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MATERNAL-FETAL MEDICINE
Effects of exercise and Kinesio taping on abdominal recovery
in women with cesarean section: a pilot randomized controlled
trial
Ceren Gürşen1 • Deniz İnanoğlu2 • Serap Kaya1 • Türkan Akbayrak1 •
Gül Baltacı1
Received: 3 April 2015 / Accepted: 17 August 2015
! Springer-Verlag Berlin Heidelberg 2015
Abstract
Purpose Abdominal muscle strength decreases and fat
ratio in the waist region increases following cesarean sec-
tion. Kinesio taping (KT) is an easily applicable method
and stimulates muscle activation. The aim of this pilot
randomized controlled trial (RCT) was to investigate the
effects of KT combined with exercise in women with
cesarean section on abdominal recovery compared to the
exercise alone.
Methods Twenty-four women in between the fourth and
sixth postnatal months who had cesarean section were
randomly assigned to KT ? exercise (n = 12) group or
exercise group (n = 12). KT was applied twice a week for
4 weeks on rectus abdominis, oblique abdominal muscles
and cesarean incision. All women were instructed to carry
out posterior pelvic tilt, core stabilization and abdominal
correction exercises. Outcome measures were evaluated
with the manual muscle test, sit-up test, abdominal
endurance test, Visual Analog Scale (VAS), circumference
measurements and Roland Morris Disability Questionnaire
(RMDQ). Mann–Whitney U and Wilcoxon tests were used
to analyze data. p\ 0.05 was considered as statistically
significant.
Results The improvement observed in the KT ? exercise
group was significantly greater compared to the exercise
group in terms of the strength of the rectus abdominis
muscle, sit-up test, VAS, measurements of the waist cir-
cumference and RMDQ (p\ 0.05).
Conclusions It appears that the addition of KT to
abdominal exercises in the postnatal physiotherapy pro-
gram provides greater benefit for the abdominal recovery in
women with cesarean section. Further studies with larger
sample sizes and long-term follow-up are needed to verify
these results.
Keywords Cesarean section ! Women’s health !
Exercise ! Taping ! Abdominal muscles ! Pregnancy
Introduction
The hormonal process that begins during pregnancy and
continues in the postpartum period leads to excessively
weak and hypotonic abdominal muscles, making the
ligaments and connective tissue softer and more elastic.
These changes result in anatomical, physiological and
biomechanical alterations [1]. Therefore, these factors are
responsible for the lack of necessary support for the waist
region, pain, disability and negative impact on health-re-
lated quality of life [2]. Studies emphasized the impor-
tance of exercise in the postpartum period [3–5]. It is
known that postnatal exercises have several benefits such
as alleviating the postnatal depression and increasing the
general well-being [3], preventing the diastasis of the
rectus abdominis muscle (RAM) [4], increasing cardio-
vascular endurance and bone mineral density, and stimu-
lating weight loss [5].
Cesarean is one of the most common types of the
abdominal surgery in women [6]. Many physiotherapy
studies in the literature focus on the health problems, which
can be seen in early period after the cesarean section [7–9].
& Türkan Akbayrak
takbayrak@yahoo.com
1 Department of Physiotherapy and Rehabilitation, Faculty of
Health Sciences, Hacettepe University, 06100 Samanpazari,
Ankara, Turkey
2 School of Physiotherapy and Rehabilitation, Mustafa Kemal
University, 31001 Antakya, Hatay, Turkey
123
Arch Gynecol Obstet
DOI 10.1007/s00404-015-3862-3
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Postnatal problems such as pain, gastrointestinal problems,
mastitis, nausea, vomiting, depression and anxiety are seen
in early period after cesarean delivery [8]. In addition to
these problems, maternal abdominal muscle strength
decreases and fat ratio in the waist region increases fol-
lowing the cesarean incision. Turan et al. [10] reported that
a recent abdominal surgery and abdominal delivery
increases the risk of diastasis recti abdominis (DRA) and
that DRA risk significantly increases after the second
cesarean section. Longer, wider and thinner RAM will
cause reduced muscle strength and facial support therefore,
it is recommended to develop effective postnatal exercise
programs [11]. It was reported that despite the positive
effects of exercise, to start and maintain postnatal exercise
programs is often a very difficult and complex process for
women [12].
