Diastasis Recti: What it is, Where to start, and What to do?

What is it?

Diastasis recti, pronounced, dī-ˈas-tə-səs l rek-ˌtī, is the separation of the connective tissue that holds the right and left abdominal muscles together in the midline of the abdomen due to increases in intra-abdominal pressure.  This most often occurs with pregnancy, however other factors can contribute such as: improper mechanics and muscle activation with abdominal exercises, repetitive heavy lifting and rapid increases in weight.  The presence of a diastasis recti can also be related to symptoms including:

  • Pelvic floor dysfunction[4]
  • Low back pain
  • Pelvic/Hip Pain
  • Posture impairments
  • Abdominal muscle weakness

Where to start?

The best place to start is prenatally!  Unfortunately, diastasis recti is not a condition that can be prevented during pregnancy.  However, studies have shown that beginning a core and pelvic floor muscle stabilization program is highly effective in improving function both during and after pregnancy.  It is highly recommended women work with a physical therapist during their pregnancy to learn safe and effective exercise strategies.

If you think you may have diastasis recti or are suffering from any of the symptoms above, the earlier you see a physical therapist the better!  A physical therapist who specializes in women’s health and pelvic floor physical therapy can diagnose whether diastasis recti is present and to what severity.  Your physical therapist and healthcare provider (OB-GYN, Primary Care Physician or other medical doctor) can work with you to determine if conservative treatment like physical therapy and/or surgical treatment is the best route for you. 

463135451

What to do? 

You may have been told to draw the abdominal wall in and engage the deeper abdominal muscles to help with diastasis recti.  While this can help to increase support and stability through the torso, it is not the whole story.  Our torso is like a canister[1]; think about when you squish a water balloon on one side and it squishes out of the other side of your hand.  Our "canister" will act in the same way.  If we are drawing the abdominal wall in alone, pressure will increase and send forces in a different direction.  Whether that increase in pressure is directed up into the diaphragm, down into the pelvic floor muscles or back into the muscles along the spine, it can lead to stresses elsewhere in the body.  It is important to coordinate breathing with proper firing of the muscles to decrease stresses throughout the abdominal region and prevent worsening the diastasis (abdominal muscle split).  

Muscle and connective tissue tightness may also play a roll in pulling the abdominal muscles away from the midline of the abdomen.  A recent series of case studies has shown that soft tissue mobilization and massage of the abdominal region with a technique call visceral manipulation, has been effective in resolving diastasis recti. [2]           C-section scaring, and/or other abdominal surgery scars may also contribute to diastasis recti.  Scar tissue massage can aid in improved movement and function of the abdominal wall to aid in healing.

A physical therapist with special training in women’s health and pelvic floor physical therapy can help diagnose and treat diastasis recti.  The techniques described above along with specific exercises, body mechanic education, binders and taping techniques to aid in realigning the abdominal muscles can assist in pain reduction and symptom free function.

Good news!  Ashlee Richardson, PT, DPT has the expertise to help treat these symptoms and get you back to a healthy, active lifestyle.  Have questions or would like to schedule an appointment? 
Call us at 402-512-3237.    

Resources:

1. Lee D G, Lee LJ, McLaughlin L 2008 Stability, continence and breathing - The role of fascia in both function and dysfunction and the potential consequences following pregnancy and delivery. Journal of Bodywork and Movement Therapies 12, 333-348.

2. Kirk B, Elliott-Burke T. The Effect of Visceral Manipulation on Diastasis Recti Abdominis (DRA): A case series. https://www.barralinstitute.com/docs/articles/effect-of-visceral-manipulation-on-diastasis-recti-abdominis--dra--a-case-series.pdf.

