Piriformis as an internal rotator?

I’d like to hear from you.  What’s your take on this?

Why is it that we can stretch piriformis by externally rotating the leg as we bring the knee toward the opposite shoulder?  Or in yoga pigeon pose?

Piriformis. The piriformis muscle is a deep muscle located beneath the gluteal (butt) muscles. The piriformis muscle laterally rotates and stabilizes the hip. This muscle is important for athletes who participate in running sports that require sudden changes of direction. The piriformis works along with other hip rotators to turn the hips and upper leg outward (external rotation of the hip). Strong and flexible hip rotators keep hip and knee joints properly aligned during activity and help prevent sudden twisting of the knee during quick side-to-side movements, quick turns, lunges or squats.

Anterior Hip Capsule Release

Free the Hips (fig. 1)

Prolonged sitting, hip flexor tightness, overuse and misuse can all cause hip problems.  Often when the “soft tissue” i.e., muscle, becomes tight the deeper layers of the connective tissue surrounding a joint will become short, stuck and glued down.  The hip capsule is unique in that it has a sort of rotatory arrangement of its fibers.

One commonly seen pathology, is the head of the femur (ball) becoming fixated into the posterior portion of the acetabulum (socket).  A pain generator to be sure, as the bone grinds on the inside of the joint space.    This may occur as a result of a dropped arch, internally rotated leg, and rotation of the femur.

One way to address the issue at the hip, is to position yourself or client/patient as shown in (fig.1).  This external rotation of the femur causes the head of the femur to migrate into external rotation, stretching the iliofemoral lig., which attaches the hip to the thigh and visa versa.    (The one that gets all glued up during bouts of great hip flexion and approximation of muscular origin-insertion.)  If you are a therapist using this technique position hands just inferior to greater trochanter.  Gravity will help those who help themselves.  To add an enhancer to this position, you may try pelvic tilts…tuck the tail bone under and back out.  Some people may feel a bit strange about this enhancer so I recommend pushing the knee into the floor for a count of 6-8 seconds, release and repeat 3-5 times.   You may also feel a bit of increase in ROM in adductors, sometimes that feels great.  DO NOT use this technique if you have to great a range of motion already.  In my opinion loose joints are more dangerous than tight joints.  Enjoy!

For more info or to book a session with Geoffrey Bishop, LMT in Flagstaff, AZ…call 928-699-1999.  e mail at staytunedaz@gmail.com

Winter Aches and Pains, Pt.1

Winter is upon us.  With the changing of the seasons there come change in the body.  A variety of muscles, that may have been in some state of hibernation, are called upon to get us through the new conditions, when the air gets cold, the snow falls and the stressors of the holidays build.  Without proper preparation and awareness, it may be easy to become fatigued and possibly injured.  Let’s discuss a few of the common concerns we see at Stay Tuned Therapeutics.

Leg, Groin and Pubic Bone pain.

Weakness or tightness in the adductor muscle group of the thigh may play a major role in the development of groin “pulls”, SI joint dysfunction, pubic bone pain, medial knee pain, etc.  Stabilizing the legs under our body in the slick conditions after a new snow fall is one of the responsibilities of the adductors.

The attachments (origin) coming from the periosteum of the pubic and ischium bones of the pelvis are common locations of strain.  Commonly noted in athletics where there is a forceful abduction during an internal rotation and adduction movement, such as soccer, we can imagine the reverse to be true as well when slipping on unstable surface such as ice. Hip adductor injuries occur most commonly when there is a forced push-off (side-to-side motion). High forces occur in the adductor tendons when the athlete must shift direction suddenly in the opposite direction. As a result, the adductor muscles contract to generate opposing forces.  We have all taken a bit of a slip, during running, walking to the car, lift line etc., leg shoots out, and we suddenly contract our adductors forcefully to bring the leg back under us.  This opposing action is a major cause for injury.

In the next entry we will look at, strength, flexibility and balance, in an attempt to prevent hip/groin injury in the winter season.  Also, we will also look at other common injuries and stressors as the holidays grow near.  Stay Tuned.

Maintenance Techniques for twitter-finger.