Kinesio taping (KT) was developed by Kenzo Kase in
1970 [13]. The use of KT gained popularity in the treat-
ment of various musculoskeletal disorders and can be used
during rehabilitation. It is thinner and more elastic than
rigid band [14]. KT can stay on the skin for 3 days due to
its water-resistant and air permeable structure [15]. Effect
mechanisms of KT include facilitation of muscle activa-
tion, enhancing blood and lymph circulation and
decreasing pain due to neurological suppression [15, 16].
Although its effect mechanism is not fully understood, it is
reported that KT may regulate muscle and fascia tension
[17]. One of the theories of regarding the muscle activity
is the stimulation of mechanoreceptors by its application
on the skin. Activation of skin mechanoreceptors causes
local depolarization and the transmission of nerve impul-
ses to the central nervous system by afferent fibers [17].
Another theory is that muscle tension may be indirectly
influenced by fascia. It is indicated that fascia, which is
responsible for the transmission of forces, regulation of the
movements and protection of the correct body biome-
chanics, is in a relationship with contracting muscle
therefore, it may affect the musculoskeletal system
dynamics [18].
In the literature, studies revealed only the immediate
effect of KT on muscle activation [17–20]. There are only
limited numbers of studies about the use of KT on
abdominal muscle activation. Ptak et al. [17] reported that
KT application on RAM did not cause a significant change
on power–velocity variables of muscle. To the best of our
knowledge, there is no study investigating the effects of
KT combined with exercise in postnatal women who
underwent cesarean delivery. The aim of this pilot ran-
domized trial (RCT) was to determine the effectiveness of
KT combined with exercise on abdominal recovery in
women with cesarean section compared to the exercise
alone.
Materials and methods
This was a prospective, assessor-blinded pilot RCT.
Women who underwent cesarean delivery were evaluated
and treated at women’s health unit of physiotherapy
department. Participants were recruited if they had cesar-
ean section and were between the fourth and sixth post-
natal months and did not receive regular abdominal
exercise program in the last 6 months. We included
women who were in delayed postnatal period, because
improvement of the muscle tone and restoration of the
connective tissue occur in this period. Also, complications
are rarely seen in this phase [21]. Women who had
abdominal hernia, DRA larger than 2 cm, history of
abdominal surgery except cesarean section and any con-
dition to prevent performing exercises were excluded from
the study. The study protocol of this pilot RCT was
approved by the university ethics committee. Informed
consent was obtained from all participants according the
principles stated in the Declaration of Helsinki and they
were informed about the study protocol. Postnatal women
were randomly assigned into exercise (n = 12) or
KT ? exercise (n = 12) groups using the stratified block
randomization procedure with opaque and sealed envel-
opes containing group allocation numbers from a com-
puter-generated random number table.
Treatment protocol
The KT ? exercise group underwent a KT application on
RAM, oblique abdominal muscles (OAM) and cesareanincision twice a week for a period of 4 weeks. Taping was
performed by the same experienced and skilled physical
therapists (first and second author). First, the scar technique
was applied using I band with a tension of 50 % on
cesarean incision when the patient was in supine position
(Fig. 1). Then, tape was applied on RAM using muscle
technique from origin to insertion of the muscle with a
tension between 15 and 25 %. Band was started on sym-
physis pubis with no tension, and then the patient was
asked to stretch the abdominal region by deep abdominal
respiration, and it was ended on xiphoid process (Fig. 2).
