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A Pregnant Physical Therapist’s Top Tips for Your Healthy Pregnancy

Navigating the pregnancy literature on proper posture, exercise and sleeping alignment can be overwhelming and the guidelines presented are often not a “one size fits all”. Afterall, everyone’s pregnancy is unique. Below you will find some quick and easy tips that I utilized and found helpful throughout my pregnancy that kept me fit, aligned and pain free throughout my work day as a physical therapist at EMH.

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PelviCorFit™ by EMH Physical Therapy Grand Opening

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Have you been working out for years, but neglecting a crucial muscle group??

At EMH Physical Therapy we recently launched our brand new PelviCoreFit™ program designed to whip your pelvic floor muscles into shape. Proper firing of pelvic floor muscles is not only essential for pelvic health but is also a key factor in overall core strength and fitness.

Visualize this:

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The pelvic floor muscles form a sling that transmit forces from the ground up and from your head down. If pelvic floor muscles are weak and unaccustomed to firing during exercise, you could be promoting a faulty movement pattern in the chain. Neglecting the Pelvic floor muscles can potentially lead to more serious conditions such as chronic hip, back or pelvic pain, urinary or fecal incontinence, GI and bowel disorders, and erectile or sexual dysfunction. At EMH Physical Therapy we will help you identify and strengthen the pelvic muscles during your general workouts to help prevent future dysfunction!

Additionally, did you know that the pelvic floor muscles play a fundamental role in breathing through connections to the diaphragm?  Think about doing cardio, executing a heavy lift, or performing a Vinyasa flow with a sub optimal breathing pattern. Strengthening the pelvic floor muscles can improve breathing which will help to optimize your workout efficiency.

Come try out our discounted  PelviCoreFit™ program, learn about proper activation of the pelvic floor muscles and bring your workouts to the next level!

We offer 2 options:

“PelviCorFit™ #1” – One fifty minute session with a DPT + Fitness Guru that includes 15 minute pelvic floor/core education followed by a 30 minute PelviCorFit™ workout, then Q&A. Regular price is $200. New Client price is $50

“PelviCorFit™ Pack” – Three (3) fifty minute sessions with your DPT + Fitness Guru. The first session is similar to the description above. The 2 follow up sessions include 45 minute PelviCorFit™ workouts plus instruction on how to implement pelvic floor awareness into your fitness program. Regular price is $500 for 3 sessions. New Client price is $130

To register call 212-288-2242

or

email info@emhphysicaltherapy.com

For more information click here

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“Cupping”: not just for Olympians

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Were you watching the Olympics this summer wondering about those red circles on Michael Phelps’ shoulders? Those marks, called “sha,” are from an ancient Chinese healing technique known as “cupping.

Cupping has been around for over 5,000 years. It’s practitioners stated it released toxins and helped correct imbalances in the flow of energy.

There were two cupping types: dry and wet. Dry cupping is performed when a glass bulb with a smooth rounded lip is suctioned onto the skin via heat. Either a cotton ball is lit on fire and used to generate heat inside the cup, or alcohol is rubbed around the rim and lit on fire before being placed on the skin.

The heat inside the bulb generates a vacuum like effect, producing a negative pressure on the connective tissue or fascia under the skin pulling the skin upwards (1).

The resulting  “sha” are painless broken skin blood vessels which heal in 3-7 days.

Wet cupping was administered in the same way, except the skin is slit prior to application to allow blood to escape (2).

This method is rarely used today.

Myofascial Decompression – cupping in the 21st century

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The modern application of cupping by physical therapists is known as “myofascial decompression.”

The purpose of myofascial decompression is to:
  • reduce adhesions, scar tissue of skin and connective tissues
  • restore normal mobility
  • improve efficiency of movement.

Instead of glass bulbs, hard plastic cups are used and instead of heat generating a vacuum, a hand pump suctions the skin. This allows for a more precise application of pressure.

The application of cupping is done with the “cup” device left in place for 5 – 10 minutes or slowly moved back and forth over the restricted area.

How can we – non super-human species – benefit?

While more studies are needed the literature thus far shows some positive effects from myofascial decompression (3), including decreased neck (4) and low back pain (5).

Empirically, we at EMH Physical Therapy observe that the cupping technique combined with functional movements reduces pain and releases tight tissues quicker for patients with painful cesarean scars, plantar fasciitis, scoliosis and other conditions.

Keep in mind that cupping is an adjunct treatment, used alongside other types of manual therapy, therapeutic exercise and neuromuscular re-education at the discretion of your physical therapist.

