♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
(upbeat music)
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Keep your distance there, Brad.
- That's right.
- Today we're talking about diastasis recti,
what is it, how to fix it.
This is science-based.
We're not just shooting from the hip here, Brad.
We're knowing what we're talking about, right?
- Well, that's right.
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- Say no more, Bob. - All right, I won't.
Brad, start up.
- Diastasis recti abdominis.
This is something, I'm gonna refer to it as DRA
so we don't have to spit that big word,
you know all about that stringing words up.
But we have a number of people over the years say
we need to get some information on this.
And we haven't been ignoring you, we kinda have.
But anyways, here it is, we've got the video.
- Well, somewhat, I suppose we didn't really feel qualified
being that we've never had a baby,
and we've never been pregnant.
- Right, so let's just do the, you know, what is it?
What is it, Bob?
It's a vertical separation of your abdominal muscles,
right where I have this yellow tape, okay?
It can happen to males or females.
- Oh, it can? - Yes.
I actually had a patient, he's was in his 70s,
and he had it, and every time he had laughed
or tightened his belly muscles,
boy, I popped right out, right in this area and--
- Why did he get it, do you know?
- I don't remember, Bob, it was a long time,
but I clearly remember this!
He wasn't in for that treatment.
He didn't care, it didn't bother him, and he lived with it.
- Okay. - But oftentimes,
most commonly, women have it with the birthing process.
It separates, and then obviously it's not attractive.
- Visually displeasing. - Right, exactly.
Plus, you know, it can cause problems if,
'cause the internal intestines and organs,
soft tissue comes out and you get pinched,
and there's issues.
So we wanna correct it if possible.
You can wear a corset or a brace.
We're not gonna talk about that.
- A type of girdle?
- Yeah, right. - Yeah, okay.
- We're not gonna talk about that,
but that option is there.
We're talking about physical therapy exercises.
So what I wanted to find out was,
how successful is this in the studies?
So I did a little research, and I went
to the Journal of Women's Health Physical Therapy.
- Very good.
- 2012, volume 36, and there was a study done there.
There was 296 female subjects after they had given birth,
and they had DRA.
They did four to six weeks of exercises,
and the primary exercise was to tighten up
and strengthen the transverse abdominis muscles.
That's the muscle where the fibers go this way.
And we're gonna show you-- - Like a belt, almost.
- Right, exactly, like that corset belt
that you can just put on and use that as oppose to it.
After four to six weeks, the results were of success
amongst all the subjects.
From 41% success, I'm not sure,
I didn't look into the details
how they came up with the exact numbers.
41% successful is a low number,
and some of 'em had 100% success.
In other words, things totally--
- You know, everybody had success.
- Right.
- But some of people only had like 40%,
which is still pretty good. - Right.
- And others had 100% success, which is great obviously.
- Yeah, wonderful.
So, you know, this is not a guarantee.
- In other words, it worked. - Right.
- And you know, I like it when they do these studies
with a lot of subjects.
- Right, yeah, you get that. - So they're trying 96, right?
- So three things, though,
that you need to follow these three rules.
Number one, you need to have the okay from your doctor.
- Right. - Okay.
Make sure that everything's gonna be okay.
Number two, with these exercises I'm gonna show,
there should be no pain.
Maybe some muscles, your muscles might get sore,
muscle soreness, but you should have no pain
while you're doing it,
or as a result of it after you get done
and all of a sudden you start feeling some unusual pain,
then you cannot continue and need to go back to your doctor
and find out what's going on.
Also, when you do the exercise,
here, I've got my yellow protrusion area here,
you need to be aware, and if anything protrudes out,
you get the little bulge there,
you cannot continue the exercise.
You have to maintain the integrity
of your abdominal muscles,
keeping everything in where it belongs.
- So that's the key?
- Right, so you're training those muscles.
There's a lot, it's a lot of biofeedback,
a lot of visual feedback you can use.
You can touch, you can take a,
well, I'll be laying on my back for these exercise.
You might have to use a mirror so you can see it,
but you can lift your head up.
So shall we continue, Bob?
- I like the idea too, like you said,
to actually, some tactile--
- Right, or palpate - Palpate, right.
- In other words, to just feel it.
- Right, there you go. (laughing)
- All right. - You want a pillow, Brad?
- No, Bob, that's all right. - All right.
- I appreciate you offering.
So we're gonna start in a supine position.
You can do this on your bed,
probably a firm surface would be best.
- [Bob] Supine position means he's laying on his,
lying on his back.
- There you go, Bob.
Hook lying actually,
so you're gonna bring your feet up like this,
this is the hook lying position, okay?
