RPM Physiotherapy

Tag Archives: Abdominal Health

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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Fertility Issues, Digestive Trouble or Pelvic Pain? Try Abdominal Massage.

The beauty of working with talented practitioners on the cutting edge of their fields is that I get to learn something everyday. Most recently, our RMT Heather Heaney, introduced me to abdominal massage, something I had never thought about before when considering massage therapy. As Heather explained, this powerful form of massage can have a significant impact on fertility, digestion and surgical recovery.

The abdomen is a critical part of the body. It houses many of vital organs including our reproductive and digestive systems. Abdominal massage helps stimulate blood flow to the vital organs in the abdominal cavity and improves their function. It can also help with scar tissue as well toning and strengthening the muscles in the abdomen.

Abdominal scar tissue can be found on the skin’s surface as well as in the deep tissue. It can be the result of surgery, injury or repetitive strain. Scar tissue adheres to the muscle fibres and can bind multiple layers of muscle and connective tissue. This prevents the muscle fibres from sliding back forth causing varying degrees of limited movement and pain. Adhesions can interfere with peristalsis (the movement of food through the digestive system), the ovaries, uterine tubes and other structures.

Research has proven that scar tissue can be weaker, have less elastic properties and be prone to future re-injury. It is also 1000 times more pain sensitive than normal tissue. Unresolved scar tissue can also lead to problems with fertility or chronic pelvic pain.

Abdominal massage can help alleviate some of these symptoms.



What should you expect from a treatment:


Initial assessments are 90 minutes in length. This allows Heather to take a full history as well as do a thorough examination of your abdominal tissue. It also leaves plenty of time for an effective massage. To properly treat the abdomen, follow up treatments have been set at 60 minutes.


Who is not appropriate for abdominal massage?

Unfortunately not every treatment is for everyone. You should avoid abdominal massage if you:

  • Pregnant
  • Currently menstruating
  • Wear an IUD
  • Have had recent abdominal or pelvic surgery and have not yet been cleared
  • Have an abdominal infection including a bladder infection


When do we offer abdominal massage?

Abdominal massage is a specialized technique offered only by Heather Heaney. Heather sees clients on Monday afternoon and evenings.


Appointments can be booked online or by calling (416) 572-0479. Questions can be directed to Heather at heather@rpmstudio.ca.

How to Improve Gut Inflammation and Bloating Using Castor Oil

Did you know that your organs can cause bloating, back pain, inflammation and so much more. It is important to take care of our abdomens and that means our organs too! We all know our diet affects our gut but the real question is what else can you do to reduce inflammation?

1. Start with diet changes and try to eat green with every meal.
2. Use a castor oil pack placed over your abdomen to help reduce gut inflammation.
3. Keep moving! Movement is health so get outside and go for a walk, hit the gym, attend a fitness class, or yoga.

If that is not enough try manual therapy to promote organ health. Manual techniques for your small intestine, liver and colon can help to reduce gut inflammation, increase energy levels and promote healthy bowel movements.

What is a Castor Oil Pack?

Castor oil helps to promote detoxification, improve hormonal balance, increase circulation, improve the function of our digestive system, and to decrease inflammation. To make a castor oil pack all you need is: castor oil, a hot water bottle and a piece of unbleached flannel (ideal).  Take the castor oil and pour a small amount of oil onto the unbleached flannel, place the unbleached flannel with the castor oil on your abdomen and the hot water bottle on top. Relax for 30 minutes to an hour and enjoy the anti-inflammatory benefits of castor oil pack!

Oja organic castor oil and compresses are now available for resale through the clinic. Ask your practitioner about the use of castor oil today.


Leah Henderson

Registered Kinesiologist / Osteopathy Candidate

Leah is a registered kinesiologist and fourth year Osteopathy Candidate. She a natural medicine practitioner and believes the body has a tremendous ability to heal itself. She uses her manual practice to help patients restore tissue mobility, position and vitality. She is a graduate of McMaster University’s kinesiology program and former varsity soccer athlete who is focused not only on short term health but also on long term recovery. She understands that people play an active role in their recovery and recognizes the benefits of both aerobic and resistance training. She has a keen interest in cranial health due to her many concussions received through sport. However, with her second degree in Gerontology she also understands the aging population. In her spare time you can find Leah spending time with friends, enjoying the outdoors or being active. She loves, to run, climb, cycle, ski or play any sport! She is a certified spin instructor and challenge course practitioner and she is committed to healthy active living!

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