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. Non-optimal 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 Integrated Systems Model will be highlighted in part one of this lecture 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 (how to Find the Primary Driver).
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. Part two of this lecture will highlight Diane’s research that led to clinical tests that reveal who can be treated conservatively and who will require a surgical intervention. If you do consult a surgeon for your DRA and surgery is suggested please ensure that they repair both the anterior and posterior rectus sheaths and use non-absorbable sutures. A good repair is not just cosmetic, it is functional and requires proper restoration of anatomy.
Upon completion of this module you should be able to:
- Understand how dysfunction in any area of the trunk can be a primary underlying cause, or significant contributing factor, of common postpartum conditions such as pelvic girdle pain, pelvic organ prolapse, urinary incontinence, diastasis rectus abdominis
- Explain how the Integrated Systems Model facilitates the identification of the primary cause (Find the Primary Driver)
- Summarize the behaviour and morphology of the linea alba in healthy vs individuals with diastasis rectus abdominis and the current clinical research of Diane Lee on this topic