Finally, it was performed on the right and left external
oblique muscles. The procedure started with no tension
from the bottom end of the 6–12th ribs and then the hip was
placed in flexion and rotation to the opposite direction and
the band was taped on pubic bone with a tension between
15 and 25 % (Fig. 3) [14]. Also, the patients in both groups
were taught posterior pelvic tilt, core stabilization and
abdominal correction exercises as well as respiration
techniques. They were asked to perform the exercises
5 days a week, 3 times a day, with 15 repetitions for each
Arch Gynecol Obstet
123
exercise. In addition, the patients were informed about
biomechanical corrections of the lumbar, thoracic and
cervical spine.
Evaluations
All assessments were performed at baseline and at the end
of the 4-week treatment by the same experienced physio-
therapist (third author), who was blinded to the group
allocation. Strength of abdominal muscles was evaluated
using manual muscle test of Dr. Lovett and recorded on a
0–5 point scale [22]. Each evaluation started in position 3
of the test. For RAM, the patients were positioned in the
supine position with the legs in flexion and arms were
straight and they were asked to lift themselves to the lower
end of the scapulae (position 3). When the patients
achieved this position, they leaned forward placing the
hands crossed on the chest (position 4). When they
achieved the position 4, then the patients were asked to
lean forward crossing the hands at the back of the head
(position 5). The same test procedure was performed for
OAM as the patients were diagonally lying. For lower
abdominal muscles (LAM), the women were in the supine
position placing the legs at 90" of hip flexion and knee
extension. The physiotherapist’s one hand was on the
patients’ lumbar area and instructed them to lower their
legs as slowly as possible. The angular degree between the
legs and the ground was recorded using a goniometer at the
point where the lumbar lordosis was observed [22].
In addition to manual muscle tests, abdominal strength
and endurance were measured with the half sit-up test.
Fig. 1 Application of scar technique on cesarean incision
Fig. 2 Application of facilitation technique on rectus abdominis
muscle (RAM)
Fig. 3 Application of facilitation technique on right and left external
oblique abdominal muscles (OAM)
Arch Gynecol Obstet
123
Patients were positioned in supine with knees at 90" flexion
and feet flat on the ground. The number of correctly
completed sit-ups for 30 s was recorded [23]. Furthermore,
the abdominal static endurance test was used to assess
muscle endurance. A 70" wood support was placed at the
back of the patient. The trunk and the legs were in flexion;
the hands were crossed on the chest. The support behind
the patients was removed with ‘‘start’’ command and they
were asked to maintain baseline position as long as they
could. The duration for this position was recorded with the
stopwatch [24]. All strength and endurance tests were
performed in same order and scored by the same physical
therapist. Patients had 5-min rests between tests.
Evaluation of DRA was made when the patient was in
the hook-lying position. They instructed to lift their head
and shoulders with arms extended until the lower angle of
scapulae left the ground during expiration. When the
patients were in this position, examiner placed her fingers
horizontally at umbilicus, 4.5 cm above and 4.5 cm below
the umbilicus and evaluated the degree of separation
between right and left RAM. Separations of 2 cm (two
fingers width) and more indicate the presence of DRA [25].
Visual Analog Scale (VAS) was used to evaluate
severity of waist pain. VAS is a valid and reliable method
for pain assessment. Patients were asked to rate their
overall severity of pain between 0 (indicating no pain) and
10 (indicating very severe pain) [26]. VAS was also used to
evaluate patients’ exercise adherence. They were asked to
mark the distance suitable for them between 0 (did not
performed any exercises) and 10 (performed all exercises).
Waist, umbilicus and hip circumferences were measured
to evaluate the recovery of the abdominal region. The
assessments were performed using a tape measure according
to the standards set out by the World Health Organization
when subjects were in standing position, at the end of
expiration and without compressing the skin. Each mea-
surement was repeated for twice and the average value was
recorded. The measurements were repeated if the difference
between the two measurements was greater than 1 cm [27].
Physical disability level due to low back pain was
evaluated with the Turkish version of Roland Morris Dis-
ability Questionnaire (RMDQ) consisting of 24 questions.
RDQ scores were calculated by adding the total number of
‘‘yes’’ answers. Therefore, the total scores range from ‘‘0
(no disability)’’ to ‘‘24 (maximum disability)’’ [28, 29].
