Three of the Chartered Women’s Health physiotherapists from Milltown Physiotherapy (practice partner Helen MacDevitt, Stephanie Crossland and Sarah Mullins) travelled to England for four days to attend a course given by Diane Lee from Canada.
Diane is a world renowned physiotherapist who is internationally recognised for her clinical work on the thorax and pelvic girdle. She is the author of two books on these topics along with contributing chapters in many highly regarded publications for physiotherapists. We were very lucky to be able to attend this course as Diane is not over on this side of the water very often!
She is currently undertaking research on the behaviour of the muscles of the abdominal wall in women with diastasis recti abdominis (DRA). The course title was “New perspectives from the Integrated Systems Model for Treating Women with Pelvic Girdle Pain, Pelvic Organ Prolapse, Stress Urinary Incontinence and / or Diastasis Rectus Abdominis”.
Why am I still having pain or experiencing dysfunction after having my baby?
It is well known that the abdominal wall and pelvic floor muscles play key roles in function of the trunk and that pregnancy and delivery can have a significant and long lasting impact on their activation patterns. Muscle imbalances can arise postnatally, thereby compromising the ability to transfer load through the trunk. This may create pain in a multitude of areas as well as affect the urinary continence mechanism and support of the pelvic organs.
What is Diastasis Recti Abdominis (DRA)?
It is a widening of the midline tissue known as the linea alba and separation of the recti muscles of the abdomen. It occurs to some extent in 100% of women in the third trimester of pregnancy (Gilleard and Brown 1996). Following pregnancy, DRA may prevent restoration of both the appearance and function of the trunk. Many women with DRA remain abnormally widened at 8 weeks postpartum and this distance remains unchanged at 1 year without any intervention (Coldron et al 2008, Liaw et al 2011). 66% of women with a DRA also have at least one support-related pelvic floor dysfunction (Spitznagle et al 2007).
What is the Integrated Systems Model for Disability and Pain?
It is a framework developed to help clinicians determine the primary cause of symptoms when multiple sites of impairment are noted during any single task and helps formulate prescriptive treatment programmes that are unique to each individual.