Why Your Orthotics Don't Work

Many of us have had some experience with orthotics. Most of us have purchased a cheap, off the shelf variety that we purchased on a whim or were suggested to us by a shoe salesman. Others of us have purchased the expensive, over the counter, "customizable" variety that you heat up in the oven and step onto as they cool, making a mold around your foot. No matter what route you took to get there, I'm guessing that your symptoms either worsened, lessened temporarily, or moved to another place in your body. 

Why? All of those orthotics are simply putting a band-aid on the problem and may not be any better for your body than if you were walking around barefoot all day. Any time you chose a shoe and what may be going inside of it, your anatomy, your compensatory patterns, and your pain need to be taken into account. Otherwise you're either putting your foot in a different, but still not properly aligned position. This will either increase pain immediately or after some time as your body adjusts its compensatory pattern and develops breakdown.

No matter where your pain is, the position and function of your entire body needs to be assessed to see where the breakdown in your movement is. The site of pain is not always the site of the dysfunction. For example, someone may be experiencing neck pain and headaches because they keep all of their weight on their toes and lock their knees. This moves their center of gravity forward causing their hips to move forward while their shoulders lean back to rebalance themselves. The head will then move forward so that they can see the world in front of them. This places excessive stress on the neck muscles and will lead to pain. 

One major theme to proper position and mechanics of the entire body is the ability to sense and feel where we are in space. Our body must be able to feel where the weight is in our foot in order to tell us where our body is on the ground. Proper positioning of the ankle joint is also essential so that our proprioceptors can tell us, again, where we are on the ground and how we are moving on it as we walk. If we cannot accurately sense and feel where our body and feet are, we develop compensatory movement strategies which eventually lead to pain. 

Cheap, over the counter orthotics are a "shot in the dark." The chance that the amount of arch support that is built into the orthotic is actually the amount we need is unlikely. The "customizable" over the counter orthotics that are heated in the oven simply support your foot in it's improper position. This is also how corkbedded shoes work. They are typically very comfortable, but as they support you in your dysfunction, your compensatory pattern will only worsen and you will eventually experience you pain again. Rigid orthotics do not work because they do not allow your foot to change from a "loose bag of bones" that is needed when your heel first strikes the ground (this is needed for your leg to appropriately absorb the force the ground exerts on you leg at initial impact) to a rigid lever that is needed when you're pushing off of your toe of your back foot. It also doesn't allow your foot to feel and sense and change in pressure as your weight moves in your foot. 

What your body needs is to sense and feel the floor. The first line of attack to achieving this goal is to be sure that you are wearing the approparite shoes for your feet. Some people need more guidance for their foot while others need the motion of their foot to be controlled as they walk. If appropriate footwear will not solve the entire problem (likely to due a structural change in the foot or ankle from surgery, fractures, arthritis, etc), orthotics may be appropriate.

The orthotics made at Integrate 360 are made of a dense foam and are customized to each of your feet. We take measurements of the foot and ankle, pictures of the alignment of the foot in relation to the lower leg, and impressions of your feet. The orthotics are made by Dr. Paul Coffin with respect to your PRI rehabilitation goals. Once you receive your orthotics, they will have been made to support your foot/ankle where they need some assistance and, more importantly, allow you to sense and feel certain areas of your foot as you walk. This is essential as your brain needs to sense where you are on the ground to activate your muscles appropariately. This allows your underactive muscles to turn on, while keeping overactive muscles off. From here, your therapist now has a "blank slate" to help teach your body to use these cues appropriately, strengthen "weak" muscles, and help your body to learn to move in a balanced way again. 

Just by changing either your footwear or orthotic, your body is now able to regain proper joint/muscle position and restore reciprocal movement allowing for perfected mechanics versus putting a band-aid on their symptom. 

Interesting in an assessment to see what will fit your needs? Call Integrate 360 Physical Therapy at 314-733-5000 or email Lesley@Integrate360PT.com or Nancy@Integrate360PT.com

What Makes PRI Unique?

