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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 BOWEN

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.

 

If you have enjoyed this blog and would like to learn more about health and wellness from our team of expert practitioners, sign up for our mailing list or follow us on facebook and Instagram.

 

 

Osteopathic Relief for Infants and New Mothers

The first few weeks of motherhood are extremely demanding and involves an incredible amount of learning. Almost all care is transferred onto the baby as parents attempt to dissect each little squeak, leg jolt, and cry in hopes of understanding what their newborn needs. As the week’s progress in the postnatal period, a remarkable instinctual communication develops between newborns and their mothers. BUT what if, your newborn is inconsolable at times and is crying due to something beyond your control? The urgency to figure it out can generate pressure, self-criticism and eventually self-doubt amongst new mothers.

 

There is an insane amount of pressure on new mothers!  As a practicing birth doula, I acknowledge that the pressure on new mothers begins during the early stages of pregnancy. A common question like, “will you be delivering naturally?” might suggest to an expecting mother, that a delivery method other than a completely medication free, vaginal, home birth is subpar or not natural.

 

The presence and accessibility to social media, and constant exposure to the “ideal” pregnancy, delivery and motherhood make it difficult for mothers not to question or doubt their parenting skills. Pressure to provide the best care continues into the postnatal phase, such as the pressure to breast feed exclusively, that is, if you are lucky enough to produce enough milk, and have your baby latch…Let’s tack on more pressure and more judgment! I have witnessed new mothers feeling guilty for their inability to soothe their colicky newborn while attending my postnatal fitness class.

I have good news. Osteopathy, specifically cranial-sacral therapy, has been extremely effective at relieving and lessening the numerous symptoms that newborns display and cause tons of distress for parents. Osteopathy offers a non-invasive solution to empower and relieve newborns and their mothers! First:

 

What Is Osteopathy?
Osteopathic manual therapy is an alternative medicine, often recommended for the relief of musculoskeletal dysfunctions and pain management. However, the scope of practice extends to the treatment of respiratory and digestive issues, menstrual irregularities, migraines, headaches, insomnia, anxiety, depression and peripheral or local pain management. 

 

Osteopathy is a natural form of medicine which views the body as one interdependent and continuous system. Theoretically, osteopathy aims to restore normality and function throughout the entire body by determining the cause of imbalance and discomfort. The treatment itself involves a subtle, intuitive manual manipulation of bone and soft tissue within the bodies’ limitations. An Osteopath will use a light tactile pressure to find increased musculoskeletal tone and work to release any tensions with a very slight palpation.  


Osteopathy for Infants and Paediatrics

Currently trending amongst midwives and numerous health practitioners is cranial-sacral osteopathy for newborns and babies. It is now recommended that new mothers make a visit to their friendly osteopathic practitioner to assess and correct any strains or trauma the baby may have endured during birth. As babies make their exit, their heads must rotate, compress and narrow, this is referred to as “molding” of the soft baby cranium. In some cases, the re-inflation or un-molding process can be incomplete. A difficult birth, such as one which required forceps, vacuum delivery, an especially lengthy labor followed by emergency caesarean most commonly contribute to cranial compression and incomplete re-inflation. 

 

Many symptoms which are commonly observed in newborns, such as: inconsolable crying for hours at a time, clenched first, belly gurgling, poor sleep patterns, knees tucked, latching or feeding difficulties, discomfort with “tummy-time” may all be associated unresolved cranial compression. More specifically, the compression of the back of the skull, at the occiput can put too much pressure on the hypoglossal, glossopharyngeal and vagus nerves. All these cranial nerves help stimulate the tongue for latching. The vagus nerve alone is responsible sending motor and sensory stimulation the almost every organ in the body, especially the digestive organs.

 

Osteopathic intervention, specifically cranial-sacral therapy immediately following birth has been very beneficial for the relief of the following difficulties during infancy:

 

Gastroesophageal reflux (GER)
GER results in crying, vomiting and discomfort after eating. Primarily, reflux has been linked to the vagus nerve, as it relates to the opening and closing of the lower esophageal sphincter as it connects to the stomach. Gemelli, Ulbricht & Romaneli (2014), observed the cessation of all regurgitation and crying after feeding in four infants after they received Osteopathic treatment over a twenty-eight-day period.

 

Colic

Some common signs of colic include: flatulence, gurgling tummies, clenched fists and knees drawn into their chest. Osteopaths Hayden & Mullinger (2006) defined infant colic as at least 90 minutes of inconsolable crying over 24 hours on 5 out of the 7 days of the week! Inconsolable meaning: no holding, rocking, walking could soothe the infant.

After four weeks of cranial-sacral therapy 12 out of 14 infants no longer required treatment for colic symptoms and the remaining two displayed only mild colic like symptoms.

 

Plagiocephaly

The term “Plagiocephaly” refers to an asymmetrical cranium, more specifically Occipital Plagiocephaly, refers to the flattening of the Occipital bone, what you may think of as the back of your skull. Since the initiation of the “Back to Sleep” foundation in 1992, which encouraged placing newborns on their back for sleeping in order to prevent the occurrence of Sudden Infant Death Syndrome (SIDS), there has been an increasing prevalence of occipital flattening in newborns. Lessard, Gagnon, & Trottier (2011), reported a significant decrease in cranial asymmetries after a total of four Osteopathic interventions. In addition to Osteopathic intervention, you may want to encourage tummy-time, first to counter act the flattening of the back of the head, but also for the added benefit of postural and core muscle conditioning.

 

Let’s not forget that the theory of Osteopathy suggests that the body tends towards normality. Naturally, these resilient little bodies can resolve many of the issues on their own. However, Osteopathic treatment can help speed up this potentially long and uncomfortable process; enabling more space for a happy and healthy development! 

Florence Bowen

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.

 

If you have enjoyed this blog and would like to learn more about health and wellness from our team of expert practitioners, sign up for our mailing list or follow us on facebook and Instagram.

 

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.

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