fbpx

Strong Abs during Pregnancy and for New Mom’s

The staff Doctors of Physical Therapy at EMH specialize in pre and postpartum physical therapy for a healthy pregnancy and a fast recovery after delivery. Preventing Diastasis Recti is one aspect of our expertise.
Please forward to all your pregnant/new mom friends and family!

Diastasis Recti Abdominis (DRA) can occur in up to 66% of pregnant women due to hormones that allow ligaments and joints to relax, the increasing baby size in utero, improper weight lifting (ie heavy food bags, other children, furniture etc), a history of prior C-section or abdominal surgery and repetitive poor mechanics during daily activities and lack of regular exercise.

Men can also develop DRA due to faulty weight lifting mechanics, obesity and chronic medical conditions that result in frequent coughing such as bronchitis.

What is a DRA?

DRA is defined as the separation and thinning of the rectus abdominus muscles (see diagram in green) and stretching of the linea alba (see diagram in blue). The linea alba runs from the xiphoid process (base of sternum) to the symphysis pubis (center of pelvic bone). Both the rectus abdominus muscle and linea alba are the main support for the front of the abdomen, keeping the visceral organs in place and functioning well. They also maintain pelvis stability during walking, lifting, bending and squatting.

What are the symptoms of DRA?

Symptoms may include:

  • Noticeable small or large bulge in the center abdomen
  • Sharp or burning abdominal pain during bending, lifting, standing and walking
  • Lower back pain
  • Feeling like the intestines or stomach may fall out
  • Poor posture
  • Longer term problems of prolonged DRA may include Stress Urinary Incontinence, Fecal Incontinence and Pelvic Organ Prolapse.

How To Measure for a DRA?

The best way to measure is a finger width measurement. Lie on your back, knees bent, head resting on floor/pillow. Place tips of 4 fingers across the body at naval or just above/below the naval per your comfort. Now raise your head and shoulders slightly upward. If your fingers descend inbetween the parallel rectus abdominus muscles on either side of your naval, measure how many fingers move downward. If there is a true split of the linea alba, your finger will fall into a space that feels squishy (your intestines live here!). A positive DRA is one where there more than 2 fingertips (1 inch or 2.5cm width) that lower. We have measured women with 3 to 4 inches ( 8cm) wide and have helped them narrow back to 1 inch (2.5cm) wide.

 

What to Do if you have a DRA?

Best to first consult a pelvic physical therapist for a tailored postural, stabilization and home exercise program targeting the Tranversus Abdominus (deepest and lowest muscle of our abdomen), the pelvic floor muscles and the multifidi muscles (lower back stabilizers). Here are some tips to help you immediately:

  • Avoid positions that may further separate the recti muscles, like doing sit ups, crunches, strong stretches of the abdomen, quick trunk rotation movements
  • Stand and sit symmetrically (not to weight bear more on one side vs the other)
  • During standing, gently unlock your knees and gently pull your stomach inward while breathing normally
  • Self bracing of your stomach with your hands pushing the rectus together when sneezing, coughing or laughing
  • Wear a pelvic and abdominal support product to help maintain erect trunk posture and decrease pain until your muscles are aligned and strong

 

 

Diastasis Recti Abdominis (DRA) or “Split Seams” can be treated by Pelvic Physical Therapy

Diastasis Recti Abdominis (DRA) can occur in up to 66% of pregnant women due to hormones that allow ligaments and joints to relax, the increasing baby size in utero, improper weight lifting (ie heavy food bags, other children, furniture etc), a history of prior C-section or  abdominal surgery and repetitive poor mechanics during daily activities and lack of regular exercise.

Men can also develop DRA due to faulty weight lifting mechanics, obesity and chronic medical conditions that result in frequent coughing such as bronchitis.

What is a DRA?

DRA is defined as the separation and thinning of the rectus abdominus muscles (see diagram in green) and stretching of the linea alba (see diagram in blue).  The linea alba runs from the xiphoid process (base of sternum)  to the symphysis pubis (center of pelvic bone).  Both the rectus abdominus muscle and linea alba are the main support for the front of the abdomen, keeping the visceral organs in place and functioning well.  They are also maintain pelvis stability during walking, lifting, bending and squatting.

What are the symptoms of DRA?

Symptoms may include:

Noticeable small or large bulge in the center abdomen

Sharp or burning abdominal pain during bending, lifting, standing and walking

Lower back pain

Feeling like the intestines or stomach may fall out

Poor posture

Longer term problems of prolonged DRA may include Stress Urinary Incontinence, Fecal Incontinence and Pelvic Organ Prolapse.

 

How To Measure for a DRA?

The best way to measure is a finger width measurement.  Lie on your back, knees bent,head resting on floor/pillow. Place tips of 4 fingers across the body at naval or just above/below the naval per your comfort.  Now raise your head and shoulders slightly upward. If your fingers descend inbetween the  parallel rectus abdominus muscles on either side of your naval, measure how many fingers move downward.  If there is a true split of the linea alba, your finger will fall into a space that feels squishy (your intestines live here!).  A positive DRA is one where there more than 2 fingertips (1 inch or 2.5cm width)  that lower.  We have measured women with 3 to 4 inches ( 8cm) wide and have helped them narrow back to 2.5cm width

 

What to Do if you have a DRA?

Best to first consult a pelvic physical therapist for a tailored postural, stabilization and home exercise program targeting the Tranversus Abdominus (deepest and lowest muscle of our abdomen), the pelvic floor muscles and the multifidi muscles (lower back stabilizers).

Here are some tips that you can do immediately:

Avoid positions that may further separate the recti muscles, like doing sit ups, crunches and quick trunk rotation movements.  Avoid being on “all fours”  or on hands and knees for too long during exercise classes.  Assuming the yoga, “cow position” where your belly drops down as your head and hips arch upwards,  puts too much pressure on the already stretched linea alba.  Plus, the yoga position of  “Up dog” and extensive backward bends are not recommended.

