(upbeat music)
- Welcome my friends to the "Bob and Brad podcast,"
produced by Bob and Brad,
the two most famous physical therapists on the internet.
I am Bob, who is
and I'm exactly one half of the Bob and Brad team.
Today, I'm gonna be joined by our guest,
Dr. Anuja Mathew
She's a physical therapist
with a Doctorate in Physical Therapy
and a Master's degree in Physical Therapy.
She also is certified in orthopedics
with an Orthopedic Clinical Specialist Certification,
and that's earned by the
by only 5% of the physical therapists across the country.
She's also trained in women's health and pelvic floor.
She's been in her practice for 10 years.
She's kind of an expert on women's health conditions
such as urinary incontinence, pelvic pain,
pubic synthesis dysfunction, diastasis recti,
prenatal and postnatal rehabilitation.
So, we'll get into a lot of those subjects today.
Please join me in welcoming Dr. Anuja Matthew.
I wonder if we could switch topics now,
and we could start talking about
the topic of diastasis recti?
- [Anuja] Mm hmm, yes.
- It's called diastasis recti or rectus?
- So it's diastasis rectus abdominis,
that's the whole diagnosis of it.
But people also call it diastasis recti,
or DRA, or
you know, most women will call it
the mommy tummy or the pooch that they have--
- Gotcha.
- Postpartum, so there, they might connect more to that.
- Well, so
who can get it?
I take it obviously pregnant women can get it.
- Well,
believe it or not, I also have a few men that I treat
who have diastasis.
Yes.
They usually come in with low back pain,
not knowing obviously, that they have diastasis.
And they usually, when I see them exhale,
when assessing them, I tell them that, yes,
we assessed and we check for it and they have diastasis.
A lot of heavy weight lifters
or people who work out at the gym a lot.
But coming back to pregnant women,
yeah, they are more prone to having it.
I would say around maybe 60% of pregnant women
will have diastasis,
just because, you know,
your belly is stretching out so much.
Your muscles are stretching out so much.
So the rectus that's joined in the middle,
when your belly is growing, it just kinda,
the connective tissue that's there is just stretched out.
- And that's, pretty much the definition..
I mean, we didn't really provide a definition
for those of you who are listening or watching.
That would be,
I know there's a test that pretty common that you lie--
- The test is pretty common.
It's very easy for anyone to do at home.
And I do recommend most postpartum women
to test this themselves.
It's very important to know whether you have it or not just,
you know, to start with some exercises
or precautions that you can take.
It's a very easy test.
You lay down on your back,
back is relaxed and flat.
You bend your knees, you take three fingers, just like that.
Put it straight down on your belly button.
And you're gonna check three, four different levels.
So you can start from above your belly button.
You just keep your fingers down there.
And all you do is lift your head and shoulder up.
A little bit of your shoulder.
You're not doing a curl up,
you're just lifting it up a little bit from the ground.
If your fingers dip in, then you have diastasis.
It also depends on how many fingers dipping
like sometimes it could just feel like one finger
dipping in, sometimes all three would dip in.
All it means is how wide the opening is or the diastasis is.
- Gotcha.
So,
well, I've gotta write down my questions here.
And you said something about prevention.
Can you, help prevent it?
- Not, I mean, if you're pregnant,
there are very few things that you can do
to really prevent it, but yes.
If you have good core strength or
you're using good activation techniques,
not just doing crunches,
that's not just building your core strength.
Actually using your
what we call the transversus abdominis muscle
or the multifidus or, and the diaphragm all together.
If you're able to activate that throughout your pregnancy
that could definitely help reduce
the chances of getting diastasis.
The other thing that I do recommend,
especially if you're an athlete
or if you're working out, if you're a runner,
to try Kinesio taping
for the belly that's growing.
So it's, a simple technique.
You can also find it online.
You just put two strips of the Kinesio tape
next to your belly button starting from where you feel
the starting of your belly till the end.
And then you just go across horizontally with each strip
in one direction then the other.
Just kinda bringing it together.
