 There is little conclusive evidence on the best method of rehabilitating a diastasis. The aim of this infographic was to provide a bite size reference for best practice approach, based on the evidence that is available for managing the condition. It also aims to raise awareness ofthose less familiar with treating diastasis, to give them an overall view on management. The take home message is that there is no one size fits all method and that each patient will
need an individualised approach. The poster highlights the need to focus on tension of the linea alba, rather than gap size. This is supported by literature evidence that inter recti distance can actually increase with TVA contraction (Lee and Hodges, 2015 and Theodorsen et al, 2019). The basis of rehab is therefore focussed on tension rather than whether the gap physically decreases during the exercise. Assessing functional response to exercise on an individual basis can potentially give them more freedom to return to the things they love. The functional ability will vary person to person, even if the diastasis presents similarly to another in size or tension.The focus should be on whether clients can create tension across the linea alba during the task, rather than relying on gap size. When functional activities are not yet appropriate, rehabilitation can be goal specific and modifications set. Further research is needed to identify which rehab protocol of strengthening provides the best results, in order that we can confidently offer our patients the best possible treatment outcome that is evidence based.
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 Leaking in cross fitters is common... and often considered a normal side effect of lifting heavy weights. But guess what, it doesn't have to be. You can cross fit/lift heavy weights and not leak! A women's health physiotherapist can make sure your pelvic rehab is functional and will meet the demands of your lifting regime. Here are some top tips for those that want to lift weights but also ensure they are protecting their pelvic floor.
1. Exhale during the exertion. This reduces the pressure going through your pelvis during the lift. 2. Belts increase pressure, which is exactly what we want to avoid to reduce urinary leakage or other pelvic floor symptoms. You may feel you can lift heavier with a belt on, but long term you pelvic floor won't thank you for it. 4. Engage your pelvic floor as your exhale through the exertion. This gives extra support and helps to manage any pressure. Make sure you let go of your pelvic floor at the end of the exertion. 5. Focus on pelvic floor engagement rather than bracing your abdominals during the lift. Engaging your abdominals alone actually increases the amount of pressure during the lift.  During pregnancy, the additional load of the baby and the uterus cause changes to the bladder, urethra and the pelvic floor. This weight creates a lot of additional work for the pelvic floor and as a result the muscles can become weaker. The hormonal changes occurring in pregnancy soften the ligaments and muscles around the pelvis to allow stretching for delivery, but again this makes it much harder for the pelvic floor to contract well. By the end of pregnancy your pelvic floor can lack the tone and strength that was there at the start of pregnancy (especially if you haven’t been doing any pelvic floor floor work in pregnancy!), making symptoms related to pelvic floor weakness very common. It is because of these changes that EVERY woman should do pelvic floor rehab after a baby, regardless of how you delivered or whether you have symptoms.
 I believe the piston analogy originally comes from Julie Wiebe. It is a great analogy to help patients understand how their core relates to their breath. As you exhale, your diaphragm and pelvic floor are naturally shortening - the piston is moving up. Performing a pelvic floor and core contraction on the exhale makes it much easier to engage the muscles, because you are joining in with the natural movement of the core. When you inhale, your diaphragm and pelvic floor move down to help make space for the lungs tor fill with air - the piston is moving down. Trying to contract the pelvic floor on inhale is much more difficult, because it goes against the natural direction that the muscles are moving in. For this reason core exercises are performed on the exhale.
When you consider the number of structures that are cut during a c-section, it's not that surprising that women can find they have some trouble regaining abdominal & core strength afterwards. Whilst they don't normally cut through the abdominal muscles, the connective tissue around the muscles is cut and so as those structures heal it can cause adhesions. This can affect how well the muscles can glide and contract through the surrounding tissue.
If you are struggling with your abdominal strength post c-section, ask your GP for a physio referral, or alternatively book in to see your local pelvic health physio.  Patients often tell me that they didn't hadn't even know that a women's health specialty existed until they heard it on the grapevine! Women's health physios have had additional post graduate training. Many have worked in musculoskeletal before specialising in women's health so can take a holistic approach to your symptoms. We do so much more than just treat incontinence. We treat pelvic pain, back pain, hip pain, prolapse, diastasis, menopause related symptoms, constipation, urgency to name but a few!!!Patients often tell me that they didn't hadn't even know that a women's health specialty existed until they heard it on the grapevine! Women's health physios have had additional post graduate training. Many have worked in musculoskeletal before specialising in women's health so can take a holistic approach to your symptoms. We do so much more than just treat incontinence. We treat pelvic pain, back pain, hip pain, prolapse, diastasis, menopause related symptoms, constipation, urgency to name but a few!!!  Personalised pelvic art available in our shopClick here to go to Pelvic Floor Poster Shop
 We often assume if something hurts we should leave it alone. But that is not always the case, especially when it comes to scars.
Scars are often sensitive because the new regenerated nerves need a bit of re-education. Nerve endings are there to protect us and they do that by sending signals to the brain which then produce pain. Nerves in a scar can sometimes be a bit too enthusiastic and send too many pain signals to the brain. Pressure from clothing, rough fabrics or touch can all be interpreted as a potential threat and the nerves respond with pain. Of course, these types of touch are not dangerous and so we need to educate the nerves to not respond to such things. We can do this through massage and touch. The more we do this the more the nerves learn that these types of touch are normal. 
The impact of a tight or hypertonic pelvic floor isn't limited to the pelvis area.
Whist a tight pelvic floor can cause symptoms such as incontinence, painful sex and pelvic pain, the effects can be more far reaching. The pelvic floor is the floor of your core; tightness here will impact other elements of the core system, such as the diaphragm. If the diaphragm becomes tense, this will impact on how optimally the chest expands and contracts with breathing. Our bodies are linked via a support system called fascia. This is connective tissue that runs throughout the body. Because fascia links diffrent areas of the body together, tension in one place can lead to tension in another. For this reason it is not uncommon to experience jaw tension alongside a tight pelvic floor.  Pressure is our nemesis when it comes to pelvic floor issues such as prolapse and incontinence. The more pressure that is present, the harder our body has to work eg. during weightlifting. Breathing is an easy way to reduce pressure. If we exhale rather than hold our breath on exertion, there is less pressure being held "in the crisp packet" that has to be managed by the core muscles. If you have symptoms on a particular activity - such as running/HIIT or cross fit, see your local women's health physio. They will be able to modify your activity to better manage the pressure you are producing with that activity.I use this analogy all the time in clinic to help patients understand the importance of managing their pressure to help improve core/pelvic floor symptoms.  Breath and Pelvic Floor PosterThe pelvic floor is not just one muscle, but many. To ensure you engage all of the muscles during a contraction you need to: Ensure you're closing from back to front. Either visualise closing your back and front passage, or that your coccyx (sitting bone) and pubic bone are coming together. Once you've got the close - draw the contraction up. You may find it helpful to imagine you are lifting up a marble with your vagina!! The lift can be tricky if the pelvic floor is very weak but keep trying and it will get easier.  |
AuthorClaire is a women's health and sports Physiotherapist. She is the owner of Spring Physio and is based in East Sussex. Archives
October 2024
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