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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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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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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.

 

 

SHOULDER PAIN SUCCESSFULLY TREATED WITH PHYSICAL THERAPY

Have you ever injured your shoulder? There are many diagnoses that your doctor can give you and some of the terminology they use can be confusing or even scary!  For example, “rotator cuff strain”, “subacromial impingement”,” bursitis”,” labral tear” and” shoulder osteoarthritis” are some of the most common names, but what do they mean and how can your shoulder become painfree with physical therapy?

Most shoulder diagnoses are very specific to the actual structure or tissue that is injured in the shoulder complex.   As physical therapists, our job is concerned not only with what structures are injured but HOW you injured your shoulder so we can teach you to heal and protect your shoulder.  Did you play tennis for a number or years?  Do you lift weights at the gym?  Did you slip and fall on an outstretched hand?

None of the above?  A poor ergonomic  work place or performing repetitive, incorrect movements at work/home and even some incorrect sleeping positions could throw off a very delicate system of muscles and nerves that control the mobility and stability of one’s shoulder.

Your doctor has probably mentioned the importance of the rotator cuff, a group of 4 muscles:  the supraspinatus, subscapularis, infraspinatus and teres minor that very closely surround the ball and socket  of the shoulder joint.  Studies have shown that these muscles contract together in a “presetting phase” which begins before any movement of the actual shoulder occurs to enhance the joint’s stability.  Without proper flexibility and strength of these small but important muscles, the “presetting phase” is altered or delayed and the bigger muscle groups such as the chest muscles, biceps and trapezius take over causing altered muscle patterns and joint mechanics which can lead to many shoulder injuries

Physical therapists (PT’s) are trained to palpate all the muscles of the shoulder  for tenderness or myofascial restrictions and can test the flexibility, strength of each muscle so we can create an treatment plan for you.    At EMH Physical Therapy we perform manual therapies to your neck, shoulder, upper back and arms; we teach an individuallized stretching and strengthening program and we  incorporate neuromuscular re-education techniques to help you return to optimum shoulder health.  Your posture and/or mechanics of your sporting activity are also evaluated and corrected to ensure you do not go back to old habits once your pain is eliminated.   By following our guidelines, most patients with shoulder injuries can return to full painfree function!