Can you please advise me about my tummy? it looks so different after my pregnancy. Is it safe to start sport again?
These were two questions an eight week post-partum woman consulted me for a few weeks ago. She still feels a gap between her abdominal muscles and she is worried. Worried that her abdominal wall has been damaged by her pregnancy. That she is doing the wrong exercises at the moment. Uncertain if she can return to her cross-fit class.
Do these questions sound familiar to you? Do you want to learn more on Diastasis Rectus Abdominis?
In this blog I wil review the book from Diane Lee: Diastasis Rectus Abdominis: a clinical guide for those who are split down in the middle.
This book has chapters on for instance:
– Anatomy and function of the abdominal wall including fascial connections
– Clinical and ultrasound imaging assessment for recruitment strategy analysis of the lateral abdominal wall and the linea alba
– Case reports and
– Treatment/training of the abdominal wall.
IMAGES, ULTRASOUND & VIDEO
What makes this book unique is that it includes over 130 online videos which can be easily accessed with a QR code. For instance it is great to see the ultrasound images of the linea alba and rectus sheaths during a head and neck curl-up. Or how the musculus transverse abdominis responses to verbal cueing. The videos also show for instance assessment of the diastasis rectus abdominis and what happens when a test performed.
I think it is great to see practical examples of what is explained in the book. This makes it a lot easier to understand and use it in your own practice.
However: if you are not experienced in interpreting ultrasounds it is quite difficult to see what Diane is explaining in a lot of the videos. By adding arrows in the images and films the reader could benefit even more.
Several cases of women with diastasis recti postpartum and in men and children are discussed. With these case reports Diane Lee shows both the process of clinical reasoning, the treatment and the result. The fact that the cases are well document with both images as well as films makes it very comprehendible.
The treatment should consist of 4 components: Release, Align, Connect/control, Move based on the the Integrated Systems Model is used in the assessment. This blog is not the place to discuss these models therefor you really need the book.
You will find different release and awareness techniques as well as training for instance the musculus transverse abdominis and the pelvic floor muscles as isolated muscles as well as integrated in movements.
“To be fully evidence-based practitioners, physiotherapists should collaborate when treating patients with low back and pelvic girdle pain, incontinence, pelvic organ prolapse, sexual dysfunction and/or diastasis rectus abdominis. Furthermore, orthopaedic conditions should no longer be considered independent from urological, reproductive, colorectal and/or sexual conditions”.
This quote hits the nail on the head. I completely agree that all physiotherapists should be aware of interactions possible between systems. Besides being aware, all physiotherapists should know what questions to ask and when to consult with a colleague. Although the interactions between the systems are known, for instance in the Dutch guidelines on ‘low back pain’: diastasis rectus abdominis or pelvic floor dysfunctions are not mentioned.
This is an excellent book for; (pelvic/women’s health) physiotherapists treating patients with diastasis rectus abdominis.
This book helped me in evaluating and giving a sound advice to the patient with the diastasis rectus abdominis.
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Diastasis Rectus Abdominis, A Clinical Guide for Those Who Are Split Down The Middle, Diane Lee, Surrey BC, Canada, Learn with Diane Lee, 2017, first edition, 319 pages, ISBN: 978-0-9732363-1-6
Price: €74,32 + vat
You can order the book at: https://blurb.com/b/7904675-diastasis-rectus-abdominis
About the author:
Diane Lee is a practicing physiotherapist with a special interest in women’s health. She has authored several books and gives lectures and teaches both national (Canada) and internationally.