Part I - Lose Your Mummy Tummy DVD

My last month of pregnancy was more difficult than we anticipated.  Aside from the pain I consistently experience during the 2nd and 3rd trimesters and my diastasis recti, I was diagnosed with gestational diabetes.  My blood sugar was well-controlled and my baby was a good size until week 38, when I was told that baby was measuring at 40 weeks and my sugars were starting to go haywire.  As a result, I had to be induced by 39 weeks.

Fortunately, my baby boy was born perfectly healthy with no signs of hypoglycemia or jaundice.  Unfortunately, mommy suffered some injuries during the birth process and I was just given a clean bill of health and cleared for full activity yesterday. 

Mommy's little angel at 8 weeks

As a result, I will begin my Tupler Technique post-partum exercise program!  I will be watching the Lose Your Mummy Tummy DVD and using Julie Tupler's technique to help correct my diastasis recti and get back into shape.

Along the way, I will share embarrassing photos of myself and keep you informed of my progress.  Wish me luck, as with 4 little boys running around, it's hard to find quiet time to myself!

Here is my mummy tummy before starting the Tupler Technique:

Though this is embarrassing to show publicly, I'm sucking up my pride in trying to help other mamas out there!

Please excuse my topographical roadmap -- when mama is only 4'11", baby has nowhere to grow except straight out!  And after 4 pregnancies, this is what happens.  Hopefully, the next series of photos will look a lot prettier than this...

Partial Review of Perfect Pushing DVD

I haven't blogged for quite a while, but I'm back with an 8-week-old baby boy!

Welcome to the world, baby J!

My last month of pregnancy was more difficult than we anticipated.  Aside from the pain I consistently experience during the 2nd and 3rd trimesters, I was diagnosed with gestational diabetes.  My blood sugar was well-controlled and my baby was a good size until week 38, when I was told that baby was measuring at 40 weeks and my sugars were starting to go haywire.  As a result, I had to be induced by 39 weeks.

I had every intention of having a fantastic birth experience using the techniques learned from the Perfect Pushing DVD, but God had other plans for me.  My epidural worked a little too well and I was having a very difficult time pushing, so I was unable to put Julie Tupler's techniques into practice.  I ended up having a vacuum-assisted delivery and was literally one push away from an emergency C-section.

So here is a partial review of Perfect Pushing:

Pros:

• All the exercises are clearly explained as they are being demonstrated
• The exercises themselves are not difficult
• I like to think that using these techniques enabled me to make one final push to avoid an emergency C-section

Cons:

• I would have loved it if pregnant women of all shapes and sizes were shown performing the exercises.
• This is just my personal opinion, but the cover image of a baby being squeezed out of a toothpaste tube is a bit creepy to me.

Diastasis Recti (part 5) - Frequently Asked Questions

Does it hurt?
No, it does not hurt.  On a 0-10 pain scale, I would have to say that it's a 1 at its worst.  Before I was diagnosed, I would mention to my husband that my abs felt odd and that I wanted to take it easy.  But that has been the extent of it. 

 
If it doesn't hurt, then what does it feel like?
Other than feeling "odd" at times, I occasionally feel a stretching sensation in my abdominal region.  This sensation is similar to the stretching I felt during my first pregnancy, though it is more localized to my upper abdominal region. 

Does it look funny?
At this point, you can't really tell that I have diastasis recti by looking at me.  The only time someone can see anything unusual is when I move in a way that increases my intraabdominal pressure, such as coughing, laughing or performing a sit-up (which is not recommended -- it's just how my OB assessed me).  I will say that I can feel a gap between the two side of my rectus abdominus muscle, especially at the upper aspect.

I have seen photos online of more severe cases and though they can be a bit scary-looking (especially photos of the severe herniations), cases like those are rare.  If you receive proper care and support, that isn't likely to occur.  Of course, I have 14 more weeks of pregnancy to go, so I'm trying to stay calm during all this.  Doing my exercises and wearing my splint help boost my confidence.

I also will add that though I am measuring large for my gestation, the baby measured normal on ultrasound.

Diastasis Recti (part 4) - Research

Research Articles regarding Diastasis Recti

Here is a list of research articles about Diastasis Recti so that you can learn more about the condition and the various treatment options.  I am not endorsing any one treatment option and am just including the studies so that my readers can make informed decisions regarding their medical treatment.  Remember, everyone is different and everyone's Diastasis Recti can present differently.  Always consult your doctor first! 

from www.bodyalignpt.com

Diastasis Recti and Pregnancy

Ranney B (1990 Oct). Diastasis recti and umbilical hernia causes, recognition, and repair. S D J Med, 43(10): 5-8.
This article discusses how to recognize diastasis recti in post-partum women.  These women expressed a desire for post-operative improvements in firmness and function of the lower abdominal wall.  The article also discusses methods of recognition and repair of diastasis recti of varying severities.