3. Move Forward.  A physical therapists guide to diastasis rectus abdominis.  https://www.moveforwardpt.com/symptomsconditionsdetail.aspx?cid=f8a7ad12-eadf-4f42-9537-e00a399c6a03

4. Spitznagle T, Leong F. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J Pelvic Floor Dysfunct. 2007 Mar;18(3):321-8

Pain and The Brain

Lunch - N - Learn

We are excited to announce our new regularly scheduled FREE education sessions hosted by Pilates Center of Omaha and CoreWorks Physical Therapy!

FIRST SESSION TOPIC: Complexities of chronic pain (development of and treatment) with Dr. Ashlee Richardson, PT, DPT.

INTENDED AUDIENCE: This education session is for anyone interested in learning more about pain science, including clients, fitness professionals, and health care providers.  Everyone is welcome, you do not need to be a current client or patient.

Read on to learn more:

Pain Lunch n Learn.jpg

Physical Therapy: An Important Part of Postnatal Care

      Our health system does a wonderful job of ensuring a safe gestational period and delivery, however does very little in caring for women following childbirth.  Our society even considers the common pathologies experienced during and after child birth as “normal” because well, “you just had a baby”.  Although the myriad of challenges that follow giving birth are common, they are not necessarily normal.  The good news is physical therapists who specialize in women’s health are an invaluable resource in providing postpartum physical therapy to help women recover from the rigors of child birth.

How Can Physical Therapy Help After Giving Birth

      Ob/Gyn Physicians are the go to for pre-natal care and delivery, however they may not be trained to address musculoskeletal implications that come with pregnancy, labor, and C-section delivery to the extent of a women’s health physical therapist.  These symptoms can range from urinary/fecal incontinence to pelvic and low backpain.  Here are just a few ways physical therapy can help:

1.    Diastasis Recti:  Diastasis recti is the separation of the rectus abdominal muscle.  This can contribute to low back and pelvic pain.  A physical therapist can assist in reducing this separation through abdominal soft tissue mobilization, specific strengthening exercises and breathing techniques. 

2.    Incontinence:  Incontinence is involuntary loss of urine or feces.  Weak or overly tight pelvic floor muscles can contribute to these symptoms.  A physical therapist specially trained in pelvic floor physical therapy can perform a pelvic exam to assess the strength of your pelvic floor muscles.   Exercises can then be prescribed to help strengthen or relax the pelvic floor muscles and muscular support around the pelvis.  Behavioral/dietary habits may also be influencing symptoms.  A physical therapist can make the appropriate recommendations and work with your dietitian, physician or functional medicine practitioner to provide the best outcomes.    

3.    Pelvis and Low Back Pain:  Pelvic, low back pain and pain during sex are common symptoms during and after pregnancy.  Contributing factors can include weak and/or tight muscles, improper biomechanics, new stresses and inadequate sleep while caring for your new baby.  A Women’s Health Physical Therapist can determine the contributing factors to your symptoms with a thorough examination and work with you to establish a treatment plan including exercise, manual therapy and education. 

4.    Post C-Section: Scar tissue can cause adhesions that prevent adequate movement of your tissues and contraction of muscles. This can lead to pain and weakness.  Once your scar is healed a women’s health physical therapist can help safely mobilize your scar to reduce and prevent adhesions. Benefits can be achieved from scar tissue mobilization even if your surgery was decades ago. These techniques can be taught so you can safely perform them at home in conjunction with your physical therapy treatments.

      Post-partum physical therapy as part of standardized treatment is extremely important to women’s health.  CoreWorks Physical Therapy is here to help you regain your pre-partum self.  If you recently had a baby or are a veteran mother, it is never too late to address your symptoms with a women’s health physical therapist. 

      Call us at 402-512-3237 if you have any questions or would like to schedule an evaluation with our trained women’s health Physical Therapist, Ashlee Richardson, PT, DPT.

