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Diastasis Recti: The “Splitting” Abdominal Muscles

It seems the topic of “Diastasis” is picking up speed in a variety of forums. Particularly on social media in mom groups and exercise discussions. There also appears to be a wide array of misinformation that continues to be spread around. I had one client tell me “I have been doing some research and one place I went to online said that if I have a diastasis I will ALWAYS look a minimum of 3 months pregnant.” This, for the vast majority, doesn’t necessarily need to be true; especially when you know what to do. I have been asked to write a few key things in regards to diastasis from a physiotherapy rehabilitation perspective.

…if I have a diastasis I will ALWAYS look 3 months pregnant

Let’s discuss what a diastasis is. The short version is it is the ‘splitting of the abdominal muscles’. A more specific answer is that in response to pregnancy, the abdominal muscles and associated tissue (fascia) stretch to allow room for a growing fetus. The muscles that are most affected by this is the rectus abdominis (the 6-pack ab muscles that sit in the front). This is not ‘bad’, cannot be prevented, and is in fact necessary during pregnancy. From a clinical perspective, I would say 100% of women who are pregnant, that look pregnant at the time of delivery, will have developed some diastasis during pregnancy. (Side note: diastasis  can also occur outside of pregnancy, but that is another discussion.)

In theory, after labor and delivery, the diastasis will ‘snap’ back together and the core muscles will work in perfect unison… Sometimes this coordination comes naturally to women post-partum. However, often women require some help in getting all the pieces working well together in a functional and coordinated fashion.

…after labor and delivery, the diastasis will ‘snap’ back together 

This is where people profit off our post-partum mommas  “Get your body BACK after baby”, “Post-partum BOOTCAMP”, “Get rid of MUMMY TUMMY in 1 simple exercise”. Unless someone is checking for diastasis recti, do so on a regular (weekly, daily) basis, and can ensure that you are coordinating those muscles well… claiming to be a Post-Partum Specialist is likely an over statement. Often times I see that someone has “healed” their own diastasis and want to “show you how” with their main credential being that they went through the same thing, and they are fine after starting back into heavy exercise at “6” weeks post-partum.

Simply asking people if they have a diastasis is not enough. Knowledge of the issue without being able to assist in modifying exercises to appropriately return to function is where many people stand. Are you wanting to start a class? Ask the instructor what they know about diastasis. If you don’t know if you have one, will they check? How many people have they checked? Not all postpartum fitness classes are created equal.

A diastasis is not necessarily a ‘quick fix’, and often people don’t realize they have it since it typically isn’t painful. What we do “know” is that a diastasis present at 8 weeks post-partum is likely to continue to be present (read dysfunctional) at a year post-partum. But what does ‘problematic’ mean if it’s not painful?

The tissue (fascia) of the diastasis doesn’t need to close in the sense of getting back to how it was, but it does need to be able to generate tension. If it can generate tension well and it is separated 2.5cm that person is going to have better function than if it is separated 1.5cm and not generating tension. (Think of tension as whether you have a firm uncooked noodle versus a soft, cooked noodle between the muscles. The cooked noodle will give away under pressure of the muscles on either side, and the uncooked noodle will hold and transfer force). Problematic could also be the contribution of diastasis to back pain, diaphragm dysfunction, and pelvic floor issues. Diastasis doesn’t cause these things, but it may contribute.

Focusing on the diastasis alone is a simplification of a complex situation, and each person will require slightly different treatment approaches.

What do I recommend? Contact your local pelvic floor physiotherapist, there is no time limit on when to go, but within the first 8-12 weeks will give time to get into a routine with baby and be early enough to have minimal “bad habits” or compensations to combat; or before you start back into exercise. It  is never too late to address anything that has developed during pregnancy and post-partum.

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WMBEXA Best New Business 2017!

We are totally blown away! This year seems to be a total whirlwind of activity, nominations and growth for us at the clinic.

The Warman and Martensville Chambers of Commerce presented the second annual WMBEXA, and we were thrilled to be nominated in several categories. Only able to apply for two we were floored to be a finalist in Customer Service and New Business announced March 2017. Since the announcement of finalists for WMBEXA, Haylie was also revealed as a nominee for the YWCA Women of Distinction Awards for Health & Wellness, we announced the arrival of physiotherapist Kendra Usunier to begin work as of May 23, 2017, and we also had the pleasure of welcoming a student, Jill, for her first clinical placement in the MPT program through April and the first week in May.

May 5, 2017 was the WMBEXA event and it was spectacular! Many exceptional local businesses were finalists, many more had been nominated in 5 categories, and dozens of other businesses were a part of the event to network and enjoy the event.

Much to our shock and amazement, Warman Physiotherapy & Wellness was awarded the best New Business of 2017!