Postural Restoration (PRI) is a form of physical therapy unique from the traditional model. It allows us to prevent injury, treat the source of pain rather than the symptoms, and treat the body holistically in ways that traditional therapy cannot. Here are some of the major differences:

1) PRI appreciates the naturally occurring asymmetries of the body. Although we may look symmetrical from side to side, we actually are not. The diaphragm (the main muscle of respiration that attaches to the backside of the front of our ribcage and the frontside of our lower spine) has a much larger attachment on the right. Additionally, we have organic differences as well. Our heart is only on our left side and we therefore have one less lung lobe on the left side. The liver sits under the right diaphragm keeping it in a better position for respiration. These differences tend to make us shift our weight on our right foot with our pelvis and lower spine orienting toward the right as well. On top of this, our world is set up to bias the right side. When entering the supermarket, you must first turn right, our car's radio is typically on the right, and we typically walk/drive on the right hand side of the street or walkway. All of these factors come together and cause us to develop certain movemement strategies or habits in which we use the right side of our body far more than the left. This can lead to repetitive injuries and/or unbalanced musculoskeletal systems causing pain.

2) Diaphragmatic function is key. We breathe, on average, 20-24,000 times a day. Breathing in an unbalanced way will quickly lead to pain or dysfunction unless we intervene. Additionally, the diaphragm essentially connects the upper and lower body. PRI is the only treatment approach that works to rebalance the diaphragm, then restore normal and symmetrical position/function. This "unlocks" the ribcage and pelvis and allows us to stabilize them in a more neutral position, and teach our arms and legs to work off of this new, correctly positioned foundation. 

3) The body is connected. The site of pain may not be the source of pain at all, it may in a completely different spot! For example, a patient with neck pain may ultimately need foot orthotics for pain relief. If their right heel twists inward (toward the center of their body), the patient may place more weight on the ball of their feet as it is wider and can support more weight. This weight shift will cause their pelvis to tip forward and their lower back to extend. This then causes their ribcage to extend backward (to keep them from falling forward) and forces their head to stick forward in order to get their eyes on the horizon. By putting an orthotic in place that corrects their heel position, they can appropriately weight bear on that bone and have better spinal alignment with less tension on their neck. PRI assess position, motion, and strength throughout the body, no matter the site of pain, so that we can fully understand how well your body moves as a whole and work to restoring mechanics to fix the source of the problem, not just treat the symptoms. 

4) Other specialties may be needed to fully address musculoskeletal pain. Our body uses "reference centers" to help us know where we are in space: feeling our heels on the ground, being equally aware of our peripheral vision, feeling pressure differences side to side in our joints. One powerful reference center is our bite. If we are missing teeth or our teeth don't fit together well, the body will move or position itself differently to try to correct for this problem. Check out the video below to see how a simple bite guard can allow us to feel those reference centers appropriately and allow our bodies to move correctly. PRI maximizes interdisciplinary care with dentists, orthotics (someone who makes foot orthotics), and neuroptomotrists (who assess vision and how the eyes work together) so that our reference centers can appropriately tell us where we are in space so that we can move through it from a mechanically correct perspective. 

Interested in seeing how PRI can help you? Want more information? Call us at 314-733-5000 or email Lesley@Integrate360PT.com or Nancy@Integrate360PT.com . We are the only PRI certified clinic in the St. Louis area. 

What's a Rib Flare and What Does it Mean?

Next time you're lying on your back, place your hands on your lower ribs. As you move your hands down those ribs toward your belly button, did you notice a drop off as your ribcage ended and your hands moved onto your abdomin? Was one side worse than the other? You, my friend, have a rib flare. These are very common, but are not normal. They are a clear warning sign that your core strength is lacking and you are on your way to pain and/or dysfunction.