Having been a massage therapist for 13 years now I have never had an injury to my arms, wrists or hands.  You can use these simple exercises to ensure a long life in whatever job you have that requires extensive use of the hands and forearms.

Take computing for instance, there is no other way you found this information, how many hours a day do you spend on the keyboard, the mouse, or just hunched over in that nice chair?  Now, how many minutes a day do you spend providing regeneration to the injured/over used tissue.  Now, what is your plan for pain free longevity in this position you so love?

You may be the type of person who just prefers having a massage to treat aches and pains, great, I’ll take your money.  However, do you realize that hard earned money you invest in therapy will go so much further if you take some responsibility?

Take 5 minutes and follow me through on these exercises, if you need a band contact me and you can stop by, or I will ship one.

Stay Tuned…

Women Need Expanded Musculoskeletal Care During Pregnancy

Stay Tuned Therapeutics offers musculoskeletal work for pregnancy in Flagstaff, Arizona.  Here’s why…

ScienceDaily (Mar. 12, 2007) — Despite the high prevalence of musculoskeletal pain during pregnancy, few women in under-served populations receive treatment for their low back pain, according to a February 2007 study in the Journal of Manipulative and Physiological Therapeutics (JMPT).  Moreover, researchers found that pain in a previous pregnancy may predict a high risk for musculoskeletal complaints in future pregnancies.

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According to Clayton Skaggs, DC, the study’s chief author, 85 percent of women surveyed reported that they had not received treatment for their musculoskeletal pain, and of the small percentage who perceived that their back complaints were addressed, less than 10 percent were satisfied with the symptom relief they obtained.

“Based on the findings of this study, doctors of chiropractic and other health care professionals need to expand the musculoskeletal care available during pregnancy, especially in underserved populations,” Dr. Skaggs said.  “As a proactive step, health professionals should consider including back pain screening as part of early obstetrical care to help identify musculoskeletal risk factors and allow for early education and/or treatment.”

Researchers surveyed more than 600 women at a clinic that serves predominantly an uninsured, underinsured or Medicaid-insured population.  Surveys were offered to all obstetrical patients and were designed to collect information about pregnancy-related pain and quality of life issues.  Of those women who responded to the survey, two-thirds reported back pain and nearly half of all women reported pain at two or more locations, including pelvic pain and mid-back pain.

The study findings suggest that pregnant women with back pain are predisposed to sleep disturbances.  In the survey, close to 80 percent of women reporting sleep disturbances had back pain, whereas only 8 percent of women without pain reported problems sleeping.  More alarming was the significant relationship between reports of musculoskeletal pain and the use of pain medication.  Three-fourths of the women who reported pain also described use of pain medication.

“We saw a direct association between sleep deficiency and back pain,” the authors said.  “These results raise the question of whether or not the high incidence of pain medication use reflects a lack of education about potential risks of medications or more an inability for the pregnant women to cope with the pain.”

The study’s authors also found a relationship between pain in a previous pregnancy and pain in the current pregnancy.  Similar to the results of other studies, researchers found that 85 percent of women who experienced pain in a previous pregnancy reported pain during their current pregnancy.

The study was the result of on-going collaboration between Logan College of Chiropractic and the Department of Obstetrics at Washington University School of Medicine.

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Adapted from materials provided by American Chiropractic Association.

American Chiropractic Association (2007, March 12). Women Need Expanded Musculoskeletal Care During Pregnancy. ScienceDaily. Retrieved September 29, 2009, from http://www.sciencedaily.com­ /releases/2007/03/070307075536.htm

7th Interdisciplinary World Congress on Low Back & Pelvic Pain

I will be going to the 7th Interdisciplinary World Congress on Low Back & Pelvic Pain.

We would like to invite you to join us for the 7th Interdisciplinary World Congress on Low Back & Pelvic Pain, to be held in November 2010 in Los Angeles, U.S.A. This program is held every three years. All the disciplines involved in the treatment and research of musculoskeletal disorders around the globe come together in a stimulating meeting related to musculoskeletal disorders. Those of you who attended the last meeting in Barcelona will need no further encouragement to attend what promises to be another great congress. This is a great opportunity to meet and talk with members of diverse disciplines from all around the world.

