RPM Physiotherapy

Category Archives: Low back pain

Demystifying Diastasis-Rectus Abdominus

The first year of mother-hood is accompanied by vast physical, hormonal and emotional changes. The female body undergoes remarkable transformation during pregnancy, the most obvious change being the growth of the abdomen, stretching to accommodate the growing fetus. In fact, studies show that during the third trimester around 70% of pregnant women develop a condition of over-stretched abdominal muscles (Boissonnault & Blaschak, 1988). This over-stretching is medically referred to as Diastasis-Rectus Abdominus (DRA) and occurs along the linea alba, the tendon that cuts through the middle of your “six-pack muscle.”


DRA is most commonly identified by measuring the space between the two inner edges of your rectus abdominus muscle (six-pack muscle). This is referred to as Inter-Recti Distance (IRD). In a clinical setting, finger widths are often used to measure this space. An IRD of two or more fingers widths is considered to be a DRA (Noble, 1982). However, IRD is not the only measurement to consider when diagnosing DRA. More recent studies have been focusing on the tension that one is able to generate along the abdominal wall and the linea alba. What that means is that the distance between your six-pack muscles is not the be all and end all. The ability of the abdomen to generate force, fully contract and maintain its structural integrity is more relevant than finger widths.



Identifying Diastasis-Rectus Abdominus


Let me be perfectly clear, DRA is a normal change that occurs during pregnancy. Your lower ribs will flare, the pelvis will broaden and your abdominal wall must expand to accommodate the watermelon-sized uterus underneath. It is the persistence of a DRA in the postnatal period which is not ideal. This is because the lack of abdominal tone, endurance or integrity can lead to dysfunctions elsewhere in the body. Many of the symptoms reported by women during their first year of mother hood can be explained by an underlying DRA. Some of these common symptoms include low back pain, pelvic area pain, stress urinary incontinence and urogynecological discomfort. Researchers Parker, Millar and Dugan (2009) found that 74% of women seeking care for low back and pelvic pain had a DRA. Multiple pregnancies very close together, previous abdominal surgeries and a mean maternal age greater than 34 years old have been shown to increase one’s risk of developing a DRA.


Currently, postpartum care consists of a six-week follow-up with a family physician. Granted there are no complications with delivery, surgical incisions or perineal sutures, the majority of women are cleared by their physicians at six weeks to resume all regular activity. Sperstad, Tennfjord, Hilde, Ellstrom-Engh and Bo (2016) observed a DRA present in 60% of the women at six weeks postpartum. Diastasis-Rectus Abdominus is often overlooked by physicians, although the awareness around the condition is growing, it is important for women to advocate for themselves and ensure they are getting the right care.


Steps to Core Restoration:

In the case of repairing Diastasis-Rectus Abdominus it is vital to strengthen the deep core muscles and to establish functional thoracic and pelvic floor mechanics. Diaphragmatic breathing and correct kegel work are important places to start for new moms looking to fix DRA. Following your six-week check up with your physician, I would recommend booking with a Pelvic Floor Physiotherapist. They will help you to restore all the muscles of the pelvis and pelvic floor, which are often significantly impacted by pregnancy and birth. It is well understood that the maximal contraction of the transversus abdominus muscle (your deep corset-like abdominal muscle) relies on the full contraction of the muscles of your pelvic floor. In other words, you can perform plenty of Rocky Balboa-style crunches (strongly NOT recommended) without actually engaging the right muscles because your pelvic floor has not fully recovered. Osteopathic manual therapy can offer additional relief and restoration by increasing the mobility of the thoracic spine, thoracic diaphragm and pelvis.  

Florence is due to begin her research on “The effects of global osteopathic treatment on diastasis-rectus abdominus in postnatal women” in the fall. If you are interested in participating in her research or learning more, please contact her via e-mail at: Florence@rpmstudio.ca



Florence was first introduced to alternative therapeutic modalities in her teens, as a dancer and competitive athlete. After high school, Florence furthered her dance training and obtained her Honors Bachelor of Science in Kinesiology from McMaster University. Teaming up with the artistic director of the McMaster University contemporary dance company, she developed introductory dance classes for children and teens across Hamilton. Inspired to further her teaching skill-set, she obtained her yoga teacher certification in Hatha yoga. Florence teaches across the city and combines her knowledge of human kinetics, dance, strength and conditioning, and yoga. Teaching movement to pre and postnatal women, and coaching as a birth doula, she gained a unique perspective into the supportive systems available to new and expecting mothers. Florence has an affinity for the holistic approach to women’s care. She is passionate about the assimilation of progressive knowledge to educate and empower women at any stage of life including: pre-conception, pregnancy and recovery after birth. Most recently, Florence completed her five years of study at the Canadian College of Osteopathy in Toronto. As a manual therapist, she believes in having her patients actively participate in their healing. She currently is working to complete her thesis which will examine how osteopathic treatment effects diastasis-recti abdominus in postnatal women.


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Avoiding Shoulder Injury This Tennis Season

Let’s do some quick math to start:


(past history of sport) + (current desk jockey career) + (public tennis courts) + (the human ability to ‘over-do’ it) = ????


