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!

Pediatric PT Toolkit - Footstool

from www.ikea.com

 A simple footstool is a great tool to include in your pediatric therapy toolkit.  I use mine all the time!

Here's how I use a footstool in my pediatric PT sessions:

•  For children who are just learning to sit with trunk control, I like to have them 90-90 sit on the stool so that they can practice sitting without trunk support, but with proximal stability.
• A footstool is a perfect height for small children to use to support themselves as they practice tall kneeling.  I have found that using a coffee table just encourages them to pull to stand.
• I will have children practice seating themselves on the stool to develop body awareness and motor planning skills.
• I have children step up onto the stool to build lower extremity strength and to help them learn how to step up onto curbs and up stairs.
• I have children step down off of the stool to work on eccentric control of their lower extremities so that they can step down from curbs or stairs safely.
• When families don't have stairs in their homes, I use a footstool and a piece of study furniture to mimic 2 steps.
• I'll have kids stand with one foot on the floor and the other on the stool to introduce single-limb stance.
• When testing with the Peabody Developmental Motor Scales - II, or when practicing jumping down from an elevated surface, the footstool comes in handy.  If you can, try to find one that is 7 inches high (or as close as possible) so that you can use it for standardized testing.

Ikea has a nice, sturdy, inexpensive (only $4.99!) footstool, but if you don't have an Ikea near you, footstools are relatively easy to find.  I keep mine up-side down in my therapy bag so that I can nest my other goodies inside of it.

This one is nice because it folds, but it's 8 1/2" high, so you can't officially use it for the PDMS-II.

 

This one is nice and safe and sturdy, but a bit pricey.  It's only about 6" high, so again, you can't officially use it for the PDMS-II unless you place it on a 1" high surface first.

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!

 

Dehydration: Signs, Symptoms, and Prevention

In my practice, especially with the geriatric population, I frequently notice that my patients show signs and symptoms of dehydration.  During this summer's heat wave, I have noticed this a bit more frequently and try to ensure that my patients drink water during and after their therapy sessions. 

Since the body is composed mainly of water, maintaining proper hydration is vital!  Severe complications of dehydration include seizures, heat exhaustion or heat stroke, kidney failure, coma, and ultimately death.  (Scary, I know!)

Signs and Symptoms of dehydration include:

• lack of tears
• decreased blood pressure caused by decreased blood volume
• dizziness or lightheadedness
• fatigue
• muscle cramping
• decreased skin elasticity (often called "tenting")
• dark urine
• constipation
• dry mouth
• thirst 
• sunken fontanels (in infants)

Obviously, the signs and symptoms listed above can be signs and symptoms of a number of medical problems.  However, if you or someone you know presents with several of the signs and symptoms listed above, try increasing your water intake and see if your symptoms improve.  However, if you suspect that someone is dehydrated and he or she demonstrates altered mental status, lethargy, and/or coma, call 911!

Dehydration can be formally diagnosed in many ways.  Core body temperature can be an indicator of dehydration, as is lower blood pressure (hypotension).  Blood tests and urinalysis also are helpful in diagnosing dehydration.  

Here is a list of ways to prevent dehydration from the Mayo Clinic- Dehydration: Prevention.

Fortunately, in most cases, dehydration can be easily treated by giving clear liquids, either by mouth or by IV infusion.  Clear liquids include water, fruit juice, sports drinks, clear broth, popsicles, or gelatin.

Lymphedema

from www.summitmedicalgroup.com

 Lymphedema (AKA Lymphatic Obstruction) is a condition in which the vessels of the body's lymph system fail to drain lymph fluid properly, which often causes swelling, or edema, in the affected extremity.  Lymphedema occurs when lymph nodes are removed or enlarged, often as a result of cancer treatment.  It is also caused by injury, skin infections, and congenital abnormality of the lymphatic system.  

A Physical Therapy evaluation of lymphedema includes taking a detailed history, performing a functional assesment, measuring the circumference of both the affected limb and the opposite limb, assessing the grade of the edema, measuring active/passive range of motion, and assessing strength.  Treatments for lymphedema often include manual lymph drainage, therapeutic exercises, compression, and patient education.  

an example of upper extremity lymphedema

To prevent the development of lymphedema, or to prevent the condition from worsening, it is vital that patients comply with lymphedema precautions and perform proper skin care:

Precautions

• Avoid a tourniquet effect on the affected limb, avoiding elastic bands or ACE bandages for compression.
• Avoid putting a blood pressure cuff on the affected limb.
• Avoid temperature extremes.
• Avoid hot water, saunas, hot tubs, and heat packs.
• Be careful when cutting your nails.
• Avoid cutting your cuticles during manicures or pedicures, especially at a salon. 
• Avoid needle sticks to the affected limb.
• Avoid cuts, insect bites, burns, and other injuries to the skin of the affected limb.
• Do not lift more than 5 pounds with the affected arm unless wearing a compression sleeve.
• Do not perform prolonged, strenuous resistance exercises unless wearing a compression sleeve.

Skin Care

• Keep your skin clean.
• Keep the skin of the affected limb moisturized with low pH lotion.
• Wear sunscreen when outdoors.
• Wear insect repellent.
• Wear gloves when cooking and gardening.

I have the privilege of working with a PTA who is a Certified Lymphedema Therapist.  She has a fantastic talent and her patients love her!  If you're in southern California and need a CLT, contact me! 

Here is a link to a video about rehabilitation after breast cancer surgery: http://www.cnn.com/video/#/video/health/2012/10/10/breast-cancer-rehab.cnn.