Scientific sessions are already being planned and the quality of the speakers will be excellent. In addition we will offer you a relaxed atmosphere to meet, chat and have fun.

We hope you will all be able to join us.

Yours sincerely,

Dr. Andry Vleeming

Dr Vert Moony

Dr Colleen Fitzgerald

Scientific Committee
Andry Vleeming, Vert Mooney, Colleen Fitzgerald, Jaap van Dieen, Maurits van Tulder, Robert Schleip, Leon Chaitow, Mel Cusi, Paul Chek, Diane Lee, Paul Hodges, Peter O’Sullivan, Paul Watson.

What is Myoskeletal Alignment Techniques?

From Erik Dalton, PhD, founder of Freedom From Pain Institute, creator of Myoskeletal Alignment Techniques.

What makes MAT Special?

Well-documented theories explain how joints become fixated from myofascial stressors; yet relatively unknown in the massage therapy community is how joint dysfunction creates protective muscle spasm and dysfunctional strain patterns, such as forward head postures, slumped shoulders and scoliosis. This reflexogenic relationship between muscles and joints is the foundation of the Myoskeletal Alignment Technique and is considered not only uniquely different from traditional thinking, but possibly an important next step in addressing abnormal strain patterns caused by muscle/joint imbalances.

Massage therapists can now safely address all soft tissues, including ligaments, nerve dura, fasciae, discs and joint capsules, responsible for much of the pain previously blamed on muscles alone. Osteopathic methods, such as muscle energy, strain-counter strain and mechanical link, are also designed to relieve muscle/joint dysfunctions, but the MAT method complements today’s bodywork practices as it was specifically designed to fit a massage-therapy format.

One distinguishing goal that establishes the MAT method apart from other techniques is its dependence on identification and correction of joint fixations. This is accomplished by systematically releasing deep spinal muscles, ligaments and fibrotic joint capsules that torsion and compress spinal joints. In some cases, a bodyworker may apply direct pressure to bones to release fibrotic muscles that create joint blockages, but the intent is always soft-tissue work.

Posture’s Roll

Most manual therapists today agree that no therapeutic approach to neck/back pain is complete unless body posture is generally improved. Whatever the root of the client’s condition, special attention must be dedicated to posture-especially the correct positioning of the pelvis. Many therapists complain that postural assessments are often too complex, too time-consuming, too clumsy-in a typical massage setting with the client draped.

The MAT method lessens assessment anxiety with an efficient five-minute hands-on evaluation that quickly identifies gross body asymmetries, such as pelvic tilts, short legs, sacroiliac dysfunctions, scoliosis, facet restrictions and hip-capsule adhesions. MAT also incorporates Vladimir Janda, M.D.’s upper-and-lower crossed visual assessment method for easy recognition of muscle-imbalance patterns that cause neck and low-back pain. Combining these hands-on and visual assessment techniques allows the therapist to immediately tell which muscles are tight and pulling unevenly on the body’s bony framework, and which weak muscles are permitting the asymmetry. Janda’s muscle-imbalance research has gifted bodywork practitioners with a remarkably useful model for explaining how predictable muscle imbalances cause predictable faulty postural patterns, such as slumped shoulders, forward heads, swaybacks and dowager’s hump. (Hands on procedures using Janda’s formula are detailed in Part II of this series.)

Ultimately, for long-lasting relief of chronic neck/back pain, the MAT system works to achieve these goals:

balancing the head on the neck

balancing the neck on the shoulders

balancing the shoulder girdle on the rib cage

balancing the pelvis on the femurs

restoring pain-free movement

Recent studies have confirmed a noticeable reduction in noxious neural input entering the spinal cord and brain when the postural goals listed above are met. In 1979, biomechanical researcher J. Gordon Zink, D.O., coined the term “common compensatory patterns” to describe routinely found postural patterns in the neuromyofascial-skeletal system. His studies were the first to validate how structure and function play a dual role in posturally initiated pain syndromes. Eventually, he concluded that postural muscle stress leads to chronic, recurrent central nervous system irritation initiated by sensory receptors, such as mechanoreceptors, nociceptors and chemoreceptors.

