ISM Perspectives for Treating Women with Conditions arising from Pregnancy

Course Description

It is well known that the abdominal wall and pelvic floor play key roles in function of the trunk and that pregnancy and delivery can have a significant, and long lasting impact. Postnatal nonoptimal strategies for the transference of loads through the trunk can create pain in a multitude of areas as well as affect the urinary continence mechanism and support of the pelvic organs. The current Integrated Systems Model will be highlighted in this course to demonstrate its use for determining when to treat the thorax, when to treat the pelvis and when to train the various muscles of the deep system (i.e. transversus abdominis and/or pelvic floor) for the restoration of form and function after pregnancy.

Widening of the linea alba and separation of the recti, known as diastasis rectus abominis (DRA), may prevent restoration of both the appearance and the function of the trunk and women with this condition often ask whether surgery will help them. Currently, there are no guidelines for clinicians to know which patients with DRA are appropriate for conservative treatment and which ones will also require surgery. This course will highlight Diane’s research that led to clinical tests that reveal who can be treated conservatively and who will require a surgical intervention. Who to treat, who to refer and how to close the DRA were the initial questions that prompted a series of studies on this subgroup of postpartum women.

Restoring form and function of the abdominal wall and pelvic floor after pregnancy requires an understanding of how loads are optimally transferred through the entire trunk including the thorax, abdomen and pelvis. The Integrated Systems Model facilitates the clinical reasoning process for determining when treatment should be focused on the thorax, abdomen and/or pelvis and how the multiple systems (articular, neural, myofascial & visceral) are integrated to produce optimal strategies for function and performance. At the conclusion of this course, it is hoped that a broader perspective will be considered for the restoration of form and function after pregnancy for women with pelvic girdle pain, urinary incontinence, pelvic organ prolapse, and diastasis rectus abdominis.

Objectives & Learning Outcomes

• To understand how dysfunction in any area of the trunk can be a primary underlying cause or significant contributing factor to common postpartum conditions such as pelvic girdle pain, pelvic organ prolapse, urinary incontinence, diastasis rectus abdominis. To illustrate how the Integrated Systems Model  can provide a framework for knowledge organization and translation.
• Demonstrate and practice some key clinical tests for the pelvis, hip and thorax to determine whether or not a patient is using an optimal strategy for function & performance for their chosen task and when there are multiple sites of impairment, how to determine the ‘primary driver’ or impairment to be addressed first.
• Demonstrate the relationship between the primary driver (from 3rd thoracic ring to the hips) can impact resting tone and activation patterning of the abdominal wall AND the pelvic floor. External palpation of the PFM will be taught.
• Demonstrate and practice treatment techniques and movement training to release, align, connect & move the trunk/hips for restoration of form and function of the postnatal woman.
• To understand the behaviour of the linea alba in nulliparous vs postnatal women with diastasis rectus abdominis that suggests when surgery (abdominoplasty and recti plication) vs conservative treatment is indicated.

Clinical reasoning of multiple findings and manual/visual assessment and treatment skills are emphasized in this course with plenty of practical time/discussion devoted to these two clinical practice tools.

At the conclusion of this course, you will have new skills to assess function of the trunk (from the 3rd thoracic ring to the hips) and understand how various impairments impact both form and function of the abdominal wall and pelvic floor and thus the musculoskeletal, respiratory and urogynecological systems. You will understand how to design a multimodal treatment program (including education, manual therapy, neuromuscular release, and movement training) to restore function and performance with a focus on conditions specific to postnatal women.

You will also know how to assess and train the abdominal wall (with or without a DRA) integrated with the pelvic floor.

Preparation & Post-Course Support

To prepare for this course, watch the 4 hour online course in your account titled The Abdominal Wall and Diastasis Rectus Abdominis. Then review any anatomy of the abdominal wall and pelvic floor unfamiliar to you.  Post course support – You will also receive in your account several short videos of the practical material we will do together in -class.  These videos will always be available to you so that you can return to review the material over and over again. That is an effective way to learn! Watch them before, learn how to do them in class and then review whenever you need to.

Recommend Reading

Diastasis Rectus Abdominis: A Clinical Guide for Those Who Are Split Down the Middle is recommended but not required for this class.  You can purchase a copy here.