Statistical analyses
Statistical analyses were performed using the SPSS software
version 21. Variables were presented as median (interquar-
tile range-IQR) for non-normally distributed quantitative
data. Differences between groups were analyzed with
Mann–Whitney U test for quantitative data. Wilcoxon test
was used to compare the change in outcome measures
between baseline and immediately after the treatment. A
p value of less than 0.05 was considered to show statistically
significant results.
Results
Twenty-four women who had cesarean delivery were ran-
domly divided into two groups as exercise (n = 12) or
KT ? exercise (n = 12) groups. Of the 24 postnatal par-
ticipants, 21 women completed the 4-week study period.
Two women in control group and one woman in KT group
dropped out of the study due to the reasons presented in the
flow chart (Fig. 4). Table 1 shows the characteristics of the
exercise and KT ? exercise groups. Comparison of char-
acteristics and outcome measures at baseline between
groups showed no significant difference (p[ 0.05),
(Tables 1, 2). In addition, there were no significant dif-
ferences between groups in exercise adherence (p[ 0.05).
KT ? exercise group showed statistically significant
changes in the strength of RAM (p = 0.01), right OAM
(p = 0.02), left OAM (p = 0.02), performance of the sit-up
(p = 0.005) and static endurance tests (p = 0.003), VAS
scores (p = 0.005), measurements of the waist and umbili-
cus (p = 0.006, 0.008) and RMDQ scores (p = 0.01) from
baseline to immediately after the treatment (Tables 3, 4).
There were significant differences in the static endurance
test (p = 0.005) and VAS score (p = 0.02) between base-
line and post-treatment evaluations in the exercise group.
Also, there was a borderline significant change in the
strength of LAM and diastasis recti abdominis in
KT ? exercise group, and the sit-up test and the measure-
ment of the waist circumference in exercise group
(p = 0.05) between baseline and post-treatment evaluations.
The improvements observed in the KT ? exercise
group were significantly greater than the exercise group in
terms of the strength of the RAM (p = 0.03), the number
of repetitions of the sit-up test (p = 0.002), and the dura-
tion of the static endurance test (p = 0.005), VAS
(p = 0.003), measurements of the waist circumference
(p = 0.02) and RMDQ score (p = 0.009) (Table5).
Discussion
This is the first study that examines the effect of KT in
addition to exercise on abdominal recovery in women
who had cesarean delivery. The results of the present
study revealed that KT added to exercise was more
effective for abdominal recovery when compared to
exercise alone. Literature contains several theories on
how KT facilitates neuromuscular healing. The first
Arch Gynecol Obstet
123
theory involves motor unit activation by the activation of
cutaneous receptors by tactile stimuli provided by KT.
The second one is that KT directly applied on skin pro-
vides blood flow by increasing the interstitial area and
thus improves muscle activation [20]. It was reported that
KT applied on RAM resulted in no change on strength-
speed parameters of muscle in short-term electromyo-
graphic activity [17]. In the present study, we found that
patients who were applied KT with exercise showed
greater increase in both abdominal muscle strength and
endurance than patients who were applied exercise alone.
This indicates that KT can increase the effect of exercise
by stimulating muscle facilitation. Similarly, studies
concluded that to examine acute and chronic effects of KT
on neuromuscular performance, and muscle activation
and function, taping should be planned for patients as part
of a rehabilitation program or in combination with exer-
cise programs [15, 20]. Activation of the abdominal and
lumbar muscles during core exercises is greater than those
of the isolation exercises [30]. Therefore, we used core
exercises in the present study to increase muscle strength
and endurance.
