Google Scholar 

  177. Richardson CA, Snijders CJ, Hides JA, et al. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine. 2002;27:399–405.

    PubMed  Google Scholar 

  178. Stuge B, Morkved S, Dahl HH, et al. Abdominal and pelvic floor muscle function in women with and without long lasting pelvic girdle pain. Man Ther. 2006;11:287–96.

    PubMed  Google Scholar 

  179. Stuge B, Saetre K, Braekken IH. The association between pelvic floor muscle function and pelvic girdle pain--a matched case control 3D ultrasound study. Man Ther. 2012;17:150–6.

    PubMed  Google Scholar 

  180. Stuge B, Saetre K, Ingeborg HB. The automatic pelvic floor muscle response to the active straight leg raise in cases with pelvic girdle pain and matched controls. Man Ther. 2013;18:327.

    PubMed  Google Scholar 

  181. Dumas GA, Leger A, Plamondon A, et al. Fatigability of back extensor muscles and low back pain during pregnancy. Clin Biomech. 2010;25:1–5.

    Google Scholar 

  182. Bewyer KJ, Bewyer DC, Messenger D, et al. Pilot data: association between gluteus medius weakness and low back pain during pregnancy. Iowa Orthop J. 2009;29:97–9.

    PubMed  PubMed Central  Google Scholar 

  183. Gutke A, Ostgaard HC, Oberg B. Association between muscle function and low back pain in relation to pregnancy. J Rehabil Med. 2008;40:304–11.

    PubMed  Google Scholar 

  184. Pool-Goudzwaard ALGM, Spoor CW, et al. The active straight leg raising test (ASLR) in pregnant women: differences in muscle activity and force between patients and healthy subjects. Man Ther. 2008;13:68–74.

    PubMed  Google Scholar 

  185. Remus A, et al. A core outcome set for research and clinical practice in women with pelvic girdle pain: PGP-COS. PLoS One. 2021;16(2):e0247466.

    CAS  PubMed  PubMed Central  Google Scholar 

Further Reading

  • Bø K, Berghmans B, Mørkved S, Van Kampen M, editors. Evidence-based physical therapy for the pelvic floor. Churchill Livingstone Elsevier: Edinburgh; 2007.

    Google Scholar 

  • Fitzgerald CM, Segal NA, editors. Musculoskeletal health in pregnancy and postpartum. Cham: Springer International Publishing Switzerland; 2015.

    Google Scholar 

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Authors and Affiliations

  1. Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway

    Kari Bø

  2. Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway

    Kari Bø

  3. Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway

    Britt Stuge

  4. Department of Physiotherapy, OsloMet-Oslo Metropolitan University (former: Oslo and Akershus University College of Applied Sciences), Oslo, Norway

    Gunvor Hilde

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  1. Kari Bø
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  1. Sport Sciences School of Rio Maior - ESDRM, Polytechnic Institute of Santarém, Rio Maior, Portugal

    Rita Santos-Rocha

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Bø, K., Stuge, B., Hilde, G. (2022). Specific Musculoskeletal Adaptations in Pregnancy: Pelvic Floor, Abdominal Muscles, Pelvic Girdle, and Lower Back—Implications for Physical Activity and Exercise. In: Santos-Rocha, R. (eds) Exercise and Physical Activity During Pregnancy and Postpartum. Springer, Cham. https://doi.org/10.1007/978-3-031-06137-0_6

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