Our abdominal muscles all attach to the bottom part of our ribcage.  The rectis abdominis (or six pack muscle) attaches to the ribcage in the front where it then travels down an attaches to the pelvis in the front. This muscle curls the trunk forward and is NOT a postural, or true core, muscle. It is also the most superficial muscle.

The next two groups are deeper toward are spine and do function as postural muscles. These are the obliques, specifically the internal obliques, and the transverse abdominis. These groups of abdominals are much wider and also attach to our lower ribs and top of the pelvis, but touch more bony surface area. When these muscles are strong and have good resting tone, they keep the ribcage held in an upright position. When these muscles become weak, they allow the front part of the bottom of the ribcage to flare upward and outward. The entire ribcage becomes extended which flattens out midback, overly arches our lower backs, cause our heads to more forward, and disallow good ribcage motion with walking and breathing. This can cause any number of issues- headaches, neck pain, shoulder problems, lower back pain, etc. 

This also causes our diaphragm to move from a functional, domed position (similar to that with a held exhalation), to a flattened, ineffective one (similar to that with a held inhalation). When the diaphragm loses it's "zone of apposition" that would normally be maintained with good abdominal strength, we cannot effective breathe with it. When we cannot breathe with the diaphragm, the primary muscle of respiration, we must find other ways to get air into our lungs. We can do this many ways: extending our lower backs to open up our abdomin, using our neck muscles to try to lift the ribcage upward, or a combination of the two. This is how pain develops. 

To fix this, the internal obliques and transverse abdominis muscles need to be targeted. Not only does the rehabilitation effort need to be very targeted, it needs to be functional, i.e., it needs to be done with proper breathing mechanics. We must return the position of the diaphragm to one of a functional, domed, exhaled position. The only way to properly do this is with your internal obliques and transverse abdominis. 

It is not possible to fully rehabilitate and restore core strength and control without proper respiration and abdominal strengthening at the same time. 

This is the foundation of any PRI treatment plan. Proper respiration cannot occur without a functional core, and a functional core cannot happen without proper respiration. Let the therapists at the only PRI certified clinic in St. Louis help you to restore your function and reduce or eliminate your pain. Call us at 314-733-5000 or email Lesley@integrate360pt.com or Nancy@integrate360pt.com 

Our Response to NPR Article About Fixing "Mum Tum"

NPR recently published an article entitled "Flattening the 'Mummy Tummy' with 1 Exercise, 10 Minutes a Day" (read it here) that has been getting a lot of attention. We wanted to give our patients and readers our take on this abdominal strengthening program.

First of all, the "mum tum" or "mommy pooch" as the article calls it, is a real thing. They do a great job describing diastasis recti (read our article on this topic here)  and it's known to cause lower back pain as well as a lot of other pain or dysfunction. Strengthening the abdominal muscles is the best way to correct this problem. In severe cases, a mesh can be surgically applied to essentially replace the ruptured tissue, but this is generally only done if the patient has developed a hernia.

In the article, Leah Keller, fitness coach and creator of this particular exercise program, states that the abdominal muscles need to be realigned in order to resolve this issue. For her exercise, she has her clients sitting cross-legged on the floor. She then has them take a deep inhale and expand their bellies. Then, as they exhale they pull in their abdominals by pulling their belly toward their spine. Next, they take short inhales followed by an exhale in which they try to pull their belly button closer to their spine. Every 2 minutes they change position, sitting on their heels, hands and knees, squatting, etc. until they've exercised for 10 minutes.

In our opinion, the basic component of this exercise is good. By having these women pull their belly button toward their spine as they exhale, they are engaging their transverse abdominis (TA) and internal obliques (IOs). This is essential in correcting a diastasis recti. Although the problem itself lies in the overstretched or ruptured linea alba that lies between the two sides of the rectus abdominis muscle (or six pack muscle), exercising the rectus itself will not improve things at all. The TA and IOs have to be targeted as those are the muscles that create a natural corset around our core, cinching in our waists and giving support to our spine and abdomen.