Postural muscles are structurally designed to resist fatigue and function in the presence of prolonged gravitational exposure. If their capacity to resist stress is lost, the postural muscles become irritable, tight and shortened. Fortunately, as balance and function are re-established in distorted myofascial structures, hyperactivity in agitated joint and muscle receptors rapidly dissipates. Zink’s conclusion leads to the underpinnings of the client’s outcome: less sympathetic muscle spasm, less limbic system activation, less stress-and less pain.

No Pain, No Gain?

I copied this article to my blog because it raises some interesting points about pain. Not all are entirely agreeable to me, but it is thought provoking.

‘Pain is inevitable, but suffering is optional.’ So goes a well-known but anonymous quote. For many athletes, pain is a normal everyday experience and success is often achieved in spite of pain. But what’s the best strategy for coping with and overcoming pain and how can athletes distinguish between benign and potentially damaging pain? Matt Lancaster looks at the latest evidence

Pain is synonymous with sport. Endurance athletes relish the challenge of ‘pushing through pain’ while boxers expect to fight on regardless of a jarring blow to the chin. Adulation is reserved not just for the star rugby player, but anyone who can play through pain and contribute to the team. Winners and heroes overcome pain. Losers don’t.

But the price of pain can be high. Pain both demands attention and creates fear(1). It can restrict the ability to concentrate on performance and take away the opportunity to compete. Pain can even end sporting careers. The relationship between pain and sport is filled with challenges for sportsmen and women as well as those who support them. However, although pain of some description is no stranger to most athletes, it’s still a curious phenomenon in many ways. For example, consider the following questions:

* How are some people able to shrug off a painful injury?
* How can two athletes with the same injury experience different pain?
* Why do some pains seem to last ‘forever’?
* Why can some people compete, seemingly regardless of pain, while others struggle to overcome even a minor niggle?

This article will explore these questions, offering practical advice about when it is appropriate to perform in the presence of pain, when you should consult a professional, and how to best approach pain in a sporting environment.

The diagnostic dilemma

If you tear your hamstring muscle or sprain an ankle it hurts – obviously. Since the 17th century, the medical and scientific world has sought to diagnose pain by identifying the particular tissue that has been injured. For example, the philosopher René Descartes proposed that a pure pain sensation is transmitted from the damaged body to an entirely separate organ, the mind, just as… pulling on one end of a rope…makes to strike at the same instant a bell which hangs at the end(2,3). Descartes separated the body from the brain, and even today it is usual for people to make a distinction between physical pain and mental pain(3,4).This is especially the case in sport.

However, there are some problems with this classical view of diagnosis. For instance, an extensive network of nerves supplies the various tissues in your back, making them potential sources of pain when injured(5). It follows that if you can identify the damaged spinal tissue, for instance using magnetic resonance imaging (MRI), it should be possible to explain the pain.

The problem is that while MRI findings of severe damage to the discs or nerves is associated with the experience of pain, studies have failed to demonstrate a clear relationship between the majority of tissue damage observed on MRI and the patient’s pain(6). What’s more, almost 40% of people who have no history of back pain have abnormal, damaged spines at more than one spinal level when scanned using MRI(7)! Likewise, the damage shown by ultrasound investigations of athletes with painful patella tendons (jumper’s knee) does not necessarily correspond directly to the degree of pain experienced by the athlete(8).

This doesn’t mean that identifying the injured structure is not important or that it isn’t crucially involved in your pain. But looking to tissue damage alone (which is both frequent and often quite subtle in sporting injuries) to explain the relationship between pain and sporting performance is probably not sufficient.

A painful process

Another theory, first proposed in 1965, suggested that far from acting like an old-fashioned telephone exchange, your brain and spinal cord can actually increase or inhibit the transmission of pain signals(9). Gate control theory was revolutionary because it proposed a mechanism for the brain to have a modulating influence on the generation of all pains, and not just mental pain(10). While the original theory has been modified and expanded, it has essentially stood the test of time and been supported by 40 years of scientific research(11).