References

1. Kravetz, R.E., 2004. Cupping glass. The American Journal of Gastroenterology 99, 1418.
2. Xue, C.C., O’Brien, K.A., 2003. Modalities of Chinese medicine. In: Leung, P.-C., Xue, C.C., Cheng, Y.-C. (Eds.), A Comprehensive Guide to Chinese Medicine. World Scientific, Singapore, pp. 19–46.
3. Cao H, Han M, Li X, Dong S, Shang Y, Wang Q, et al. Clinical research evidence of cupping therapy in China: a systematic literature review. BMC Complementary & Alternative Medicine 2010;10:70.
4. R. Lauche, H. Cramer, K. -E. Choi et al., “The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain—a randomised controlled pilot study,” BMC Complementary and Alternative Medicine, vol. 11, article 63, 2011.
5. Y. D. Kwon and H. J. Cho, “Systematic review of cupping including bloodletting therapy for musculoskeletal diseases in Korea,” Korean Journal of Oriental Physiology & Pathology, vol. 21, pp. 789–793, 2007.

 

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Having trouble losing the “Mom Belly” Post Baby?

Why diastasis recti may be your problem and how you may be making it worse…

checkyoself

 

If you’re doing a million crunches to get your abs back post baby but can’t seem to lose that last little “pooch,” STOP!! You may be experiencing a very common postpartum complaint: diastasis recti.

 

What is diastasis recti?
It’s a separation of your rectus abdominis (6-pack muscles). As your belly expands during pregnancy, the connective tissue between the right and left sides of the muscle (called the linea alba) stretches to accommodate your growing baby. This separation may persist postpartum and in some women does not naturally reduce. This gap leaves your abdominals less functional, weaker and allows the other soft tissues to hang out. This causes that little belly that most new moms learn to hate.

Do I have diastasis recti?
Lay on your back with your knees bent and feet flat on the floor. Place 2 fingers at your belly button. Now lift your head like you’re trying to look at your belly while keeping your abs relaxed. Do you feel a gap along the midline of your abs at your belly botton, how about above or below the belly button? If you can fit more than 2 fingers in this “gap” you have a moderate-severe case of diastasis recti.test

What can I do about it?
Don’t freak out! You can learn a simple exercise to “brace” your abdominals that will begin to close this gap. Begin on your back with knees bent, feet flat and try to engage your deep abdominals by inhaling and bringing the navel to the spine as you exhale. See the exercise program below (“Other Resources” at the bottom of this blog) for a beginner plan geared towards closing the gap of your diastasis recti. If your goal is to get back to running, yoga, barre classes, spin classes etc., it’s recommended that you attend a few (anywhere from 2-12) PT sessions in order to strengthen your abdominals and avoid stressors that you’re not ready for. For example, planks and crunches are too challenging for abdominals weakened by diastasis recti and can worsen the separation if done improperly or too soon.

Bracing Steps (standing & lying down)

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bracing1

 

 

Other Resources:

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Home exercise program for beginners: View at www.my-exercise-code.com using code: TGQQAGV

http://mumafit.com.au/  A site created by an aussie mom of 3, Maternal Wellbeing Specialist, and International Holistic Life and Wellness Coach. She also has a very popular app that has quick and easy exercise programs for during and after pregnancy.

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Event: Healthy Body After Baby Talk

Parents Feet and Baby Booties

This fall is turning into a busy one for us here at EMH!  Not only do we have Dr. Echenberg joining us this October, but we will be hosting an event at the end of November for new and expectant moms.  In addition to getting to meet other moms, this event will be a talk by our very own therapists, Kirsten Hober and Charissa Morrisroe on the effect pregnancy has on the pelvic floor, how your body changes both during and after pregnancy, and some exercises and posture techniques that are easy to implement while caring for your baby.

[Read more…]

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

 

 

Pelvic PT highly rated in new IC Guidelines

The American Urological Association (AUA) released a new update to their 2011 Guideline on the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). The original guidelines included research studies up through 2009. This new revision includes research studies through 2013. Read the amended guidelines here!

“Although the science relevant to IC/BPS is continually improving and evolving, it is still a challenging and complicated condition to diagnose and treat,” said Philip Hanno, MD, who chaired the multi-disciplinary Panel that developed and updated the Guideline. “…this Guideline is fully aligned to the latest science and provides physicians with a relevant blueprint to treating patients.”

