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Diastasis Research- Geeking out!

Today I had the amazing opportunity to participate in a research study on Diastasis recti. The study was done by the very prolific Diane Lee, and hosted at Physio Excellence in Toronto. My colleague Samantha from Core Expectations was also a participant. I was geeking out on DR with the best! :)

I was the first participant studied. I was told that Diane wanted to take ultrasound images of the linea alba during functional movements, specifically in clients who had rehabilitated a DR with the "T" technique. I was thrilled that the core assessment and analysis was so thorough and lasted 2 hours. I learned a lot today!

We began with a general postural assessment. Diane described me as "well balanced" which surprised me because despite being fit, I tend to feel generally out-of-whack in alignment as I notice offsets when I exercise. I proceeded to pass the weight load transfer test (which I haven't passed previously) and was feeling pretty good about my functional form. Diane then noted that my pelvis was twisted to the L. She looked at my thoracic spine and yes, I am locked up on the L side. She adjusted my rib position and lifted me, twisting me to the R. She asked me to relax my shoulders and I felt beautifully tall and uncompressed. She then removed her fingers from my ribs and what happened to me was so very impressive I will never forget it. I literally sank into my L hip and slowly twisted to the L like a corkscrew. I suddenly felt light headed and nauseous; I started to sweat and had to sit down. I told her I felt very unwell and drank some water. She coached me to do some alternate nostril breathing- in one side and out the other- to reset my CNS.

Yes go figure- the CNS distributes through the thoracic spine and mine is taking a beating. I am feeling pretty out of whack in the nervous system- pretty geeky stuff I know!

Diane performed another series of seated tests with my arms extended in front resisting movement. Without core cuing I could resist lift by pushing down, but had no strength resisting when pushing up. I had strength to resist towards the R but not the L.  I appeared to be vulnerable L2 to L4- lumbar. When I cued my core my posterior stability and strength improved dramatically.

So why is this happening? Through ultrasound we began to look at how my muscles were recruiting. It was fascinating to see my muscles layered- assessed as lean "clean diet" muscles visible as very black (no junk in them Diane said!), my connective tissue had good collagen which appeared very white. My abdominal fat wall was thin thin thin :) All good stuff. Externally we could feel that my proximal linea alba (top) had great tension. There was laxity below my navel. I know I struggle to connect to my TVA which surprises me considering I used a very transverse-focused exercise program to rehab my DR. As I recruited my core with pelvic floor contractions we could see on the ultrasound that my TVA did not extend very low and was not being recruited on the R side.

Moving down the abdomen towards the pelvic floor we looked at my pelvic organs and their placement- how is my PFM doing at supporting everything? My uterus was nice and high :), my (full) bladder appeared asymmetrical. As I recruited my core I appeared to have a good contraction and lift, but the R side was not releasing, resulting in asymmetry.

Back to the transverse- through a series of different cues I was able to recruit the R TVA. The cue that worked for me was to imagine a cable between my hip bones in the front and pull my hips together. That's my TVA homework- wake up gimpy R side.

What about the linea alba? How was it behaving through all of this? Interestingly I learned that the linea alba widens when it creates tension. My DR measures 2mm. Current protocols define a DR as 2cm or more, so I fall within the "normal" range. Without core recruitment the laxity in my CT during funtional movement (crunch) was visible on ultrasound. With core engagement the CT widened to 26mm with tension, so it is functional and behaving as it should WITH proper core cues.

The point of this work is to retrain the core to fire with synergy through the use of cues with exercise. This will restore autonomic core function to support daily movements and activities without cuing. I admitted I miss crunches and Diane did not tell me I could never do them. She felt I was strong enough to perform the exercises and with 4-6 weeks of dedicated work I could perform the movement with enough function to support my back and not compress my spine. I take this as great feedback on my level of strength. She gave me the exercise homework and I will do it! I will also visit Physio Excellence a few times to fix my thoracic rotation because my CNS/mojo/chi needs to be flowing! :)

When I was leaving Diane was summarizing and made a comment about how I inflate my ribs prior to inhalation and it's messing a bit with my recruitment. I was confused and when I spotted myself I realized that I was indeed opening my rib cage with my diaphragm prior to inhalation! It was a nanosecond but the movement was there! Diane explained that the diaphragm is a muscle not only involved with breathing, but also as a core stabilizer and a mover. I corrected my form. I don't seem to do it when I am dynamic, as in during exercise- only when I am stationary focusing on form. Go figure. Today I learned I can (and do) cue to palpitate my diaphragm without involving breath. Who knew?

I am officially geeked out! I had such a fun, interesting morning. I was absolutely grateful to spend 2 hours with 3 very knowledgeable women discussing the finer points of core training. What a tremendous learning opportunity. The research on DR is still so limited; the ongoing work that is being done in the field is so very important and I am honored to contribute to it!

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