If you listen to the language people use to describe their pain, it soon becomes apparent that pain is quite simply pain, and is not separated into physical or mental compartments. All pain invokes not just a pure sensory response, but a range of thoughts and emotions also(3,12) and pain emerges from the integrated, combined action of the pain system(2,3). Simplistically, this system can be viewed as three separate parts of the nervous system, all of which modulate pain.

How do some people shrug off a painful injury?

Remember that following an acute injury, such as an ankle sprain, pain receptors are first stimulated by the mechanical stress and strain placed upon the tissue. ‘Inflammatory soup’ soon floods the tissue leading to peripheral sensitisation. Several hours later, similar chemicals will also lead to spinal modulation(19). Pain and sensitivity to movement and pressure increase over a period of a few hours; the time between the transition from the original mechanical pain (which may pass) to the maximum sensitised state may provide athletes with a ‘window of opportunity’ to shrug off their pain and continue competing.

However, this mechanism is probably only the tip of the iceberg. When you are totally focused on your opponent, or consumed by the contest, supraspinal and spinal modulation may act to inhibit the transmission or limit the awareness of the pain signal(18). We’ve all heard stories of sportsmen and women who have continued despite an injury which (theoretically) should have caused them to stop: a boxer with a broken hand, rugby players with torn ligaments, a long jumper with a strained hamstring etc. In the cut and thrust of competition, the pain system can ‘shut the gate’, and athletes are able to continue in spite of injured tissue(18). However, once your attention is drawn back to the acute pain (particularly following competition), awareness of the pain becomes strong again, especially if this also coincides with an increase in peripheral and spinal modulation.

So, should you ignore pain and try to shrug off an injury? Acute sensitisation is a normal, helpful process to encourage you to stop using the injured tissue and avoid further damage(20). It might be helpful to ask yourself the three questions in the box below.

There are a few other questions, which are perhaps even more important. We’ll get to these later. But remember, acute pain usually occurs for a good reason. It makes sense to seek professional advice as soon as you can. Sometimes people can overcome acute pain and continue to compete, but that doesn’t necessarily make it a wise decision!

How can two athletes with the same injury experience different pain?

Studies have confirmed that people respond differently to similar levels of painful stimulation(19). Differences exist not just in our individual sensitivity to a painful stimulus, but also in our perception of pain and how we display it. Pain is individual, even when the stimulus is not, but while we cannot know exactly what someone else is experiencing, our brains undergo quite similar activity when confronted with someone else’s pain(21). This is the basis for empathy and acknowledging someone’s pain is normal and important.

Our individual sensitivity to pain is in part explained by our genetic makeup (22-24), while studies involving twins have shown that learned behaviours are also important (25). Again, the division of pain into real and mental is unhelpful and the variation in pain between two athletes with the same injury lies at all levels of the pain system. Even for the same athlete, pain sensitivity varies under different circumstances, and perhaps not surprisingly, can become significantly less during competition(26).

It’s also worth noting that different groups in society may have significantly different pain responses, and this applies within sport. A study performed 40 years ago demonstrated that contact sport athletes could tolerate experimental acute pain for longer than non-contact athletes, while both groups could tolerate more acute pain than non-athletes(26).

Pain sensitivity may also be different in different people at different times; the way athletes display that they are in pain can vary, both between individuals and also between groups of athletes from different sports. It might be an extreme example, but imagine a footballer who could potentially be rewarded with a penalty responding to the pain from a kick in the shin. Now, assuming the tissue damage is equivalent, think about the same incident involving a Thai kick boxer who is in the middle of a title fight. Get the idea?!

Why do some pains seem to last forever?

During ongoing or chronic pain, adaptive changes at all levels of the pain system often outlast their usefulness in helping us protect injured tissues. Movements and pressures that would otherwise be normal continue to cause pain long after the risk of further injury has passed and often even once the tissue has essentially healed.

Examining possible tissue damage remains important when considering ongoing or recurrent pains, but a broader approach is required to address an athlete’s fear and anxiety about their ongoing pain and help them return to their sport. Focusing too much attention on pain can actually increase pain(18). It is probably more helpful to concentrate on working hard to strengthen the tissues at a sensible rate, regain normal fitness and aim to return to training.

