Show Notes by Elaine Stevenson from Myotherapy Reading Room
Gráinne Donnelly is an NHS Specialist Physiotherapist, in Pelvic, Obstetric and Gynaecological Physiotherapy. She has a particular interest in the assessment and treatment of diastasis recti.
The word diastasis has an unfortunate tendency to strike fear into pregnant and post-natal women, and their clinicians alike, much of it unjustified.
Themes covered in the discussion included:
- why diastasis is such a feared condition
- relationship between fear and misinformation
- a review of the anatomy of the affected tissues
- common referral pathways, including self-referral
- when treatment is required
- differentiating between functional vs problematic
- physical strategies used in treatment: breathing, abdominal wall control, pelvic floor function and exercises
- the importance of seeing a pelvic health physio before returning to high intensity exercise, eg running, for all women
- the role social media plays in driving unrealistic expectations
- training of the rectus abdominus and address atrophy
- navigating the confusion created by conflicting opinions and perspectives of the health and fitness professions
- the importance of language and lessons from our understandings about pain
- appearance (‘mummy tummy’), strength and function
- need for education of health professionals re role of women’s health physiotherapists in the management of this condition
- links to low back pain, urinary incontinence, pelvic floor function and pelvic organ prolapse
- measurement issues: size of gap vs strength
- importance of setting meaningful goals and getting back into sport and activities (ie moving away from ‘can’t do’ cultures)
- pathways, physio rehab, referral into surgery, rehab post surgery (where surgery required)
- strategies that affected women use to cope with diastasis
- the importance of seeking help between pregnancies, as opposed to waiting until you’ve finished your family
Related Reading and Resources:
Video: Lisa and Erin – https://www.instagram.com/p/BrBJqyOB7ok/
Benjamin DR, Frawley HC, Shields N et al. Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy 2018. doi: 10.1016/j.physio.2018.07.002. [abstract]
Bø K, Hilde G, Tennfjord MK et al. Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: Prospective cohort study. Neurourol Urodyn 2017; 36(3): 716-721. [abstract]
Davenport MH, Ruchat SM, Sobierajski F et al. Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis. Br J Sports Med 2019; 53(2): 99-107. [abstract]
Gillard S, Ryan CG, Stokes M, Warner M, Dixon J. Effects of posture and anatomical location on inter-recti distance measured using ultrasound imaging in parous women. Musculoskelet Sci Pract 2018; 34: 1-7.
Dianne Lee & Associates Physiotherapy. Diastasis rectus abdominis & postpartum health. https://dianelee.ca/article-diastasis-rectus-abdominis.php
Mommers EHH, Ponten JEH, Al Omar AK et al. The general surgeon’s perspective of rectus diastasis. A systematic review of treatment options. Surg Endosc 2017;31(12):4934-4949
van de Water AT, Benjamin DR. Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): A systematic review of their measurement properties and meta-analytic reliability generalisation. Man Ther 2016; 21: 41-53. [abstract]
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