One problem that we have is initiating this exercise while sitting cross-legged on the floor. This places the thigh bone in too much external rotation in the hip and will draw the pelvis forward, arching the back, and placing the abdominals in an elongated position called "positional stretch". Trying to contract a muscle this way is very difficult and not very efficient.

The main problem we have this exercise is the breathing technique. By taking in small breaths, ribcage motion is restricted, utilizing accessory respiratory muscles from the neck and shoulders is encouraged, and poor respiratory mechanics are being taught during abdominal activation. Sure, this may cause some TA an IO strengthening as the muscles are being contracted for some time, but it's completely nonfunctional. It is essential to learn proper respiration while activating the core. This not only allows the client to strengthen the abdominals, but to teach them to keep them engaged, subconsciously, while they walk, talk, and breathe throughout the day. That is fully correcting the problem and stabilizing the core. The former is simply contracting the abs for 10 minutes a day with poor mechanics.

Want more information or to learn to correctly recruit your core while breathing normally? This is a pillar in all of our treatment programs at Integrate 360 Physical Therapy. Call us at 314-733-5000 or email Lesley@integrate360pt.com or Nancy@integrate360pt.com today!

The Best Way to Sit

Whether you're back to sitting waaaaaay too much because you're back in school or it's just a normal part of your work day, you might as well choose to sit in a way that will best avoid pain and promote good musculoskeletal alignment. 

These recommendations are based on the postural patterns we assume when we are not musculoskeletally stable (i.e. Are experiencing pain or poor posture) as defined by PRI. They are for someone presenting as a left AIC and/or right BC person (Don't remember what that means? Review it here). These will be most impactful after seeing a therapist at Integrate 360 for a thorough evaluation. Not only will this let you know what pattern you are in, we can customize the recommendations for you - no guess work!

1) Sit with your knees at hip height or higher. This allows your pelvis and lower back to stay in a neutral or slightly rounded position. Most furniture is made for people who are 5'8". If you are shorter than this, your knees are likely lower than your hips. This pulls your pelvis forward which will arch your back and create pain. You can always put a footrest, or even your backpack, under your feet to bring them up. Also be sure to get rid of any lumbar support or roll you may be using. This will put your lumbar spine in too much extension or arch.

2) Feel your heels. Make sure that your heels are in contact with the ground. Pushing up onto your toes and not being able to get your heels to the ground subconsciously tells your brain to activate the calves and other extensor muscle groups. This sets your body up for failure when it's time for you to get up and move. Your brain is not prepared to use all of your muscle groups appropriately to move you forward. Plus, if your heels cannot reach the ground, there's no way your knees are at hip height.

3) Shift your left hip back. Pretend there is a spool of thread between your knees that you are trying to pull closer toward you as you pull your left knee back toward you. Our pelvis' tend to get stuck pointing toward the right when we get out of a good musculoskeletal position. This will help to pull the pelvic back toward the left, placing it in a much more neutral position.

4) Lower your left shoulder. Our diaphragms are much stronger on the right side than the left. This causes us to bend our trunks to the right slightly and lower our right shoulder. By bending back toward the left, crunching our left abdominal wall, or simply lowering our left shoulder, we help to better align our spines.

5) Reach across your body. Because of that diaphragm position and right hand dominance, we tend to reach with our right hands a lot. Reaching with you left hand makes your brain more aware of the left side of your body which will help to keep your posture symmetrical. It will also help to keep your body moving in a reciprocal and alternating way - the way our bodies should move all of the time! Unfortunately, in this world of sustained sitting and repetitive movements, this is harder and harder to incorporate into a normal day. This can lead to repetitive movement injuries and pain. 

6) TAKE BREAKS AND MOVE! Easier said than done, we know, especially if you're in a classroom. But try to take breaks as much as possible. Get up and move around. It can be simply walking to the back of the class to the front, using the restroom, or getting a glass of water. Keeping our bodies moving keeps them healthy, and you awake!