Providing an appropriate environment for people to overcome ongoing pain is important and not always easy in sport. Coaches or team-mates who are angry at or ignore athletes with ongoing pain may contribute further to those athletes avoiding the very things that will help them return to full activity (such as a rehabilitation programme), and generate further anxiety that doesn’t help either(27). Getting this balance right and remaining positive is therefore important. People who develop an exaggerated, negative mindset towards their ongoing pain have been shown to experience both increased pain and emotional distress(28). Pain is a normal part of sport but the right mental approach can prevent it from becoming a catastrophe.

Does this mean it is OK to ignore ongoing pain? Well, it’s not quite that simple. Once again consider the three Cs. Any pain that has been present for more than a week or so, or keeps returning periodically is worth getting checked out by a professional who can not only assess for tissue damage but can also understand your pain and hopefully point you in the right direction before the maladaptive changes to your nervous system become entrenched.

Why are some people able to compete, seemingly regardless of pain, while others struggle to overcome even a minor niggle?

Although pain (especially acute pain) is related to tissue damage, this damage alone is not sufficient to explain pain fully. Pain is not just a sensation but results from the interaction between sensory inputs and brain processes, such as emotion and conscious thought. And pain is individual, not just to you as an athlete, but also to the time, circumstance and environment you find yourself in. Within the mechanics of the pain system, individual variation and modulation occur subconsciously, which helps to answer this question.

To ultimately address the relationship between pain and sport however, it is necessary to consider one further aspect of pain: your own ‘personal values’. We’ve already considered the three Cs as a guide to considering how to act in the presence of pain; however, as anyone involved with sport knows, making decisions about athletes in pain is often a judgement call. The three C questions only have meaning if we add a further, more personal line of questioning:

* Am I prepared to cope?
* How important is contributing a worthwhile performance to me?
* Am I prepared to suffer the consequences?

Having a pain killing injection two days before an Olympic final, regardless of the risks, would seem quite a reasonable thing to do for most elite athletes if it was the only way they were able to compete. Under similar circumstances, few casual joggers would agree to the same injection just days before a fun run. Entering a boxing ring, running 100 miles a week or crashing into a rugby scrum is not for everyone. Some people can continually and repeatedly overcome pain for the sake of their sport because they are prepared to. Sometimes they are rewarded with success, and sometimes, despite their desire to cope and contribute, their body succumbs to the consequences. Winners and heroes overcome pain sometimes. Losers often try and fail. Perhaps the most successful sports people are those who best understand the relationship between pain and performance: they are prepared to overcome pain, but make wise, informed decisions about when it is worthwhile trying to do so.

This post was copied from www.pponline.co.uk

References
1. Pain 2005; 113:235-240
2. J Bone Joint Surgery 2006; 88-A:58-62
3. Pain: The Science of Suffering (Columbia University) 2000; 17-31
4. Pain 2005; 113:238
5. Clinical Anatomy of the Lumbar Spine (Churchill Livingstone) 2002; 187-214
6. Phys Ther 1998; 78(7):738-753
7. N Eng J Med 1994; 331(2):69-73
8. J Ultrasound in Medicine 2000; 19(7):473-479
9. Science 1965; 150:0071-9
10. J Electromyography and Kinesilogy 2004; 14:109-120
11. B J Anaesthesia 2002; 88(6):755-757
12. Anesthesiology 2005; 103(1):199-202
13. Swiss Med Weekly 2002; 132:273-278
14. Acta Orthopaedica Belgica 1998; 64(4)
15. Acta Anaesthesiol Scand 2001; 45:1121-1127
16. Can J Anesth 2002; 49(6):R1-R5
17. Annu Rev Neurosci 2003; 26:1-30
18. Brain 2003; 126:1079-1091
19. Trends in Pharmacological Sciences 2005; 26(3):125-130
20. Topical Issues in Pain 1 (CNS Press) 1998; 45-57
21. Pain 2006; 125:5-9
22. Human Molecular Genetics 2005; 14(1):135-143
23. Proc Natl Acad Sci 1999; 96:7744-7751
24. Pain Practice 2005; 5(4):341-348
25. Arthritis & Rheumatism 2004; 51(2):160-167
26. Sport Jrnl 2003; 6(2)
27. Pain 2005; 113:155-159
28. Clinical Jrnl Pain 2001; 17:52-64

Pain Management During Pregnancy

What happens to the abdominal muscles during pregnancy?