Physical, emotional and social changes may be seen in
most women in the postnatal period [31]. Abdominal re-
Women with caesarean section for eligibility (n= 27)
Excluded (n= 3)
♦ abdominal hernia (n= 1)
♦ history of abdominal surgery (n=1)
♦ declined to participate (n= 1)
Analysed (n= 10)
Lost to follow-up (personal reasons) (n= 2)
Exercise Group (n=12)
Discontinued intervention (allergy to tape)(n=1)
KT+exercise Group (n=12)
Analysed (n= 11)
Allocation
Analysis
Follow-Up
Randomized (n= 24)
Enrollment
Fig. 4 Flow chart of participants
Table 1 Baseline characteristics of participants who completed the study
Exercise group (n = 10) KT ? exercise group (n = 11) z p
Age (year) 30.5 (29.0–32.0) 32.0 (29.0–33.0) -0.24 0.80
Height (cm) 165.0 (163.7–170.0) 161.0 (160.0–168.0) -0.92 0.35
Weight (kg) 65.0 (62.0–72.0) 68.0 (55.6–72.0) -0.03 0.97
BMI (kg/m2) 24.9 (23–27.2) 25.9 (23.6–27.3) -0.35 0.72
Education (year) 15.0 (15.0–17.0) 17.0 (15.0–21.0) -1.33 0.18
Cesarean delivery (n) 1.0 (1.0–1.0) 1.0 (1.0–1.0) -0.69 0.48
Time since birth (mo) 5.5 (4.0–6.0) 6.0 (5.0–6.0) -0.67 0.50
Values are presented as median (IQR). Mann–Whitney U test
Arch Gynecol Obstet
123
training applications planned in postpartum women include
abdominal exercises, aerobic exercises, postural and waist
health training and external supports (corset). These
applications improve abdominal muscle tonus and control,
enhance pelvic stability and aim to reduce the development
of DRA [32]. A review of the literature showed that the
delayed postnatal period and postpartum care can last up to
6 months as many physiologic changes that start in preg-
nancy minimally may continue during this period [5, 21].
Therefore, this study included women between the 4th and
6th postpartum months for the healing of the connective
tissue and muscle tone.
Weak abdominal muscles play an important role in
pathogenesis of waist pain in the prenatal and postnatal
periods [33]. We have found that severity of pain signifi-
cantly decreased in both groups immediately after the
treatment. However, this decrease was greater in
KT ? exercise group. This finding supports the view that
improvement in muscle strength and endurance may be
associated with improvements in patients’ symptoms.
Table 2 Comparison of
outcome variables at baseline
between exercise and
KT ? exercise groups
Exercise (n = 10) KT ? exercise (n = 11) z p
Strength
RAM 3.8 (3.2–4.3) 3.6 (3.3–4.3) -0.21 0.83
OAM (right) 3.4 (3.0–4.0) 4.0 (3.3–4.3) -1.51 0.13
OAM (left) 3.4 (3.0–4.0) 3.6 (3.3–4.3) -1.22 0.2
LAM 3.6 (3.3–3.7) 3.6 (3.3–3.6) -0.11 0.91
Sit-up test 23.5 (14.7–27.7) 21.0 (19.0–28.0) -0.07 0.94
Static endurance test 29.7 (24.0–45.7) 40.0 (31.7–83.0) -1.09 0.27
Visual Analog Scale 2.5 (2.1–3.8) 2.6 (1.5–6.4) -0.38 0.69
Diastasis recti abdominis 1.5 (1.3–1.6) 1.5 (1.5–1.5) -0.08 0.93
Circumference measurements
Waist 76.5 (72.5–83.3) 77.5 (72.5–81.5) -0.07 0.94
Umbilicus 89.1 (84.8–93.1) 87.5 (79.0–92.0) -0.38 0.69
RMDQ 3.0 (1.0–6.2) 1.0 (0.0–5.0) -1.03 0.3
Values are presented as median (IQR), rectus abdominis muscle (RAM), oblique abdominal muscle (OAM),
lower abdominal muscle (LAM), Roland Morris Disability Questionnaire (RMDQ), Mann–Whitney U test
Table 3 Comparison of
changes in abdominal muscle
strength and endurance between
baseline and post-treatment in
exercise and KT ? exercise
groups
Baseline median (IQR) Post-treatment median (IQR) z p
RAM
