What is Diastasis Recti?
Diastasis Recti Abdominis (DRA) is separation of the abdominal wall. We have a line of connective tissue that goes down the center of our body separating the muscle bellies of our rectus abdominis (the “six pack” muscle). If the abdominal wall grows (due to weight gain there or growing a baby) or if excessive pressure is placed on the abdominal wall without proper core activation strategies, that can cause Diastasis Recti. It can occur in men and women who have not been pregnant. During pregnancy, as baby grows, the abdominal wall is stretched. This is why most women have DRA towards the end of their pregnancy. This a normal physiological change. But there are some things you can do to help during pregnancy and postpartum (yes, even years later) as well. How do I know if I have it? During pregnancy, if you notice bulging in the midline (a vertical line especially near your belly button) or discomfort in that area, you should check for diastasis. Bulging more often occurs during more strenuous activities such as heavier lifting or abdominal exercise. Postpartum the separation should come back together naturally. Research shows the time frame varies but usually around 6-12 weeks. But for some women, it can take longer or may not resolve on its own. One of the challenges is that DRA often goes undiagnosed. Diastasis Recti can contribute to back and pelvic pain, and is sometimes described as the “mommy tummy” or “pregnant pooch” that never went away. Sometimes there will be pain or discomfort on the abdominal wall or a feeling of generalized core weakness. You can check yourself for DRA, click here for a video. Keep in mind that in addition to checking the inter-recti muscle width (the amount of space horizontally between the two sides of your rectus abdominis muscle), you also need to assess the depth. Meaning, how deep do your fingers sink in and do you feel any firmness in that connective tissue. Note that up to two fingers wide can be considered normal- the abdominal muscles will always have some space in between. For depth, we want minimal depth and a firm feeling when we press down in the midline. DRA can occur anywhere between the sternum and the pubic bone so make sure to check in a few different places. What can I do about it? It is important to learn intra-abdominal pressure management strategies. Big words, right? What that means is learning how to use the inner core system functionally. The pelvic floor, abdominal wall, diaphragm, and deep back muscles all working together without putting excessive pressure on the abdominal wall or pelvic floor. A functional core system will not only help DRA, but can also help with back pain and other issues as well. Unfortunately, it is not as easy as just doing one or two exercises. It is truly understanding where these deep muscles are and how to apply these concepts into your daily activities as well as other types of exercise. The learning curve is different for everyone but in my opinion, worth the time and effort. During pregnancy, avoiding activities or positions that cause bulging and staying connected with your deep core muscles as pregnancy progresses can help. It is important to note that these deep abdominal muscles help to support your back and stabilize you. It is also the muscle that you want to use to help push during a vaginal delivery and is important to reconnect with postpartum. Also note that alignment and breath patterns can contribute to increased abdominal wall pressure. RIght after having a baby, give your body time to heal. The same core activation exercises and breathing techniques can help to reconnect with the core post-baby. I also recommend checking for DRA before returning to exercise. Remember that you are likely lifting and holding a growing baby, so your alignment when you are holding them can make a difference. For example, if you are leaning back and jutting your hips forward, you will notice more pressure on the abdominal wall, which is what we want to minimize as much as possible. If you had a baby months or years ago, it is not too late to make changes. Working on breath, alignment, core activation, and pressure management strategies is helpful. Not only learning exercises that can help, but also learning how to implement these concepts into everyday life (like lifting kids and laundry baskets) and how to carry over into exercise. You may have heard if you have DRA, do not do planks or crunches. That is not true for everyone, and most of the time you can work back to those exercises. Learning what exercises are appropriate for your body now, how to tell what you are not ready for yet, and how to modify/change those exercises is very important to facilitate healing. Working with a women’s health Physical Therapist can help to teach you all of the concepts and exercises noted above. It can also address other areas of weakness, pelvic floor issues, c-section scars, areas of stiffness such as the ribcage or low back, and much more. Pregnancy and birth is not easy on our bodies. Remember that you need to take care of yourself in order to take care of your family. Make the time and prioritize yourself.