Boissonnault JS, Blaschak MJ (1988 Jul). Incidence of diastasis recti abdominis during the childbearing year. Phys Ther, 68(7): 1082-6.
This study determined that diastasis recti occurred most often at the umbilicus (belly button).  There was a significant relationship between the timing during a woman's pregnancy and the presence or absence of a diastasis recti.  It was initially noted during the second trimester, but incidence peaked in the third trimester.  The researchers concluded that it is important to assess for diastasis recti above, below, and at the umbilicus throughout pregnancy.

Bursch SG (1987 Jul). Interrater reliability of diastasis recti abdominis measurement. Phys Ther, 67(7): 1077-9.
This study's goal was to provide data regarding the incidence and degree of diastasis recti, to describe the measurement system used, and to determine the interrater reliability of the measurements.  Forty women who were immediately post-partum were tested via palpation by four raters.  This measurement system was found to be unreliable among raters.  All 40 subjects had some degree of diastasis recti and the authors conclude that the incidence and severity of diastasis recti may be underdiagnosed and that a reliable method of measuring the amount of separation is needed.

Mota P, Pascoal AG, Sancho F, Bo K (1988 Jul). Test-retest and intrarater reliability of 2D ultrasound measurements of distance between rectus abdominis in women. J Orthop Sports Phys Ther, [Epub ahead of print]
This research study found that ultrasound imaging is a reliable method for measuring the inter-rectus distance at rest and during abdominal crunch and drawing-in exercises

Diastasis Recti Treatment

 Chiarello CM, Falzone LA, McCaslin KE, Patel MN, Ulery KR (2005 Spring). The Effects of an Exercise Program on Diastasis Recti Abdominis in Pregnant Women. Journal of Women's Health Physical Therapy, 29(1): 11-16.
This research study used the Tupler Technique and found that the occurrence and size of Diastasis Recti is much greater in non‐exercising pregnant women than in exercising pregnant women. 

Tadiparthi S, Shokrollahi K, Doyle GS, Fahmy FS (2011 Oct 20). Rectus sheath plication in abdominoplasty: assessment of its longevity and a review of the literature. J Plast Reconstr Aesthet Surg, 65(3): 328-32.  

The article concludes that plication (folding over and tucking loose tissue, then suturing it together) with non-absorbable sutures is long-lasting and durable.

Hickey F, Finch, JG, Khanna A (2009 Jun). A systematic review on the outcomes of correction of diastasis of the recti. Hernia, 13(3): 287-92.
Though it is primarily cosmetic, except in the case of herniation, there is high patient satisfaction after surgical correction of diastasis recti.

Palanivelu C, Rangarajan M, Jateaonkar PA, Amar V, Gokul KS, Srikanth B (2004 Jul-Aug). Laparoscopic repair of diastasis recti using the 'Venetian blinds' technique of plication with prosthetic reinforcement: a retrospective study. Aesthetic Plast Surg, 28(4): 189-96. 

 This was written by plastic surgeons, so they advocate surgical repair of diastasis recti for cosmetic reasons and to restore abdominal muscle function.  The authors state that use of a prosthesis is necessary to prevent recurrence.

Nahas FX, Ferreira LM, Mendes Jde A (2004 Jul-Aug). An efficient way to correct recurrent rectus diastasis. Aesthetic Plast Surg. 28(4). 189-96.

I need to get my hands on the full text of this study for all the details, but basically they conclude that the procedure of advancement of the recti muscles seems to be a reliable method for correcting recurrent rectus diastasis in patients with surgically repaired rectus abdominus muscles that were inserted laterally, near the ribs.

Nahas FX, Augusto SM, Ghelford C (1994 Jan). Should diastasis recti be corrected?.Aesthetic Plast Surg. 21(4): 285-9.
The researchers performed CT scans on patients who had surgical repair of their diastasis recti.  After 6 months, they had complete correction.

Asaadi M, Haramis HT (1994 Jan). A simple technique for repair of rectus sheath defects. Ann Plast Surg. 32(1): 107-9.

This study describes one particular surgical method that has shown no recurrence or herniation.

General articles regarding Diastasis Recti

Brauman D (2008 Nov). Diastasis recti: clinical anatomy.  Plast Reconstr Surg.  122(5): 1564-9.
92 abdominoplasty patients were studied and the researcher found that: the linea alba only stretches 1-2 inches, abdominal wall protrusions can be caused by distension of the entire abdominal wall, significant protrusions can occur without diastasis, and those with flat abdomens may still have a diastasis.

Repta R, Hunstad JP (2009 Jun). Diastasis recti: clinical anatomy. Plast Reconstr Surg. 123(6): 1885; author reply 1885-6. 
This is a comment regarding the article mentioned above.  I hope to find the full text soon because I'd love to know what everyone has to say about this!