Exercise 3.8 (3.2–4.3) 4.0 (3.2–4.3) -1.34 0.18
KT ? exercise 3.6 (3.3–4.3) 4.3 (3.3–4.6) -2.55 0.01
OAM (right)
Exercise 3.4 (3.0–4.0) 3.4 (3.0–4.3) -1.63 0.10
KT ? exercise 4.0 (3.3–4.3) 4.3 (3.3–4.6) -2.26 0.02
OAM (left)
Exercise 3.4 (3.0–4.0) 3.4 (3.0–4.0) -1.00 0.10
KT ? exercise 3.6 (3.3–4.3) 4.3 (3.3–4.6) -2.26 0.02
LAM
Exercise 3.6 (3.3–3.7) 3.6 (3.3–4.0) -1.00 0.31
KT ? exercise 3.6 (3.3–3.6) 3.6 (3.6–4.0) -1.85 0.06
Sit-up test
Exercise 23.5 (14.7–27.7) 23.5 (16.0–28.2) -1.88 0.05
KT ? exercise 21.0 (19.0–28.0) 25.0 (24.0–31.0) -2.81 0.005
Static endurance test
Exercise 29.7 (24.0–45.7) 35.3 (27.7–64.0) -2.80 0.005
KT ? exercise 40.0 (31.7–83.0) 98.0 (49.7–132.0) -2.93 0.003
Bold values are statistically significant (p\ 0.05), Wilcoxon test
Arch Gynecol Obstet
123
Abdominal exercises are recommended to patients to
reduce waist circumference and abdominal fat. Katch et al.
[34] reported that the size of fat cells in abdominal, sub-
scapular and gluteal regions is decreased via progressive
4-week exercise program. Another study revealed that
abdominal exercise training was effective in increasing
abdominal strength but it was not effective in reducing
abdominal fat [35]. Our results have revealed an average
decrease of 2.3 % in waist circumference and 2.5 % in
umbilicus circumference in KT ? exercise group and 0.4
and 1 % decrease, respectively, in exercise group.
Szcegielniak et al. [36] proved that KT was an effective
treatment method to reduce pain and edema in patients who
underwent abdominal surgery. According to circumference
measurements, they found that waist circumference
decreased by 2.5 % in taped patients and 0.5 % in control
group patients. This finding emphasizes that KT added to
exercise stimulates abdominal re-training in the postnatal
period.
A recent systematic review reported that KT has very
few and relatively minor side effects [37]. In our study,
slight redness occurred on the skin only in one patient after
application and therefore the patient was excluded from the
study.
Table 4 Comparison of
changes in outcome variables
between baseline and post-
treatment in exercise and
KT ? exercise groups
Baseline median (IQR) Post-treatment median (IQR) z p
VAS
Exercise 2.5 (2.1–3.8) 2.2 (1.1–3.5) -2.25 0.02
KT ? exercise 2.6 (1.5–6.4) 0.0 (0.0–1.7) -2.80 0.005
Diastasis recti abdominis
Exercise 1.5 (1.3–1.6) 1.5 (1.3–1.5) -1.34 0.18
KT ? exercise 1.5 (1.5–1.5) 1.5 (0.5–1.5) -1.84 0.06
Circumference measurement
Waist
Exercise 76.5 (72.5–83.3) 77.2 (71.8–82.5) -1.48 0.13
KT ? exercise 77.5 (72.5–81.5) 76.2 (69.0–80.5) -2.75 0.006
Umbilicus
Exercise 89.1 (84.8–93.1) 87.8 (84.3–92.0) -1.88 0.05
KT ? exercise 87.5 (79.0–92.0) 84.0 (76.5–91.5) -2.65 0.008
RMDQ
Exercise 3.0 (1.0–6.2) 3.0 (0.7–6.2) -0.44 0.65
KT ? exercise 1.0 (0.0–5.0) 0.0 (0.0–3.0) -2.38 0.01
Bold values are statistically significant (p\ 0.05),Wilcoxon test
Table 5 Comparison of
changes (D1, D2) in primary and
secondary outcome measures
between exercise and
KT ? exercise groups
Exercise KT ? exercise z p
D1 D2
Strength
RAM 0.0 (0.0–0.3) 0.33 (0.0–0.3) -2.10 0.03
OAM (right) 0.0 (0.0–0.3) 0.33 (0.0–0.3) -1.10 0.26
OAM (left) 0.0 (0.0–0.3) 0.33 (0.0–0.3) -1.10 0.26
LAM 0.0 (0.0–0.0) 0.0 (0.0–0.3) -1.27 0.20
Sit-up test 1.0 (0.7–2.0) 3.0 (1.0–5.0) -2.30 0.02
Static endurance test 4.3 (2.2–14.1) 25.0 (17.0–61.5) -3.38 0.001
Visual Analog Scale 0.4 (0.05–0.6) 2.6 (1.0–3.0) -2.92 0.003