And honestly, this can be done either
during pregnancy when your belly is growing,
and even postpartum it helps.
To just to kinda keep it together
just or at least get their feedback
to bring the muscles of the belly together.
- That's a fantastic,
you know, again.
Not my area of expertise and, that's very helpful.
I, you know, it's
one that's easy to apply, and.
- Yeah, - [Bob] That tape can--
- And you can definitely do it yourself.
Yeah, it's very easy.
There's no positioning of any muscle required.
Something you can practice at home by yourself.
- With diastasis recti, is there,
are there complications or health implications of it?
I mean...
- Yes, definitely.
I mean, if it gets worse, if it's really bad
you could get a hernia or an umbilical hernia that you have.
These patients obviously then will require surgery
'cause just,
treating them with physical therapy is not gonna help.
The other symptoms that you would notice is low back pain.
Most people come in with low back pain
because your diastasis,
your muscles that are actually supporting your spine
they don't have enough tension anymore.
So when you stand, you walk,
it's all gonna strain your lower back.
So a lot of pain people come in with low back pain
and they have diastasis.
Hernia is one.
The other thing people notice is constipation,
indigestion, they feel bloating right after they eat.
Basically, you know,
all your organs are behind this muscle that's there.
And it could, actually make it
either push out when you're too full,
or your digestion is gonna get affected
because it's not moving the way it's supposed to
because there's not enough tension there anymore.
- It makes complete sense.
Your, abdominals are kinda your natural binder
for your back. - Yes.
- You got a cut in your binder,
it's not gonna provide support, but
it's interesting that you mentioned this now.
I know a guy who I think had it, you know?
And he (laughter)
t-shirt even, and.
- Yeah, a lot of men, they think they have a beer belly.
Most of them probably have diastasis.
- Right.
Yeah, it was
the strangest thing I'd seen, so.
So now,
can you describe some of the exercises that you do
like postpartum?
- Yes, so the first and foremost thing
I should talk about is,
the main thing to control
is the intra-abdominal pressure that's built up.
And the best thing to take care of this
is to do diaphragmatic breathing or relaxation
or the right technique of breathing,
which will avoid creating
this increase in intraabdominal pressure
trying to push things out more.
So, definitely start with diaphragmatic breathing.
It's the easiest thing to do.
All you do is when you breathe in
you breathe in all the way in to your belly.
Feel the air go down to the bottom of your belly.
And when you breathe out,
you imagine breathing out of blowing out a candle, like.
When you're doing that,
you're actually also activating your transverse abdominis,
which is one of your core stabilizers
or your primary core muscle.
So you can do this maybe once a day
maybe 10 or 15 repetitions.
You don't go crazy with it.
You're not doing it all day,
just because it's a relaxation technique.
You're just doing it 10 to 15 times.
Deep breath in through your nose,
breathe out,
through your mouth, like you're breathe
like you're blowing out a candle or blowing into a balloon.
That's one of the things.
- I imagine what you're trying to prevent is,
someone who's more of a chest breather.
They could have abdominal tight all day.
- Yes. - [Bob] Is that correct?
- Yes.
Also someone who's a chest breather
doesn't have enough excursion of your diaphragm,
which also causes a lot of abdominal tightness
and wrong recruitment of their muscles, really,
when you're breathing in and out.
The other thing that you mainly do for diastasis
is a head lift with bracing.
So you're lying down in the similar position
that you're testing your diastasis,
you're flat on your back.
You have your legs bent, your feet flat on the floor.
You can either use your hand to approximate the
to belly of your diastasis or your rectus.
Or you could use a towel wrapped around your waist
to kind of pulling it almost like
a corset or a binder that you make.
You could pull it,
not too tight that you're actually strangling your belly,
but just enough to approximate it.
And then you do the same thing that you did for the testing.
You lift your head up and a little bit of your shoulders up.
And that's the most important exercise for your diastasis.
You're bringing it to - How many times
do you repeat that?
- You could do it 10 to 15 times
each time holding for about three to five seconds.