Developed as a treatment guide and planning tool, the 2011 guidelines introduced a six step treatment plan. Newly diagnosed patients generally begin with strategies outlined in Step One and then, if those strategies do not bring symptom relief, are advised to try Step Two treatments and so forth. The treatments are classified within the steps based upon their risk of adverse events and/or if the treatment is reversible. Surgery, for example, would never be used as a first line intervention because it is irreversible and could cause very serious complications. Rather, surgery is listed as a Step Six treatment and would only be considered after the patient has tried and failed the therapies listed in Step One Through Step Five.

Two Key Changes

Comprehensive Physical Therapy Encouraged

In Step Two, Pelvic Physical Therapy was suggested for patients who present with pelvic floor tenderness with the highest review possible, Grade A. It states:

Appropriate manual physical therapy techniques (e.g., maneuvers that resolve pelvic, abdominal and/or hip muscular trigger points, lengthen muscle contractures, and release painful scars and other connective tissue restrictions), if appropriately-trained clinicians are available, should be offered to patients who present with pelvic floor tenderness. Pelvic floor strengthening exercises (e.g., Kegel exercises) should be avoided. Standard (Evidence Strength Grade A).

Botox Therapy Rating Improved!

Botox A was reclassified from Step Five to Step Four. New research emerged which showed that using BotoxA at a lower dosage, (from 200u to 100u) substantially reduced the risk of a troublesome complication, the need for self-catheterization. If a Botox treatment silences the nerves which control urination, a patient may be forced to self- catheterize until the effect wears off, often for months. One criteria for the use of Botox is the ability of a patient to self-catheterize if necessary. If a patient is unable to do so, this therapy is not recommended. The guidelines state:

Intradetrusor botulinum toxin A (BTX-A) may be administered if other treatments have not provided adequate symptom control and quality of life or if the clinician and patient agree that symptoms require this approach. Patients must be willing to accept the possibility that post-treatment intermittent self- catheterization may be necessary. Option (Evidence Strength- C)

Learn more about IC Treatments, including all treatment options in the AUA Guidelines here!

Pelvic Pain App developed by Evelyn Hecht, PT

evelyn-and-joe-300x178

 

 

“She inspires us to not accept the status quo, to strive for wonderful things and not just acceptable things. There’s a lot of good nuggets of wisdom and interesting ways of looking at the profession. Some Apps are fun but the best are more about life”-  Dr Joe Simon

 

I felt this quote was the best to describe my thoughts about this interview. Dr Evelyn Hecht has been treating patients with Pelvic Floor Dysfunction (PFD) longer than there has been a doctorate program at my alma mater. But innovation is not the key to riches. Evelyn saw a need in the marketplace and decided unlike many in our industry not to wait for someone else to do it .

Lately i have consulted with more and more physicians and surgeons on their legacy or exit strategy. Evelyn is no where near the end , matter of fact , she is on the cusp of a new road in healthcare. Apps are a highway of free traffic from possible clients from around the world. Evelyn has just made it easier for the vast population to accept her as the expert in the field.

Pelvic floor therapy is a growth factor for practices across the country. This new specialization is growing with a medical network from physicians, physios & psychologists.

INTRODUCING, PELVIC TRACK a new app to help PATIENTS and practitioners to work together. The challenges associated with communication with the therapist dealing with pelvic floor therapy. Again , it was not looking for a better mousetrap but to create one that doesn’t exist from the need of her patients and her therapists.

The motivation for our new grad and younger (not age but career wise)  listeners. Evelyn has made strides and conquered the niche market. Marketing pelvic floor therapy through facebook, through her blog and now through her App is something i would ask all my listeners to take a deeper look at.

I hope you find the takeaways that I did.

For more info or to read the article directly click  HERE

To purchase or for more info on Pelvic Track App click HERE

Pregnancy achieved following manual pelvic physical therapy for Mechanical Infertility

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Sumer Samhoury, MSPT

Manual Physical Therapy can help some women with Mechanical Infertility achieve  pregnancy.   To understand what Mechanical Infertility is and how manual pelvic physical therapy helps, let’s first review the steps to becoming pregnant.