Diastasis recti abdominis 0.0 (0.0–0.1) 0.0 (0.0–1.0) -0.84 0.40
Circumference measurements
Waist 0.6 (0.0–1.1) 1.7 (1.0–2.8) -2.18 0.02
Umbilicus 0.9 (0.3–1.6) 3 (0.5–3.9) -1.27 0.20
RMDQ 0.0 (0.0–0.0) 1.0 (0.0–3.0) -2.62 0.009
Values are presented as median (IQR), D1, D2: differences between baseline and last visit
Bold values are statistically significant (p\ 0.05), Mann–Whitney U test
Arch Gynecol Obstet
123
There were several limitations of the present study.
First limitation was inability to use more objective
methods including electromyographic measurement or
isokinetic dynamometer to evaluate the activation of
abdominal muscles, strength and endurance. Although
isokinetic dynamometer is recommended as an objective
assessment method, it is still very expensive and rarely
preferred at clinical settings [22]. On the other hand,
abdominal sit-up and static endurance tests are useful,
valid and reliable functional performance tests. The intra-
tester reliability was reported previously as 0.93 for sit-up
test, 0.77 for the abdominal static endurance test [38, 39].
The interpretation of the results with a small sample size
was the second limitation of this study. Therefore, further
studies with larger sample sizes to investigate chronic
effects of KT on abdominal re-training in the delayed
postnatal period and to achieve more significant results
are warranted. Absence of sham taping was also another
limitation of the present study. However, it would be
better to combine exercise and KT and compare with
exercise group as well as the sham group. We also tried
to eliminate therapist-effect in our study with placing
different physiotherapists in the intervention and
assessments.
In conclusion, this is the first study to evaluate the
effectiveness of KT combined with exercise on abdom-
inal muscle strength and endurance, waist pain and waist
disability level in women with cesarean incision. We
found an increase in abdominal muscle strength and
endurance, and decrease in pain severity, an improve-
ment in waist and umbilicus circumferences and a
decrease in disability level in postnatal women who
received KT with exercise. Based on our findings, KT
added to exercise is a more effective method than
exercise alone to enhance abdominal re-training in
women who had cesarean section. This method can be
included in postnatal physiotherapy programs to accel-
erate the effectiveness of exercises. This pilot study
showed that KT combined with exercises may improve
the quality and efficiency of the postnatal health care.
We believe that the results of this study will give insight
to obstetricians, physiotherapists and other health care
professionals who plan postnatal health care and reha-
bilitation programs. However, further studies with larger
sample sizes, more objective evaluation methods and
long-term follow-ups should be planned to investigate
the chronic effects of KT on abdominal recovery in
women with cesarean section.
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflict
of interest.
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	Effects of exercise and Kinesio taping on abdominal recovery in women with cesarean section: a pilot randomized controlled trial
	Abstract
	Purpose
	Methods
	Results
	Conclusions
	Introduction
	Materials and methods
	Treatment protocol
	Evaluations
	Statistical analyses
	Results
	Discussion
	References