Diastazis Rekti’de Fizyoterapi ve Rehabilitasyon
Özet
Diastazis rekti abdominis (DRA), linea alba’nın genişlemesine bağlı olarak rektus abdominis kaslarının orta hattan ayrılmasıyla ortaya çıkan, özellikle gebelik ve postpartum dönemde sık görülen bir durumdur. Hormonal değişiklikler, büyüyen uterusun yarattığı mekanik stres, abdominal duvarın gerilmesi ve bağ dokusu zayıflığı DRA gelişiminde temel faktörlerdir. Kadınlarda daha yaygın olmakla birlikte erkeklerde ve çocuklarda da görülebilir; obezite, ağır kaldırma, kronik öksürük ve visseral yağlanma gibi durumlar da risk faktörleri arasındadır. DRA yalnızca kozmetik bir problem olmayıp abdominal duvar stabilitesinin azalması, gövde kontrolünde bozulma, bel ve pelvik ağrı, pelvik taban disfonksiyonları ve yaşam kalitesinde düşüş ile ilişkili olabilir. Tanıda ultrasonografi altın standart olarak kabul edilir; palpasyon, dijital kaliper ve fonksiyonel değerlendirmelerle birlikte inter-rektus mesafe ve linea alba özellikleri belirlenir. Tedavide temel yaklaşım fizyoterapi ve egzersizdir. Transversus abdominis aktivasyonu, solunum kontrolü, pelvik taban eğitimi, hipopresif egzersizler, Pilates, manuel terapi, kinezyolojik bantlama ve NMES gibi yöntemler kullanılmaktadır. Türkiye’de geliştirilen Denizoğlu Metodu, motor kontrol temelli progresif yapısıyla DRA rehabilitasyonunda etkili bir yaklaşım olarak sunulmaktadır. Cerrahi ise yalnızca egzersiz tedavilerinin başarılı olmadığı şiddetli ve ilerleyici durumlarda, eşlik eden herni varlığında düşünülmektedir.
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