Pilates and Physical Therapy: A Beneficial Relationship

“Ideally, our muscles should obey our will. Reasonably, our will should not be dominated by the reflex actions of our muscles.” - Joseph Pilates

Pilates and Pilates based equipment were founded on the basis of rehabilitation.  The founder of the Pilates method, Joseph Pilates, began to develop his work in WWI.  He served as an orderly in a hospital where he used his method of exercise as a form of rehabilitation for injured and sick soldiers. Joseph and his wife Clara later emigrated to the USA in the early 1920s and together they developed and taught the method in their studio in New York.  Pilates soon became very popular with the dance community, as it offered a chance to improve technique or recover from injury.

Injuries often start with abnormal mechanics and are usually aggravated by common activities that you perform daily. A healthy pain free body starts with proper alignment and biomechanics of your entire body, which is a core concept of the original Pilates method. Pilates based exercises and principles can not only be utilized to rehabilitate your injury, but will also teach you to find your best body alignment to prevent future re-injury. Pilates based exercises are designed to restore the natural curves of the spine and re-balance the muscles around the joints.  Core muscles are targeted that stabilize the low back, pelvis, hips and shoulders.  Together, core muscle strength and good alignment allow our joints to absorb shock properly

The Pilates method was designed to teach control of the body and correct muscle imbalances. This allows therapists to not only treat an injury, but to also find the source.  With a Pilates based Physical Therapy program you will learn to understand your body’s alignment and how to replicate it in your exercise program and activities of daily life for faster recovery and injury prevention.  A wide variety of athletes continue to use Pilates today to prevent and treat injuries and improve in their sport. 

Contact us and learn how our Pilates based approach can help you with faster recovery so you can return to the activities you enjoy doing pain free.

New Year. New You. How Physical Therapy Can Help.

Many of us may be planning new health and fitness goals for 2017, and plan to increase our activity levels.  We applaud and encourage you as you work towards a healthier more active you and want to help you remain injury free so you can achieve these goals.

Photo by kapulya/iStock / Getty Images
Photo by kapulya/iStock / Getty Images

Regular exercise is imperative to maintaining good health, however sudden increases in activity levels can lead to an increased risk for injury.   Our movement screen and posture analysis will assess strength, range of motion and posture to identify imbalances and compensations.  Based on these findings, individualized corrective exercises will be recommended to normalize movement before increasing physical demand.  We will also teach you how to perform specific exercises with the correct technique, breathing pattern, and range of motion.

Regular movement screens can be an invaluable tool to keep you healthy, active and pain free.  Just as we receive regular medical and dental screens to assess the status of our health, regular movement screens work in the same way.  These screens are important to determine what areas need to improve to prevent future problems and fix problems that may arise.  With a regular movement screen, areas that are at risk can be determined to help prevent injuries and keep you informed on your progress.  Remaining injury/pain free will help you stay consistent with your training and in turn, improve performance and reach your goals. 

If you are interested in improving your movement patterns, decreasing compensations and reducing injury risks, please contact us at 402-512-3237 or email us at ashlee@coreworksphysicaltherapy.com.

*Movement screens are 55 minutes.  This service will not be reimbursed by your insurance company.

We wish you a happy, healthy new year and cheer you on as you reach your 2017 goals!

 

The Mysterious Pelvic Floor

If you’ve taken a Pilates class, you’ve probably heard your instructor talk about engaging your pelvic floor.  And you’ve probably wondered... “what exactly is a pelvic floor,” “why should I engage it,” and “what should I feel.”  Well, I am here to hopefully clear some of that up so you can in turn get the most out of “engaging your pelvic floor!”

What do these muscles do?
Your pelvic floor muscles are a group of muscles which are located at the bottom of your pelvis.  Their functions include:

  • Provide support and stability to your pelvis and low back;
  • Support the pelvis organs, including: your bladder, uterus and rectum
  • Help you breathe efficiently; and,
  • Help control bowel and bladder function.  
Pelvic Floor Image.jpg

Why strengthen the pelvic floor muscles?
We do not see these muscles, nor think about them on a regular basis so they often get neglected.  Other factors like pregnancy, menopause and obesity may also contribute to pelvic floor weakness.   