Please contact us at 314-733-5000 or lesley@integrate360pt.com or nancy@integrate360pt.com for more information. 

How to Correctly Wear a Backpack

It's that time of year - back to school! Getting back into an academic routine can be really fun, but whether you're walking across your college campus or up the stairs at your high school, your backpack can be damaging your posture and causing a lot of pain. Here are some pointers to lessen the negative effects a backpack can cause.

1) Tighten the straps. Whenever you are carrying a heavy weight (be it a backpack, laundry basket, or groceries), it's the easiest on your body when you carry it as close as possible to your center of gravity. For us, that happens to be at belly button level in the center of our bodies. So for a backpack, you want it as flush to your back (the center of it around belly button level). Most people tend to wear their straps loosely so there's a visible gap between their lower back and the bag itself. Go ahead and tighten up the straps and feel the difference. If your backpack also has a belt that can go around your waist, that will also help to distribute the load appropriately. 

2) Use BOTH straps. It's easy to swing that bag up over just one shoulder, especially if you're in a hurry. But having this heavy weight just on one side of your body will typically cause you to lean away from the bag and forward. This causes a lot of stress on your lower back as well as makes your to contort your neck to see the world in front of you. This excess neck strain can lead to tension headaches. 

3) Don't carry so much. Easier said than done, we know, but making more frequent trips to your locker, car, or apartment so that you're carrying a lighter load will put much less strain on your body. It'll help you get to your 10,000 steps a day goal too!

4) Be careful how you lift it. As we've previously inferred, backpacks can be tremendously heavy. Therefore, it's important that you use good body mechanics when picking up your bag. If it's on the floor, remember to squat or lunge down to the bag. Then, pull it close to your body near your belly button. Next, stand up keeping that bag at belly button level. Once you're up you can move the backpack onto your shoulders. 

5) Choose the right bag. Backpacks can come in different sizes. There's also options like messenger bags and roller bags. Choose one that will be the most convenient for you understanding that, from a musculoskeletal health perspective, the best bag is a rolling one, followed by a standard two strap backpack, with the worst option being the messenger bag. If you do decide to use a messenger bag, wear it across your body so that the load is more evenly distributed across your body and not all on one side. 

Have a great year!

Hamstrings: Should You Stretch Them?

Many people suffer from hamstring sprains, strains, and tears. A lot of people think they have "tight" hamstrings. We repeatedly hear from our clients, "I've always had tight hamstrings". So the natural tendency is to stretch them. However, before you stretch your hamstrings, we suggest watching this video by Dave Drummer, DPT, PRC at the Hruska Clinic. In this video, Dave explains the importance of proper position of the pelvis for hamstring length and strength. If the pelvis is in the proper position, the hamstrings should have adequate length. At Integrate 360 Physical Therapy, we have objective tests that tell us if your pelvis is in the proper position. If a client has limited hamstring length once the pelvis is in the proper position, we will teach them hamstring stretching activities in a specific position. If you suffer from chronic hamstring injuries or would like to know more, please contact us at 314-733-5000 or email lesley@integrate360pt.com or nancy@integrate360pt.com.

The $100 billlion per year back pain industry is mostly a hoax - an article review

"The $100 billion per year back pain industry is mostly a hoax" is an article that summarizes the thoughts and views of Cathryn Jakobson Ramin in her new book, Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery (read it here).

In her book, Ramin expresses that most proceedures and treatments to ease back pain are not effective and can sometimes create additional back pain. She mentions things like lumbar fusions, discectomies, opioid medication, even chiropractic adjustments. She eventually reveals that the only treatment that can reliably ease back pain is to move. Within the section discussing chiropractic, she reports that "adjustments" can temporarily decrease pain due to a rush of adrenaline, but the manipulation involves pushing a joint past it's biomechanical range which is contraindicated for many health conditions. Some chiropractors have adjusted their intervention-style. ""They have restyled themselves as rehabilitation specialists,” which means they’re training patients in effective back-strengthening exercises as a reliable physical therapist would, she tells Quartz, “and are doing a great job with it.”"