Stand and sit symmetrically in good posture  (don’t stand on one leg or sit with crossed legs leaning on one hip for too long)

When you are standing, gently unlock your knees and pull  your stomach inward while breathing normally to give abdominal  support and prevent “hanging out” on your ligaments

When you sneeze, cough or laugh you you can self bracing of your stomach with your hands pushing each side of the rectus abdominal muscles towards the midline, or hold a pillow against your stomach for bracing

Wear a pelvic and/or  abdominal support product to help support the growing baby in uteruo , maintain erect trunk posture and decrease pain until your muscles are stronger by doing core exercises.

By keeping your core toned during pregnancy and taking the steps to prevent further widening of your recti muscles, you can prevent extensive DRA.

 

 

Women’s Pelvic Health

Women's Pelvic Health

 

 

Check out this link ( link) to see Evelyn’s interview on physical therapy for women’s pelvic health in the Los Angeles Times. The app, Pelvic Track, is now available on the Apple store.

 

 

Pelvic Health Physical Therapy app Launches November 2013

Watch for the launch of my new app: “Pelvic Health PT, The Hecht Program“. Launch Date: November 2013!!

Pelvic floor dysfunction (PFD) affects women (6 out of 10) and men (#’s unknown) and includes painful intercourse (women), painful or lack of erection (men),  constipation, incontinence after prostatectomy surgery (men), leaking of urine and/or feces with laughing, exercise or with the urge to go.  PFD can cause abdominal  bloating, urinary urgency,  straining during bowel movements,  pain in the pelvic/groin, lower back and hips.

The app, Pelvic Health PT, The Hecht Program” is a tool that I designed along with Kalpesh Wireless, a software company, to help men and women suffering from PFD, some too embarrassed to talk to their doctor about it, take action. By following some of my tips, techniques and exercises, you can regain a healthy pelvic floor.  This app is best used while working with a licensed physical therapist who specializes in pelvic floor rehabilitation.

When your physicians have run medical tests and all are negative for infection or inflammation and medication does not help, the most likely cause of your symptoms could be due to muscle and fascial restrictions, trigger points, weakness and incoordination of the internal and external muscle of the pelvis. The pelvic nerves  become pinched as they travel from your sacrum through the gluteal, hip and pelvic muscles to innervate the pelvic floor region leading to further dysfunction and pain.

For over 17 years, my practice has healed thousands of men and women with PFD by lengthening  restrictions, mobilizing the skin, muscle and nerves, teaching a tailored stretching and strengthening and postural home program.

The Pelvic Health PT, The Hecht Program  has over 50 exercises and awareness techniques to regain a healthy pelvis and pelvic function. Improved sexual function, decreased pain, improved bowel and bladder habits, and a stronger core are the results.

The  app has 4 parts: 1) Symptom Tracker 2)  Set Reminder, 3) Pelvic Relaxation & Stretching, 4) Pelvic Floor and Core Strengthening.

1) Symptom Tracker: Before starting some of my exercises and awareness techniques, go to the “My Symptoms” page and input each one of your symptoms /dysfunction. Be as detailed and descriptive as you want. Then for each symptom/dysfunction, rate the level of pain or discomfort on scale of 0 to 10, 0 = no pain or no trouble and 10 = worst pain or the most difficult.  After you input this detailed information, start to incorporate some of the awareness techniques and exercises that your pelvic floor physical therapist recommends.  If you do not have a pelvic floor physical therapist and working independently under the care of your physician, start slowly with the gentle tips/exercises incorporating one or two new things at a time. No exercise should increase your pain or symptom for more than 3 days following the exercise.  If this happens, stop the exercise and consult with a pelvic floor physical therapist.  If all is progressing well, at the 2 week or 1 month from starting Pelvic Health  PT, The Hecht Program, go to “My Symptoms” page and rate your symptoms at that point.  After 2 months, you should see some functional progress.   The symptom tracking helps you see that your body CAN change and motivates you to continue doing what you have started.

2) Set Reminder: You can program a reminder in your I-phone for an exercise or awareness technique that needs to be done many times a day. For example, a quick way to lower stress is to perform the Diaphragmatic Meditative Breath.  Program your reminder in the app for this exercise every 2 hours. You can become more calm during the day and prevent the build up of muscle tension, shallow breath and decreased oxygenation.

3) Pelvic Floor Relaxation and Stretching: Most people with PFD need to do the awareness techniques and pelvic floor relaxation BEFORE they start to do the strengthening, or, “Lengthen before Strengthen”  Anyone with pain should also do the relaxation exercises, assess their postures during the day (via photograph), adjust poor postures and do not start any strengthening exercises when first starting my program. Contracting or shortening an already tight muscle/fascial group will  cause further tension and result in increased pain.  Your pelvic floor physical therapist will guide you to become aware of your pelvic muscles, teach you how to relax and  lengthen all the muscles that attach onto the pelvis (hamstrings, inner thighs, hip flexors, plus more) before doing any strengthening.

4) Pelvic Floor and Core Strengthening: Once the muscles are stretched, the trigger points released and you are doing regular daily stretches, a gentle core strengthening program can begin. The app gives a progression from basic pelvic floor and abdominal recruitment, to full planks for maximum core stabilization training.  To insure long lasting results of pelvic floor rehabilitation, the core must be strengthened.

The app is best used while under the care of a licensed physical therapist who specializes in pelvic floor rehabilitation.   Your  physical therapist can direct you on which specific exercise to perform, teach you how to do the movements, perform manual therapies to reduce tension and trigger points and guide you on when to start a strengthening program.