First the anatomy. The rectus abdominus consists of two bands of muscle fibers that are glued together by the linea alba. (See Picture). It runs from the 4th / 5th rib down to the pubic bone. 

During pregnancy the growing baby and hormones (primarily relaxin) cause the linea alba to “unzip” in such a way that the rectus abdominus separates. (See picture). This separation, referred to as diastasis, allows the baby to come forward rather than push backwards on the spine – normal condition of pregnancy. The problem comes when the recti over separate leading to lower back discomfort, sciatica, weak abdominals, separation of the symphsis pubis and more.

“Weak abdominal muscles, like diastasis recti, contribute to poor posture which in turn cause joint misalignments, nervous system interference, and ultimately, pain and inflammation.”- Dr. Laura Brayton.

“I see this frequently in my pre and postnatal massage practice; women who have a diastitis recti have more lower back pain than women who don’t have one.” – Mollie Bollers, CMT, CIMI, Doula

Do I have the separation?

Here’s a way to find out. Lay on your back with your knees bent. Place your finger tips directly on your navel pointing toward your feet. Relax your abdominals. Slowly lift your head until you feel a ridge pulling in the midline of your body. This is diastasis. For the majority of women this separation is detectable by the 5th month.

How to prevent the separation from worsening?

First, be informed that abdominal exercises such as crunches, criss cross, jackknife, roll-up, roll over, and other exercises that involves flexion and extension of the spine ARE NOT for the pregnant mother. As a rule, during pregnancy, do not perform exercises that in the prone position require exertion of the abdominal muscles through lifting of the head and shoulders off the floor or mat and/or double leg lifts.

Exercises calling for you to lay on your back decrease your circulation and your baby’s. Also, exercises that involve rounding and “curving” of the spine (for instance when your shoulders roll forward) shift your weight back onto the spine. The shift can over stretch ligaments of the spine, tilt the uterus back increasing your chance for back labor cause, supine hypertension (decreased circulation) and more.

What to do?

There are proper exercises that avoid these complications and allow you to modify abdominal or core strengthening exercises. The key is to do it correctly by working the transverse abdominus that wraps around the abdomen like a belt.

Here is an exercise that works the tranverse abdominus.

Step 1: Sit comfortably with the legs crossed. Head, shoulders and sacrum (area between the lower back and buttocks) should be supported by a wall behind you. If you feel tight in the lower back and hips and feel as if this may inhibit your posture, place a pillow(s) underneath your buttocks that allow your legs to rest at a sloping angle to the floor.

Step 2: Place one hand at the top of your recti (where your ribs come together) and the other hand over the center of button). Elbows should be relaxed and by your side. Chest and shoulders should also be relaxed much the same way they are in a sigh of relief. The same muscles are affected.

Step 3: Breathe in through the nose â” nose in hands. Keep your chest relaxed and still. Stretch the lungs by expanding the belly. Exhale with hands drawn back to the spine.

Step 4: Tighten the abdominals. Make a slight cough to engage the tummy muscles. Repeat 3 times breathing slowly.

Step 5: On the last exhale hold the backward movement. Count out loud to regulate your breathing. Start with 30 seconds and work up to 2.5 minutes a day.

Practice this exercise 3 times a day. Try it before breakfast, lunch and dinner.

And remember that most trainers are not aware of diastisis and other prenatal and post-pregnancy healing issues. If you need help with your mummy tummy, it is in your best interests to find a fitness specialist with knowledge and experience in the special needs of prenatal and post-partum women.
Editorial provided by Anne Martens. Anne is the owner and founder of Bella Bellies Studio which is a fitness studio designed for prenatal and post pregnancy exercise.