Make sure when you're doing this,
you're not holding your breath 'cause that's
exactly the opposite way of what we're trying to do.
- Oh sure.
- Holding your breath will just increase
your intraabdominal pressure more.
So you're breathing out when you're coming up.
And ideally, anyone could breathe out
probably four, five seconds.
I would say, just hold it there,
till you can completely breathe out and then you go down,
take the normal breath and then repeat it.
- So you could said you could do this with your hands too?
You could-- - Yeah.
At the clinic, I usually have patients
just use their hands like at the belly,
you just bring them together.
You feel the muscle working,
you feel the belly coming together,
the belly of the two rectus coming together.
You can do it that way too.
The ideal way they say is to do it with a towel.
But I really found that the patients responded well
with them using their hands to bring it together, just.
- 'Cause then they're getting the feedback too.
- Yeah, and they can feel that muscle.
The other thing with diastasis is,
we're not trying to close the gap.
We're not trying to bring the two muscle belly together.
All we're trying to do is
increase the tension in the muscles.
So when you have to use it, it's not loose and elastic.
It now has more tension in it.
So along with,
yeah, so along with your rectus,
you also need the muscles around it to have enough tension.
So definitely add more core strengthening to it.
And also some of your oblique strengthening to it.
And I would say if your diastasis is really bad
definitely see a PT, but
at least start doing like the basic things that you could
with breathing and the head lift technique.
- Do you do some side planks or,
do you have a go-to for--
- So,
planks, it's a good question.
With planks, usually when you are pregnant
and doing a full plank
could actually put more strain on your belly,
and could maybe worsen your diastasis,
there's not enough research on that yet.
So I cannot tell you for sure.
But we do use a modified plank technique
where you put your knees down and you go into a plank.
- Gotcha.
- And going into a side plank, similar way you put,
you start with your knees down and going into a side plank.
Postpartum, obviously your muscles are weak,
so you don't wanna jump in
right into doing all the heavy stuff.
So start with really,
really basic stuff
where you're just doing gentle core activation.
You can slowly go to the modified side plank,
modified plank and then eventually progress
to a full plank in the side plank.
- Gotcha.
Well, do you feel, I mean
I don't know if you track this (mumbles)
but what's your rate of success with the diastasis recti?
- So, I know I said that we're not trying to close the gap
but I have seen patients
if they have like three finger distance
if it has come down to two or one finger.
Which is great,
which to even get down to that is a lot.
But it also takes a lot long time,
a lot of dedication, a lot of homework,
from the patients as well.
And when I say long time,
it could be anywhere from eight to 12 weeks
or even beyond that.
That's for any muscle.
- Sure. - [Anuja] Yeah.
- You almost need a fitness minded person to
- Yeah, to,
yes, to get to that.
But I have seen good success and good results.
- Is there, I, again,
I'm sorry, if this sounds really ignorant, but
is there any soft tissue work you do on it
as far as the scar tissue there or?
- So, not really working on
the diastasis that's stretched out,
but visceral mobilization really helps.
It's a soft tissue.
It's not a mobilization of your soft tissue
but your viscera, that's in your abdomen.
That helps also do some work on your obliques
and your psoas.
So release in that area more than releasing the scar tissue.
The scar tissue release comes if you have a C-section.
Then you definitely work on that scar tissue
and you release that
because that's gonna have adhesions
to your surrounding tissue.
- With the visceral adhesions,
will that be a source of pain sometimes?
- No, only because
only because your viscera
is challenged so much with the diastasis.
As I said, with all your organs pushing out and
there being intra increase in triabdominal pressure.
So visceral mobilization could have,
with some of these patients,
also if they have an issue with constipation
so you can at least address that with the diastasis.
So, not really working on the scar tissue of the diastasis.
Not something-- - Gotcha.
That makes sense.
That makes complete sense so,
really found it surprising, the whole back pain issue
but it makes so much sense that.
- Yeah, most men they're like,
"But I, how could I have this?"
- Yeah, right yeah. - [Anuja] I wasn't pregnant.
- Yeah.