Mechanics of pregnancy

To achieve pregnancy, the process of ovulation and fertilization within healthy, mobile, and supported reproductive organs (ovaries, fallopian tube and uterus) without presence of adhesions & scar tissue has to occur. The steps to pregnancy are

 

  • The woman’s body releases an egg from one of her ovaries (ovulation)
  • The egg is grasped by the “fingers” of the fimbria, located at the ends of the fallopian tubes.
  • The egg travels through the open, non blocked fallopian tube toward the uterus (womb)
  • The man’s sperm joins with the egg (fertilization)
  • The fertilized egg attaches to the inside of the uterus (implantation)

Mechanical Infertility

Mechanical Infertility (MI) is defined as the inability to become pregnant due to intra pelvic and abdominal adhesions on/around or within the reproductive organs. MI affects approximately 2.5 million ( 40%) of the 6 million infertile women in the United States who have not conceived after 1 year of unprotected sexual intercourse.

Adhesions around the ovary can prevent the release of the egg (ovum) from the ovary. Adhesions can squeeze the fallopian tube (s)like a used tube of toothpaste, so the egg cannot travel to the uterus to hook up with the sperm.    Adhesions can pull the uterus out of a centered, midline position which makes implantation of the fertilized egg difficult. Adhesions within the uterus could increase uterine spasms which can result in miscarriage.

What are Adhesions?

An adhesion is a sheet or band of scar tissue that binds two parts of tissue or organs together.   Normally, with no scar tissue present, organs are slippery and they glide against each other. Adhesions can look like thin sheets similar to  plastic food wrap or they can be thick fibrous bands,  like ropes.  These bands of scar tissue can wrap around your internal reproductive organs squeezing them too tight or pull the organs out of their normal centered alignment which prevents their  optimal  function during pregnancy.

Cause of Adhesions

Adhesions naturally develop when the body’s healing/repair mechanisms respond to any tissue disturbance, such as surgery, infection, trauma, or radiation.  Our body naturally cleans a damaged area, which is followed up by the laying down of collagen fibers to replace the damaged tissue.  The replaced new collagen is haphazard, fibers get bunched up  and cross-links form. As healing time continues, cross links may grow into microadhesions, then adhesions and may eventually thicken into scars  When a woman has pelvic or abdominal surgery,  such as a C-section or other gynecological surgeries,  the only visible scar is on the outside where the incisions may have been made, but  tissue also heals on the inside,  resulting in internal scarring.

The formation of internal pelvic adhesions is known to accompany any inflammatory process, whether it be internal trauma and bleeding (ruptured ovarian cysts or ruptured appendix), Endometriosis, or sexually transmitted infections such as Chlamydia, Gonorrhea, pelvic inflammatory disease (PID).  Pelvic spasms, bowel obstructions and chronic abdominal/pelvic pain can also lead to adhesions.

The most common cause of adhesions within the uterus is due to previous uterine surgeries such as D&Cs either for abortions, miscarriages, or excessive bleeding. In addition, adhesions may be related to child birth when there are uterine infections or bleeding associated from childbirth, or if a Cesarean Section is performed.

What is Manual Pelvic Physical Therapy?

Manual pelvic physical therapy is a gentle hands on approach, no surgery, no drugs, to improve motion, decrease restriction and improve organ function. Manual therapy techniques for Mechanical Infertility can include:

  1. Myofascial Release to decrease restricted muscles and fascia (the web-like covering that surrounds all organs, muscles and nerves of the body)
  2. Visceral Mobilization to improve organ mobility and function
  3. Pelvic lymphatic drainage to reduce pelvic congestion

Myofascial Release is a safe and effective hands-on technique that applies gentle sustaining pressure to the restricted connective tissue to eliminate pain and restore motion. The slow sustained, gentle pressure allows fascia to elongate.

Visceral mobilization technique is a gentle hands on technique to release tight ligaments and connective tissue which surrounds and supports the internal organs. Just as a therapist would mobilize the shoulder for someone who has lost motion  tight  ligaments that support the organs also need to be treated.

The lymphatic system helps our body detoxify, drain stagnant fluids, regenerate tissues, filter out toxins and maintains a healthy immune system. Pelvic lymph drainage helps to re-circulate body fluids, stimulates the immune system and promotes relaxation and balance in the autonomic nervous system.

Pregnancy Achieved

In 2012, Doctor Mary Ellen Kramp, DPT published her infertility case study in the Journal of American Osteopathic Association demonstrating that 6 out of 10 women diagnosed with mechanical infertility conceived and delivered their healthy babies at full term following  manual pelvic physical therapy. These women were found to have mechanical infertility due to lymphatic congestion, sacral dysfunction and restrictions in uterine mobility and were treated with a group of manual therapies Dr Kramp described as above and  termed  “The Infertility Protocol”.

At EMH Physical Therapy, we received training to treat Mechanical Infertility and can offer this service to women to  help them achieve pregnancy.

 

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.