This course is open to all disciplines who treat/train postpartum women.
It is well known that the abdominal wall plays a key role in function of the trunk and that pregnancy and delivery can have a significant and long lasting impact. Postnatal suboptimal 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. These suboptimal strategies are highly variable, individual and task specific and thus require individual assessment and training. For some, the individual muscles of the abdominal wall require attention (release and/or isolation training) prior to training while others do not.
Diastasis rectus abdominis is very common in the obstetric patient. While most women recover both form and function of the abdominal wall in the postnatal period, persistent separation of the rectus abdominis muscles occurs in some. Rehabilitation has traditionally focused on exercises to ‘close the gap’ and reduce this separation. New data, and a controversial new interpretation, (Lee & Hodges 2016 JOSPT) support exercises that increase tension in the linea alba (regardless of what this does to the midline gap) to optimize the transfer of force between sides of the abdominal wall.
Objectives & Learning Outcomes
The aim over these 2 days is that by the end you will:
- Understand and clinically apply the anatomy of the abdominal wall including the fascial organization of the linea alba, rectus sheaths, abdominal aponeuroses, and their continuity/organization with the thoracolumbar fascia
- Have the necessary clinical skills to assess the recruitment strategy of the abdominal wall and the behaviour of the linea alba in response to verbal cuing for contraction, the active straight leg raise (ASLR) and curl-up task. In addition, participants will be able to determine the relationship between the posture/position of the thorax (individual lower thoracic rings) and pelvis on the presented recruitment strategy for a three tasks (response to verbal cue, ASLR and curl-up)
- Understand how to prescribe individualized treatment/training programs for restoring form and function of the postnatal abdominal wall
During these 2 days you will learn:
- The current evidence pertaining to the functional and postnatal abdominal wall
- The skills necessary for assessment of the abdominal wall (muscle recruitment strategies and behaviour of the linea alba in response to the chosen strategy). This will include tests to understand the relationship between the recruitment strategy and ‘twists’ between the thorax and pelvis
- How to treat and train to restore form and function of the abdominal wall
- To discuss the current clinical theories as to when a surgical consultation should be considered for repair of the linea alba
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