    

“I was thrilled to be a finalist in the company of 4 other amazing businesses. It seems that I although I have no problem talking for hours on end about the pelvic floor and all things physio, I have difficulty standing up for a 2 minute acceptance speech!

This clinic has been a vision of mine since I was in the school for Physical Therapy and I am so fortunate to have been able to make my dream a reality. This dream coming true would not be possible without the support of my family. My parents for being supportive and providing assistance whenever needed. My wonderful amazing and supportive family; my husband, Rob, for allowing me to work days, nights and weekends; often 60+ hours a week, as well as being our resident clinic ‘handy man’. My 3 year old daughter Emily for coming to the clinic ‘to do work stuff’ and dance with the skeleton when I’m sneaking in a client in need on a day off. THANK YOU.

I must thank my wonderful therapists and our support staff. They have been an integral part of the success of the clinic, and have fully embraced my business vision. It is common to see and hear crying babies and children at the clinic since we see so many women who are pregnant and post-partum, we feel providing care is most important, regardless of the ability to find childcare. THANK YOU.

There is no doubt that without the support of the community and our wonderful clients – past, present, and future – we would not be where we are today. Our success in our business journey would not be possible without you. THANK YOU.”

Helping you, help yourself. From infancy to old age.

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Is your NECK causing your arm or shoulder Pain?

Case Study: A client HD came to the clinic after several weeks of shoulder, shoulder blade and arm pain. This pain started in the shoulder and moved down the arm. The client would describe the pain as ‘sharp’, ‘burning’, ‘shooting’, ‘deep achy’, and ‘pins and needles’ depending on what they did. Initially their pain would come and go, but over time the pain would stay for longer periods of time. This client found that sometimes anti-inflammatory medication and massage helped, but it always came back. Since their pain started in their shoulder it was believed that it was a shoulder injury (rotator cuff). After assessment by a physiotherapist it was identified that HD had issues from the neck resulting in shoulder and arm pain. With treatment including home exercises, stretches and programming, the client was able to return to full function and a pain-free state of being!

neck-pain

The story of HD is not uncommon. Often people are not sure where to go for a variety of issues and complaints. Your local Warman Physio is able to provide assessment and treatment of any ache or pain occurring within the body, whether it was caused by an injury or ‘just showed up’ one day.

Physiotherapists are trained to provide assessment and treatment of all the body systems including the muscles, tendons, ligaments, and nervous system to identify what is causing any pain or issue.

Following is a list of conditions that Physiotherapists can help with in the neck and arm:

  • Disc bulges in the neck
    • often causes pain as is outlined in the image above with the red highlighted areas depending on the level the bulge is present
  • Nerve compression or irritation of nerves of the neck
    • pain down the arm with moving the head a particular direction like in shoulder checking
  • Carpal Tunnel syndrome
    • pain and tingling in the hand often upon waking from a night’s sleep to start
  • Rotator cuff injuries
    • pain in the shoulder often with reaching over head or behind the body
  • Tennis/Golfer’s elbow
    • pain on the outside/inside of the elbow often with lifting/carrying

 

How does the neck cause pain in the shoulder and arm?

The body is a complicated group of systems that work together to allow us to complete our everyday tasks. Our neck has 7 vertebra (C1-C7) that go from the base of the head to the base of the neck. Within your neck there are 2 joints at the top and bottom of each vertebra, and most of them are separated by small discs. Our spinal cord is enclosed inside a tunnel within the vertebra. The nerves that go down into the shoulder and arm come out from between the vertebra, through the muscles and down the arm. These nerves then control the muscles (creating movement) as well as sensation (touch, temperature, etc). If something happens to the nerve throughout it’s path down into the arm it can create issues in the movement, sensation, or both!Sometimes it is hard to figure out where pain is coming from – the muscles, joints, nerves, tendons (attach muscle to bone) or ligaments (attach bone to bone). Leave the guess work out of your pain and have it assessed by your local Warman Physio!

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Pregnancy, Pain & Physiotherapy

As physiotherapists that works with women who are pregnant and women’s health (pelvic floor physiotherapy) and many of us parents ourselves, we find that often women have many questions while pregnant.

Shouldn’t I be sore? Isn’t it normal to have pain while pregnant?

A little bit of pee when I sneeze/laugh/stand-up is ok though right?

My answer to this in short is NO!  Often newly pregnant women will be told a variety of things to appease them in reply to many complaints.

 well it’s what you signed up for…

you’re pregnant, what did you expect?

Women are often otherwise brushed off when concerns of pain are raised. This is beginning to change! Women who are pregnant need not be in pain, discomfort or other physical distress; and are often not accepting these as answers to their concerns.  Often, physiotherapy can help!