Though this math seems a bit unorthodox, I’m sure you can extrapolate from the title that this can result in injury. Shoulder injuries, in particular, are common in overhead sports such as tennis, swimming, and baseball. When looking closely at the overhead serve in tennis, there is great complexity to it with involvement from your ENTIRE body. If one or more areas are lacking in strength or technique, often times we will see an increase in arm speed to maintain power with a resultant increased risk for shoulder injuries (among others… but lets focus here today).


Here are six tips to help keep you on the court this season:

Proper warm-up → we all know we need to do it, so just do it! This should be a full body warm-up and can include activity while NOT holding onto a tennis racket. When you are hitting balls, ensure you are using your legs and core to generate power and to progressively increase your racket speed. Don’t start your warm-up with big serves.

Build up your weekly tennis frequency → It’s great that you are active, but most people can’t go from zero days a week to multiple days a week of tennis without feeling sore or setting themselves up for future injury (consider tips 4 and 5 for options to stay active in the early season). On top of this, give yourself intermittent breaks to recover during the match to reduce the amount of time you play fatigued.  

Opt for ball placement over power → I’m definitely better at watching tennis than playing, and what I’ve learned is that a higher first serve percentage typically equates to winning the match. Bring down your serve speed, work on your ball placement, and save your shoulder.

Cross-training → This is a must, and there are a LOT of options. If I am being picky, I would suggest reducing the amount of prolonged gripping and overhead motion in your cross-training program. As a starting point, consider cycling and body weight exercises as a way to maintain aerobic endurance and strength.

Sport-specific training → This type of training is more relevant to the advanced tennis athlete, and where complexity of programming really takes shape. An example is provided here:


This exercise may look simple, but subtle errors in exercise technique will also appear when performing the tennis swing and serve. Add repetition with poor technique and this is where shoulder injuries flourish. Careers are spent building and implementing these programs, so I strongly advise a consultation with a physiotherapist or strength and conditioning specialist if you would like to explore this type of training

Consider taking a few tennis lessons → Humans are like cars. You need to change the oil, replace a few filters here and there, and even upgrade the sound system; I’ll let you decide what the tennis equivalents are to those.  Allow a critical eye to observe your game, fine-tune your swing, and help reduce your injury risk.


That’s it! I hope you are able to implement some of the tips above and keep yourself playing tennis throughout the season. If you have concerns regarding your swing, injury, or pains affecting your tennis game, coming in for a detailed biomechanical assessment will bring you one step closer to avoiding injury and improving your body’s tolerance of the sport. Highlighting and resolving biomechanical and strength deficits is something that can’t be done by reading this blog, so please use our expertise appropriately.



  1. FifthSet International. 2012, Nov 21. Prepping like a Pro: Core Training for Tennis Players. Retrieved from https://www.youtube.com/watch?v=iuvFgyHILyY



Jordan is a graduate of the University of Toronto Physiotherapy program and has since been practicing in orthopaedic settings. He has developed an interest in sports physiotherapy through his many years as an athlete, participating in baseball, golf, snowboarding, and more recently rock-climbing, cycling, and strength training.  He is dedicated to improving mobility, optimizing function, and strengthening to help achieve your goals through the use of manual therapy and individualized exercise prescription. He also has additional training in acupuncture and sports taping.


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Pain Down There?

So you have pain down there, and like many people, you don’t know what to do about it. Many women ignore their pelvic pain for reasons such as – they are embarrassed, they hope it will go away or they think it’s normal to have pain (especially after having

Pelvic pain is NOT normal and should be assessed by a professional.

Pelvic pain may be associated with or caused by one of the following:

  • A long or complicated labour, C-section scars or episiotomies
  • Dyspareunia (pain with sex)
  • Dysmennorhea (painful periods)
  • Pudendal Nerve Irritation
  • Sacroiliac Joint Dysunfction
  • Interstitial Cystitis
  • Vaginismus
  • Vulvodynia
  • Endometriosis
  • Polycystic Ovary Syndrome

If you think you might have one of the conditions above, you most likely have high tone (or tightness) in your pelvic floor. Other than pain, pelvic hypertonicity may cause symptoms such as:

  • Incontinence
  • Urinary or fecal urgency, incomplete voiding or hesitancy
  • Constipation or straining with bowel movements
  • Unexplained pain in your low back, hips or groin

And much more…

So what should you do? First of all, STOP doing your kegels! Many people think that they can resolve their pelvic issue by strengthening their pelvic floor. Other than the fact that you’re probably not doing them properly, kegels can actually make matters worse. A tight pelvic floor requires relaxation and lengthening first in order to prepare the muscles for strengthening later on – and we can help with that! Make an appointment with a pelvic health physiotherapist for a full assessment and a
start on the road to pelvic recovery!

Sandra Ghaly – Pelvic Floor & Paediatric Physiotherapist

Sandra graduated from Dalhousie University with a Masters degree in Physiotherapy after completing her Bachelor of Kinesiology degree with honours from McMaster University. She has worked with a variety of clientele but has developed a true passion in working with both the paediatric and women’s health populations. Sandra has extensive experience assessing and treating a variety of paediatric conditions and most recently has become certified as a pelvic health physiotherapist. She also has additional training in acupuncture and kinesiotaping. Sandra finds great value in guiding each individual through a tailored rehabilitation program to optimize their function and quality of life.

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Photo Credit: Emily D Photography

Headshot Photo Credit: Phillipa C Photography


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