From a physical therapy standpoint, this article is great news! According to Ramin, many surgeries and proceedures patients undergo in order to ease their back pain is either not effective or, at best, have a placebo effect. As movement and strengthening exercises seems to be the most effect way to manage and heal your back pain, everyone has the ability to alleviate their pain. 

Although we don't tend to agree that subluxations and poor musculoskeletal positions cannot anatomically happen because they can't be seen on x-ray, Integrate 360 Physical Therapy has the tools you need to become pain-free including repositioning joints and musculoskeletal structures.

When we evaluate a patient whether it's their first or tenth visit, we assess how well the body is able to move both passively and actively. We look for malposition, subluxations, joint and muscle range of motion, muscular strength, etc.

Once we have finished this assessment and educated you on what is causing the pain and how we're going to work together to fix it, we get to work. We typically start with some form of "repositioning" activity. Afterward, we assess your body's ability to move again as well as your alignment. If something is still malaligned, we may choose to reposition the structure with manual mobilization or muscle energy techniques (a specific movement within a specific position where you use your muscles strategically to pull yourself into proper position - kind of like an adjustment that you do yourself). We then continue to work on restoring the strength and balance of your body. 

These interventions will likely remedy the pain in and of themselves, but sometimes we need to encourage our patients to be more physically active overall, or just like the article mentions, move more. Now that we've addressed pain, posture, alignment, and strength in our sessions, your daily walks (or whatever way you chose to move) will be much more effective and/or can be participated in as it no longer causes pain.

Let the therapists at Integrate 360 Physical Therapy help teach your body how to move correctly to eliminate pain now and prevent future pain. Call 314-733-5000 or email us at either Lesley@integrate360PT.com or Nancy@integrate360PT.com

Running - Can It Do More Harm Than Good?

It's officially running season! For so many people it's their preferred method of exercise - it's cheap, can be done anywhere, great for cardiovascular fitness and calorie burning, etc. However, important to make sure this activity is actually benefitting you and isn't going to causing you problems down the line. 

It's important to acknowledge the fact that running is very repetitive. Your body is constantly moving forward, therefore, your limbs are constantly moving in the same way and your trunk is held comparatively static. This can cause overuse injuries of muscles or joints - most commonly shin splints, ITB irritation, hamstring tendinitis, hip bursitis, or groin pain. As your body is moving in one direction, it only moves in one out of the three planes of movement. Therefore, the muscles that control joint and bone motion in this plane are the ones that tend to become overly active and breakdown when problems arise.

How do we fix this? We need to make sure that our bodies move in ALL THREE planes of motion! This can be done in many ways. First of all, taking steps to ensure activation and motion in the other planes of motions is paramount to maintaining a healthy body. Postural Restoration is a form of physical therapy makes this tri-planar motion the heart of our rehabilitation effort. When you come in for your evaluation at Integrate 360, we assess your body's musculoskeletal position and integrated strength. This will help us assess where the body is not moving appropriately and restore strength throughout the body so all of the parts work together well.

We will also make sure you are able to breathe appropriately when running. Not only does proper use of the diaphragm dictate whether or not tri-planar motion is even a possibility, but compensated breathing patterns stress other muscles of the body as well as limit your cardiovascular endurance. If you are not able to breathe comfortably through your nose and out of your mouth for the duration of your run, you are not allowing yourself to achieve maximum performance and setting yourself up for an injury in the future.

Wearing appropriate running shoes is also a game changer. Not any running shoe will do. They need to have the proper amount of structure that your foot needs to maintain a good, stable foundation for the rest of your body to work off of while running. Not only will the shoes set you up for mechanical success, they will also help your feet to feel where they are on the ground and help to activate and/or inhibit the proper muscle groups at the appropriate time.