Now, to get the transverse abdominis muscles to fire,
what we're going to do or contract,
you're gonna think about doing a posterior pelvic tilt.
So I'm going to do this.
If you put your hands under your lumbar spine
and you think about squishing your fingers,
that will give you that posterior pelvic tilt.
So you get that to push down.
- [Bob] You're lessening the arch in your back.
You're making it less prominent.
- And then think about your belly button going down
in towards your spine, that lumbar spine.
And then, suck things in
so that in goes up into your rib cage,
your stomach goes up into your rib cage.
And while you're doing all that,
you need to be aware of what's happening with your DRA.
Is it staying in where it belongs?
If it is, that's wonderful.
You'll do that and hold, and then you're gonna relax.
That's one contraction, you can do it again,
taking your time, this is--
- [Bob] How long do you hold it, Brad?
- You can just hold it one to three seconds.
- [Bob] Okay, so not very long.
- Yup, the whole idea is training those muscles.
Tilt, bring it in, suck it in, and squeeze and relax.
You know, monitor with your fingers.
If you had a mirror, you know,
if I had a mirror right here, you could use that
or simply look up, but it's a little uncomfortable
on the neck muscles after awhile.
- [Bob] I would think, though, just using your fingers
would give you feedback. - Right, yeah.
I think we're gonna have a personal preference there.
- [Bob] Sure.
- All right, now, you do 10 of those, okay?
Now, after you those for a few days,
you can do them daily, you can do them more than once a day,
but when you feel comfortable
getting the muscles to contract the way you want them to,
you can feel the muscles too as well as the DRA protrusion,
or the lack of it, hopefully.
Then all that is done,
then we're gonna go to the next phase, okay?
So we're gonna do the same thing,
posterior pelvic tilt, in with the belly button
and up into the rib cage.
And then we're going to take the right leg,
the left leg stays in this position,
and we're gonna go up into a straight leg raise.
It's about 45 degrees that you'd,
you know, you don't have to measure it,
but about to here, and then you're gonna go down.
And while you're maintaining it,
so we're taking a static exercise and adding some movement,
so it starts to relate to real-life scenarios.
And then you just go up and down
while maintaining that core posture
with the proper closure.
- [Bob] And if you're not able to do it,
you're probably not ready for this one yet,
right? - Right, exactly.
- [Bob] I mean, if it causes the protrusion
or if you're just not able to do it.
- Exactly, and you can do both legs, obviously you want to.
If this is too hard,
but you can just go out to here and maintain the closure,
then just start and do that, okay, 10 times on each leg,
and then the 45 degrees, okay?
And then, you're gonna work on that for a few days
until you can consistently hold it.
Now, it's gonna be very difficult,
particularly initially after you have had,
obviously, Bob and I can't relate to having babies,
but we've had wives who had babies,
and we've got feedback that way.
So those muscles are gonna talk awhile to tighten up.
So that, you know,
that's why on the study, it was four to six weeks
that these exercises--
- [Bob] Patience, patience, patience,
you may have to work on the first exercise
for quite awhile before going to the second one.
- Right, exactly.
And you can continue, and if you,
once you get better, again,
do all the steps again, and you can go to both feet out,
which is quite a bit more aggressive.
With that, you can add some flutter kicks in.
We're trying to introduce some movement
while you're doing this as is when you're on a daily life.
Okay, so that's all I'm gonna show today, Bob.
- [Bob] What's the third exercise?
I thought there was a third exercise, a static crunch?
- Oh, gosh, thank you, Bob!
As I'm actually doing it 'cause when you're up like this,
I'm looking here, then you can do the same exercise.
The can do the variations here or just alternate.
- Oh, so that's what you mean by static crunch.
- Right. - You're actually just
lifting the head. - Right.
- You're not curling too much,
but just kinda moving it straight up as much as possible.
- So it works the muscles a little bit harder.
- [Bob] Sure.
- Ooh, I can feel my six pack, Bob.
(laughing)
- We'll have to see, we'll have to verify
that whether there's six there or not
'cause there might be only three or two.
- And actually, you do that.
There is more advanced exercises,
as far as doing this while you're standing,
so that when you're moving around--
- So you carry it over from supine to standing?
- Right, to everyday life. - Sure, gotcha.
- But we're just gonna take it that far today, so.
Very good, I think that it's, oh, by the way,
if you're having problems with it, if there is the pain,
you may have to go to a physical therapist
if you're really having problems with the feedback
and getting things to close up the way it should be.
So, very good, good luck with your thing,
with the exercises, and enjoy.
- Thanks for watching.
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