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Are you sitting at a desk all day? Are your kids? This year, more people are working at home and spending increased time in front of the computer. While this has connected us in new ways, it has also resulted in a more sedentary lifestyle. Excessive sitting can contribute to muscle tightness which frequently leads to weakness of the hip flexors, hamstrings and pecs. This can lead to back pain or stiffness, neck pain or tightness and more. One of the benefits of working from home is that YOU are in control of how you set up your environment. These tips may be beneficial both at home or in your office.
Computer set up:
Choosing the right chair can make a big difference! Expensive ergonomic chairs are not always necessary and may not be the right fit for everyone. The most important factor in a chair is height, particularly if you are seated much of the day. You want your hips to be higher than your knees, and you want both feet to be comfortably resting on the floor. Check your posture- are you sitting upright or are your head and shoulders slouching forward? Ideally you want to sit upright with your back resting against the chair, shoulders relaxed and down, elbows bent at 90 degree angle, and feet comfortably on the floor. The most important advice is to vary your position while you work. Adjusting the height of your chair throughout the day and changing your position can help. Using a “sit to stand” desk is even better, and there are adjustable stands you can put on your current desk. Standing all day is not ideal either. My favorite position when working at home- get on the floor! Sit with your back against a wall with your legs straight in front of you, lay on your stomach propped up on your elbows, or try tall kneeling. Varying your position throughout the day will help you feel better NOW and may help prevent future injuries. Make sure that you are getting up and moving regularly during the day. Set an alarm on your computer or phone to remind you. Stand or walk around when you are talking on the phone. Add in stretches or mobility exercises when you take a quick break or during lunch, and make sure your lunch break or before/after work routine includes a quick walk outside or workout. Remember, an hour workout does not compensate for sitting all day long so integrating these tips can help minimize muscle tightness. Here are a few of my favorite stretches to incorporate into your day to counterbalance too much sitting. -Hip flexor stretch- In half kneeling, tuck the tailbone under (go into a posterior pelvic tilt) to feel a stretch in the front upper thigh of the bottom leg. Hold for a minute or two and then repeat on the other side. -Seated hamstring/gastroc stretch- Sit against a wall with legs straight. If legs are unable to fully straighten, you can sit on a book, rolled up yoga mat or towel. Put a towel, sheet, or yoga strap around the ball of one foot. Try to straighten the knee and gently pull your toes toward your nose. Hold for a minimum of 30 seconds, a few times on each side. -Door chest stretch- Stand in the doorway and put your arms out to the side (bend elbows to 90 degrees with hands up toward the ceiling). Rest both forearms on the doorframe. If the door frame is too wide or you want to focus on one arm, you can do this on one side at a time if you prefer. Step with one leg through the door, keep your weight on your legs, not your arms. Gently lift the chest, but do not arch into your low back- hold and breathe. You can move the arms up or down to stretch different parts of the pec muscles. Do not stretch into pain. For kids, the same concepts apply but you may have to make some adaptations to their desk set up at home. Smaller kids sitting in adult chairs or at adult desks or regular tables may need some easy accommodations. If their feet cannot touch the floor, use a stool. If they have a lot of space between their back and the back of the chair, fill the space with a pillow. Encourage them to not sit in that same position all day! Here are a few more stretches to incorporate when sitting. Make sure to click the links above to see videos- and visit this page for more helpful videos such as seated thoracic extension, glute bridges, and the sidelying windmill. If you are sitting reading this, get up and move! by Rachel Miller, PT, DPT
Happy New Year! Every January is an opportunity to start with a clean slate. It is a time of New Years resolutions and the perfect time to set goals for the year ahead. I’m sure 2020 started out the same way but the year didn’t go quite as planned for most of us. One challenge was figuring out how to stay active and keep exercising despite not being able to go to the gym. The good news is the pandemic has opened up more options- virtual live classes, online on demand class libraries, and virtual personal training. These options are not only offered by large national fitness companies, but also many small, local gyms and studios. These small boutique studios not only have instructors that you may already know and love, but they also really need your support. While you have more options