The Women’s Health Podcast

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]

Links:

Biography:https://www.absolute.physio/aboutus
Practice: Absolute Physioat Maguiresbridge, County Fermanagh in Northern Ireland.
Twitter:https://twitter.com/ABSPhysio
Twitter:https://twitter.com/diastasisphysio
Instagram:https://www.instagram.com/absolute.physio/
Instagram: https://www.instagram.com/diastasis.physio
Facebook:https://www.facebook.com/Absolute.PhysioNI/
Email: [email protected]