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On “The impact of hypopressive abdominal exercise on Linea Alba morphology in women who are postpartum: a short-term cross-sectional study.” Arranz-Martín B, Navarro-Brazález B, Sánchez-Sánchez B, McLean L, Carazo-Díaz C, Torres-Lacomba M. Phys Ther. 2022;102:pzac086. https://doi.org/10.1093/ptj/pzac086

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Extract - We read the article by Arranz-Martín et al with great interest. However, we are concerned about the theoretical rationale, methodology, and conclusion of this paper. In the Introduction, the authors state: "Linea alba stiffness appears to play an important role in the transmission of muscle forces across the midline to achieve optimal abdominal wall function. The extent of distortion or slackness in the linea alba seen during abdominal muscle tasks has been proposed as a means of evaluating linea alba stiffness, hence its contribution to supporting the abdominal wall and transferring loads across the midline during a task." However, the distortion index is only a proposed measure that has not been tested for reliability and validity. Lee and Hodges introduced the linea alba distortion index to describe the distortion of the linea alba: "…the distortion index is not a perfect measure of LA [linea alba] tension, as a curved LA may also become tense if loaded by intraabominal pressure. Thus, the measure is not expected to maintain a linear relation to tension, but to provide a surrogate index that can be quantified without highly specialized equipment (eg, elastography). Pilot data from a validation study to compare the distortion index and measures made with elastography support this proposal (unpublished data)."

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Abdominal Hypopressive Perinatal care Physical examination Physical therapy techniques Postnatal care

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Mota P, Theodorsen NM, Gluppe S, Bø K. On “The impact of hypopressive abdominal exercise on Linea Alba morphology in women who are postpartum: a short-term cross-sectional study.” Arranz-Martín B, Navarro-Brazález B, Sánchez-Sánchez B, McLean L, Carazo-Díaz C, Torres-Lacomba M. Phys Ther. 2022;102:pzac086. https://doi.org/10.1093/ptj/pzac086. Phys Ther. 2023;103(4):pzad018.

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