Having the right glasses or contacts in while running also makes a significant difference. It's important to have a prescription on that allows your to see distance well. This allows you to see the world around you which allows your body to anticipate the environment ahead and prepare on how to handle it from a mechanical standpoint. Proper distance vision also allows your body to "unlock" or "relax" and promote tri-planar movement. If you're using monovision contact lenses, progresses lenses, or even bifocal lenses, you could also be setting yourself up for compensated movement and a future injury.

For more, check out our recommended shoe list here.

What are some things you can keep in mind while running to promote tri-planar movement? Look at this list of tips from the PRI website here.

Want an evaluation to see the current condition of your body and personalized rehab to get on your A game? Call Integrate 360 Physical Therapy and 314-733-5000 or email Lesley@integrate360pt.com or Nancy@integrate360pt.com

Diastasis Recti - What You Need to Know

As we discussed at the end of our last blogpost, there are a lot of problem that crop after a woman has delivered her baby. These can include incontinence and pelvic pain (read our previous blogpost here for more information on that) and diastasis recti. These are signficant issues that need to be addressed as soon as possible since they signal a complete failure of at least one part of our core and can lead to severe pain problems and dysfunction. As we've already addressed the pelvic part of this dysfunction, today's blogpost will focus on diastasis recti.

First of all, let's discuss what it is. One of our abdominal muscles is our rectus abdominis (aka the "six pack muscle") which flexes or curls our trunk. The left and right side of this muscle is held together by some connective tissue called the linea alba. The diastasis recti occurs when the linea alba is over stretched or breaks. This most commonly occurs during pregnancy where the abdomin grows very large in a relatively quick amount of time. It can also occur with excessive abdominal circumference or adipose tissue or possibly with the overuse of the Valsalva maneuver (read our blogpost on that here.)

This is most commonly diagnosed by a healthcare professional. The patient will lie on their back with their knees bent and feet flat on the floor. They will then lift their head off of the ground to activate the rectus abdominis muscle. Once, activated the left and right side of this muscle should be easily palpated. If the space between these sides is wider than 2 fingertips, it's generally considered that they have a diastasis recti.

Why is this important? This finding suggests that at least a quarter of your core muscles do not function as they should. Think of a closed can of coke. You can squeeze it as hard as you want and you will not be able to pop the can. However, prick a hole in the can with a needle, and you'll be able to crush the can with enough pressure from your hand. The rectis abdominis is the pinprick in the soda can. Now that your core is damaged, you will not have the intrinsic core stability needed to do more normal activities in a biomechanically correct way. This will lead to compensations and further breakdown of your body until you're left with a loss of function or development of significant pain.

Physical therapy is the leading intervention for a diastasis recti. Typically, therapists try to work out the abdominals in a "safe" manner to restore our core strength. In our therapist's experience,t this is a bandaid on the problem and although it can ease pain in the short term, it does not correct the problem as much as possible.

At Integrate 360 Physical Therapy, we treat this issue is a very holistic manner. We look at the position and function of the entire body to see what is feeding in to the dysfunction. Typically, we find that the lumbar spine is too arched or overextended which places the pelvis in a tipped forward position. The rectis abdominis attaches to your lower ribs and the front of your pelvis. When your pelvis is tipped forward, the muscle is elongated and subject to "stretch" weakness which means it cannot work very well. We utilize repositioning activities to help restore normal spinal position. From there, we not only activate the rectis abdominis, but we restore true core strength through utilization of the transverse abdominis and obliques to support the rectis abdominis and take additional strain off of this tissue. We also focus a lot on proper breathing patterns so that the diaphragm can be appropriately utilized. This will help to reduce pressure on the diastasis recti and support proper posture. Assessing and intervening on all of these areas is what allows us to "heal" our patients more completely than in traditional settings.