now, you need to find what works for you. Make your workout plan pandemic proof! When designing a fitness plan here are some helpful tips: What type of exercise or physical activity do you like to do? Finding something you enjoy will help increase your chance of actually doing it- and sticking with it. Start there. Stay accountable. Make your workout a priority and put it on your schedule. Other ways to stay accountable are signing up for a LIVE virtual class so you are expected to show up at a certain day/time. Recruit a workout buddy- plan virtual workouts together or get outside for a socially distanced walk or run. One of the best ways to stay accountable is scheduling regular private workout sessions (yes, even virtual sessions can have amazing results). Add variety. We are often more likely to do what we like. For example, if you grew up running and love to run, it may be easy for you to consistently run a few times a week. I challenge you to do what you don’t like to do. Current guidelines recommend adults get a minimum of 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week- or a combination of both. Strength training twice a week is also recommended. Not surprisingly, more exercise will provide greater health benefits. You should have a combination of cardio, strength, and mobility/flexibility in your exercise routine. What does your body need? What is hard for us is what we likely need to work on consistently. If cardio is not your favorite, a heart rate monitor can be helpful to make sure that you are pushing yourself enough. If you sit all day for work, feel tight and not very flexible, you may benefit from regular mobility/flexibility work (like yoga or pilates). Depending on your medical history or current injuries, you may have some limitations that affect your ability to exercise. If you need help figuring out what works for you, starting with a Physical Therapist or personal trainer may be beneficial. Make a plan. You can always change it up, but exercising consistently is important. If you miss a week or two, give yourself some grace and restart as soon as you can. Remember, what you eat is also very important. A combination of healthy eating and exercise can make a big impact. Regular exercise will make you physically stronger, can reduce anxiety and depression, aid in weight management, lower blood pressure, improve heart health, sleep quality and more. I wish you a happy, healthy and strong 2021! by Rachel Miller, PT, DPT
Breathing. We all know it's important. We all do it- in fact, an average adult takes over 17,000 breaths every day. Even though it is something that we don't often think about, HOW we breathe is very important. Increased stress and anxiety can activate the sympathetic nervous system, where the body is operating in “fight or flight” mode. Diaphragmatic breathing exercises are a way to stimulate the parasympathetic nervous system, which can help rest and restore. You can start now by inhaling for a count of three, holding it for 1 second, and then slowly exhaling for a count of four. Repeat a few times and then continue reading. As a Physical Therapist, I often see breathing patterns that can contribute to someone's pain or issues. For example, someone who breathes into their upper chest and overuses their accessory breathing muscles in their neck, will often have more neck tightness and pain. Excessive "belly breathing" can contribute to "pressure related issues" such as hernias, diastasis recti (abdominal separation), pelvic organ prolapse, and a non-functional core. Now you are likely thinking, well, how should I breathe? In my opinion, I prefer 3 dimensional breathing- the lungs should expand forward- but also sideways and backwards. 3D breathing will help to mobilize the thoracic spine (upper back) and the ribs. A very important muscle for breathing is your diaphragm. Your diaphragm forms the top of your inner core, your pelvic floor is on the bottom, your deep back muscles in the back, and your transverse abdominis in front. These muscles must all work together to create a functional core- a core that is reflexive and kicks in automatically when you need it. Did you know that holding your breath is one of the most common ways to "cheat" when you are exercising? This is way to compensate for lack of core stability, and will limit your ability to engage your deep core system in that moment. As a Pilates instructor, I emphasize the importance of breathing, and often assign a breath pattern to an exercise. Pilates focuses on core strengthening, but also breathing, posture, and control. It is a great way to strengthen your inner core, as these muscles are so different that many people have difficulty finding and strengthening it. I often cue to exhale on exertion- whether that is during the hardest part of an exercise or even with lifting kids or laundry baskets around the house. This helps to activate the deep core muscles. Give it a try. And give some extra attention to your breath pattern - you may be surprised with what you find. |
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September 2022
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