Studies have shown that an exercise program that involves strengthening the pelvic floor are effective ways to decrease low back pain and prevent/help with incontinence.  These muscles support the organs in the pelvis to reduce the risk of organ prolapse (An organ prolapse is when the pelvic organs bulge into the vaginal canal).  Pelvic floor strengthening can also help improve sexual function and recovery from giving birth.

How to strengthen your pelvic floor?
So, what exactly does it mean to engage your pelvic floor?  The pelvic floor muscles are different from a lot of muscles we exercise and use regularly.  They are more internal and because we cannot see them like we can muscles in our arms and legs they can be more challenging to contract. 

Imagine your pelvic floor muscles like a hammock that is hung up between your tailbone, sitting bones and pubic bone.  When the muscles contract, it is as though that hammock is being pulled taught and lifting.  This contraction will feel like you are stopping the flow of urine mid-stream or holding in gas if the time isn’t right.  If these bodily function cues are not resonating, some other visuals that may help include imagining an elevator rising from the base of the pelvis toward your naval or a layer of material lying flat at the bottom of the pelvis that is being pulled up from the center as you contract the pelvic floor muscles.  (Please note that stopping the flow of urination mid-stream is a tool that can be used to ensure you are correctly engaging the right muscles.  It is however not recommended as an exercise to strengthen these muscles and should not be performed regularly as it may lead to infection).

If you are having difficulty finding your pelvic floor muscles, attempt contractions in different positions. For example, try lying on your back with a folded blanket or towel under the back of your hips to allow gravity to help you.  As you get stronger you can progress to removing the towels, to sitting, and finally to standing! 

When to seek professional help?
It is important for these muscles to relax and contract at the appropriate times.  Just like any of our muscles, problems can occur when the pelvic floor muscles become weak, stretched or too tight.  

It may surprise you that physical therapy is an option for individuals who are experiencing problems related to the pelvic floor.  Physical therapists who specialize in women’s/men’s health and pelvic floor dysfunction can assess your pelvic floor function and tailor an exercise program to meet your specific needs.   It is recommended you talk to your physician or seek a physical therapist who specializes in the pelvic floor if you are experiencing any of the following symptoms:

  • Leak urine when you exercise, laugh, cough or sneeze;
  • Inability to make it to the restroom in time or constantly having an urge to use the restroom;
  • Inability to contract pelvic floor muscles or decreased sensation in the pelvic area; and,
  • Pain in your pelvic area or pain with intercourse.

Ashlee Richardson, PT, DPT is the owner of CoreWorks Physical Therapy and co-owner of Pilates Center of Omaha.  She specializes in women’s health and pelvic floor dysfunction.  If you would like more information or to set up a physical therapy appointment email: ashlee@coreworksphysicaltherapy.com

Open House + Pilates for Pink Breast Cancer Research Fundraiser!

Join us for dinner and drinks to celebrate the opening of CoreWorks Physical Therapy.   Open house will take place following the Pilates For Pink Pilates class held by the fabulous instructors at Pilates Center of Omaha. 

Come see the facility, meet the staff,  finish out your week with a great workout, and enjoy some free food and drinks! 

Pilates For Pink
This is an all equipment Pilates, TRX, and Barre circuit class led by the fabulous instructors at Pilates Center of Omaha! 

Donations to The Breast Cancer Research and Development Fund will be accepted for class participation.  Proceeds are in support of breast cancer research taking place at the Fred & Pamela Buffett Cancer Center.

Event Details:
Date:
Friday, November 4th, 2016
Time: Pilates class will be held from 6:00 - 7:15 PM; Food and drinks to follow in celebration of the grand opening of CoreWorks Physical Therapy.
RSVP: Space is limited in the Pilates class, please e-mail ashlee@pilatescenterofomaha.com to reserve your spot. 
Location: 11303 Wright Cir., Omaha, NE 68144 (1 block south of 114th and Center)