12605341_1021012697944690_92971813689463588_oPelvic Girdle Pain

First up PGP or pelvic girdle pain (think your gluts or bum, pubic bone and hips). This can often be addressed with not only manual skills of a physiotherapist but also home programming and Rost Therapy “rescue” exercises.  We work with women who are pregnant to assess and determine their specific underlying causes of the pain and provide you with a home program that helps you help yourself. Our basic principle is, if we are able to do something in-clinic to help a client to feel better then we should be able to provide a home exercise to help keep it that way.  Rost Therapy in particular takes a look at pelvic symmetry and utilizes the muscles that attach around the pelvis to promote symmetry. This can be provided to you with some home exercises to help.  To us there is nothing worse (from treatment perspective) than providing a treatment the client must continue to return and pay for over and over, ultimately not allowing them to continue their progress at home. In the image above you can see the start of the Rost Symmetry position (feet together, knees apart), often when in this position individuals experiencing SIJ pain will have one knee sitting higher than the other.

How can I help PGP now?

Check how you are sitting or laying.  We often want to cross our knees or pull them together; this creates tight muscles and tension in the inner thigh which can be an underlying cause pelvic girdle pain.  Instead of crossing your knees, cross your ankles and let your knees sit open (wider than your hips).  This is also why when laying on your side we suggest you place a pillow between your knees (think thick enough to lift knee to hip height).  This will encourage relaxation and decreased tension in those inner thigh muscles.

Pelvic Health Issues

Now, the pelvic floor and pregnancy.  We get many women who are pregnant coming into the clinic that are anxious because they haven’t been ‘doing their kegels’.  Do no fret, we do not necessarily recommend kegels to women who are pregnant.  Let’s think of the reason why for a minute.  Kegels are a strengthening exercise for your pelvic floor muscles.  These muscles are like a sling between your pubic bone and tail bone, and their main function is to close the anus, urethra and tighten the vagina.  Essentially kegels are intended to pull everything up and in.  Now, when we go into labour, we want the babies to come down and out.  See my predicament? We work with women to promote pelvic floor relaxation and function, as well as labour and delivery prep of the pelvic floor.

Leaking, pain with intercourse, back pain, hip pain, and constipation can all be signs of pelvic floor dysfunction!

How can I help my pelvic floor now?

Relax that pelvic floor! If you’re sitting in a chair imagine that you are trying to drop your vagina/vulva towards the chair (similar sensation to relaxing prior to a bowel movement) while breathing in, then rest as you exhale. This is an active relaxation.

Many times when we see women for pelvic floor therapy we find the pelvic floor is very tight and high. Anyone only ever really talks about the kegel ‘strengthen the pelvic floor!’ and strengthen we try.  Without a balanced relaxation all we do is shorten.  Imagine you go to the gym and you want to do bicep curls (hand to shoulder) and someone tells you to just pull up and hold there for 10 seconds, rest for 1 second then repeat.  Your elbow wouldn’t straighten all the way down and it would begin to stay bent.  This decreased relaxation causes tight and short muscles which makes it very difficult for them to do their job, which at this time (pregnancy) the end goal is allowing a baby down and out.  This could be one (of many) reason women are experiencing higher degree tearing of the pelvic floor during delivery.

No one individual is the same, and each assessment will lead to different treatment plans for my clients.  Which is why I recommend a comprehensive prenatal assessment when pain starts, or at approximately 32-36 weeks gestation prior to delivery for delivery prep. Keeping these things in mind could save you later.

In a nut shell: don’t ‘sit like a lady’ and relax that pelvic floor!

 

Haylie has been practicing pelvic health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. She now adds to this education and treatment, her knowledge and experience in pediatric pelvic health providing workshops and presentations in addition to assessment and treatment. Haylie has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms since she started practicing. This ultimately brought her to open her family-friendly clinic in 2014.  At Warman Physio clients are encouraged to bring their infants and children to treatment if they need. Haylie was recognized as YWCA Women of Distinction finalist for Health & Wellness in 2017, the ABEX Young Entrepreneur Award Recipient in 2018, and a finalist in the 2019 SABEX and WMBEXA Awards.
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Don’t Let Your Love of Running HURT You!

Just in time for spring running weather, Warman Physio will be offering a Running Clinic March 10, 2016! The education session will provide information on:

– common running pains/issues
– typical training mistakes
– stretches that are geared towards runners to try
– possible gait analysis (chosen ahead of time)
– how to tell when an appointment is required
– possible information on ‘prehab’ before changing running routine
– the importance of strength as well as endurance and it’s affect on running

We will be providing snacks and beverages for those who attend. The location of the event will be determined by the number of people that register for the event – to register please e-mail info@warmanphysio.com titled “Registration for Running Clinic”, or call the clinic at 306-373-9355 (306-373-WELL). There will be a limited number of spaces, make sure you don’t miss out!

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