Braekken IH, Majida M, Ellstrom Engh M, Holme IM, Bo K (2009 Dec). Pelvic floor function is independently associated with pelvic organ prolapse. BJOG. 116(13): 1706-14.

Diastasis recti may be a factor in pelvic organ prolapse.

Diastasis Recti (part 3) - Tupler Splint

I got a nifty package in the mail this week and was so excited when I saw that it was my Tupler Technique Women's Package!

I wore my splint for the first time today.  It was a bit tricky to put on the first time, but after watching the video on the Tupler Technique website, I was able to get it on.  Once on, it felt like a nice, tight bear hug.  I wore the splint on my family's outing to the zoo in 95 degree heat and I wasn't horribly uncomfortable and hot while wearing it.  

*Keep in mind that I am only 4'11" and short-waisted, so take that into account:

PROS:

•  Easy to don once you get the hang of it
• Comfortable to wear (I wore mine over a maternity camisole)
• My belly and back felt very supported while wearing the splint
• I did not experience any problems with the splint riding up or down
• Since it does not extend past the hips, I had no problem going to the bathroom or changing clothes while wearing it.  (though those would be opportune times to readjust the splint to ensure proper fit)

CONS:

• At $48, it can be cost-prohibitive for some, but seriously, the relief I felt was worth more than $48!
• Because I'm short-waisted, the arms of the splint would get bunched up if I did any sort of bending. (but I shouldn't be bending anyway -- good body mechanics, right?)  When this did happen, it was a little lumpy under my clothes.
• If you have your heart set on a white splint, they only come in size L and XL. 

Diastasis Recti (Part 2)

** Update 9/13/12 **

I just received an email from Helene Byrne with BeFit-Mom.  She sent me this link to a fantastic resource: Diastasis Recti or Abdominal Separation.  Other than providing an overview of Diastasis Recti, this site includes a list of movements that should be avoided and videos of exercises that pregnant women can perform to lessen the severity of the condition.  I've been performing pilates-type transversus abdominus bracing exercises and pelvic tilts in supine, which are similar to the first 2 videos which show exercises in standing.  I will start the exercises in standing tonight!

Diastasis Recti

It's always an interesting juxtaposition when the Physical Therapist becomes the patient.  Since becoming a PT, I've had to undergo PT 3 times -- once for a severe ankle eversion sprain, once for pregnancy-related sciatica and diastasis of the pubic symphysis, and once for a partially torn rotator cuff.  I now find myself back in the position where I will have to undergo PT for diastasis recti.

I am currently pregnant and noticed that when I coughed one evening, only the upper left portion of my abdominals contracted.  Intrigued (and a bit freaked out), I asked my husband if he observed the same thing, or if my vantage point of my swollen belly from a supine position was the culprit.  Unfortunately, he observed the same thing.  A week or so later, my OB-Gyn confirmed my suspicion.

If you've never heard of diastasis recti, it occurs (often during pregnancy) when the vertical line dividing the left and right halves of the rectus abdominus muscle (AKA linea alba) splits and the two sides of the muscle separate.  Fortunately, this can be treated with an abdominal binder and physical therapy.  In more severe cases, the diastasis can herniate, causing the pregnant woman's uterus to push through the opening.  In these cases, postpartum surgery may be indicated to repair the tear.

from www.diastasisrecti.org

Since I am not yet in my third trimester, I just have to sit and wait and hope that nothing gets worse.  In the meantime, I am using good body mechanics, doing some simple exercises, wearing a belly support in an attempt to approximate the two sides of my rectus abdominus muscle as much as possible, and praying that I don't experience the joy of a herniation.  If a woman experiences a painful herniation, insurance should cover the surgical repair.  (unfortunately, they will most likely cover stitching the two sides together, not a tummy tuck -- darn!)

After baby comes, we'll have to see if I need surgery, or if I can just go to PT.  After performing extensive research, I decided that I want to use the Tupler Technique to help repair my diastasis.  I have the program on my Christmas wish list so that I can be ready to go right after baby comes in January!  I briefly considered becoming licensed, but realized that flying back and forth between California and New York is not feasible for me, especially in my present condition.

As my journey progresses, I will update my condition and how I have dealt with this.  I want to be able to help other women with diastasis recti make the best decisions they can regarding their wellness. 

** Update 9/13/12 **

I just received an email from Helene Byrne with BeFit-Mom.  She sent me this link to a fantastic resource: Diastasis Recti or Abdominal Separation.  Other than providing an overview of Diastasis Recti, this site includes a list of movements that should be avoided and videos of exercises that pregnant women can perform to lessen the severity of the condition.  I've been performing pilates-type transversus abdominus bracing exercises and pelvic tilts in supine, which are similar to the first 2 videos which show exercises in standing.  I will start the exercises in standing tonight!