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Can a Multivitamin Reduce Breast Cancer Recurrence?
There is a great deal of controversy regarding the value of multivitamin supplements in cancer prevention. However, with respect to preventing breast cancer recurrence, an important study was published in the Journal of Breast Cancer Research and Treatment in 2011 by Kwan ML, et al.
Another Chance to Make a Difference
Just a few months ago, "the worst natural disaster to strike the United States since Hurricane Sandy" hit Louisiana. During this storm, one area experienced 31 inches of rain in 15 hours as almost 7 trillion gallons of water rained down in just one week across the state.
Little Sticker, Big Impact
It's the end of an election year. Hilary Clinton and Donald Trump were the subject of conversation for everyone, everywhere for the entire 2016 calendar year. I don't think any of us can deny that this election affected us all very deeply on a personal level.
Southwest Acupuncture College Brings It to Division 1 Athletes
When Michael Phelps' photograph with the distinctive round marks left by cupping went viral, the Division 1 student athletes treated through the Dal Ward Athletic Center at the University of Colorado (CU) could relate.
A Simple Protocol for Holiday Stress
It's winter, a time when we should be deep in reflection, eating warming foods and sleeping long hours. Following nature's rhythms, we restore our bodies and minds in preparation for the renewal of spring.
2016: A Year in the Life of Acupuncture
Happy Holidays, may you, your family and friends have peace, joy and blessings throughout this special time of year. As 2016 comes to a close, we can look back and celebrate the many events and accomplishments for the profession of acupuncture.
News in Brief
New President / CEO Takes Office at Yo San University. Electroacupuncture for Constipation?
Chiro School Reunion: Whatever Happened to...?
I opened the door to the closet slowly, carefully, since I knew it contained a large number of precariously stacked file boxes. It also held numerous outdated gizmos with electrical cords of various lengths that could trip or strangle a person.
Meshing TCM With Environmental Pediatrics: Where's the Overlap?
Pediatrics has a long history within Chinese medicine dating back to the late Han dynasty (i.e., the late 200s CE), with the two primary areas of emphasis being herbal medicine and xiao er tui na (pediatric massage).
DVT: Know the Signs and You Could Save a Life
I lost a friend several months ago. He died from a pulmonary embolism (PE) secondary to a deep-vein thrombosis (DVT) that originated in his lower leg. Bobby was in his mid-60s, soft-spoken and had a big heart.
Overuse Injuries in Young Athletes (Pt. 2)
Most overuse injuries are benign, but there are some high-risk injuries that, if unrecognized or inappropriately treated, can result in significant loss in time from the sport or even require leaving the sport.
A Letter to the Profession from the New President at AAAOM
Volunteering for a national, nonprofit organization brings with it such highs, lows, and accomplishments, as well as a steep learning curve.
All Fiber Is Not Created Equal
Sometimes the best place to start is at the end. So, the conclusion of this article is that all fiber is good ... but some fiber is better. Let's break it down. There are two main types of fiber: soluble fiber and insoluble fiber.
Branding: Set Your Practice Apart
Dr. Brad started his practice seven years ago on a shoestring budget. He created his generic logo in five minutes using a website because he didn't have the time to figure out how to make something special.
Herbs for Digestion: The Power of Bitter
Many cultures (and indeed herbal clinicians) around the world have long respected the role of bitter herbs and foods for promoting digestion. For example, aperitifs – drinks consumed before a meal to stimulate appetite and digestion – were originally derived from bitter herbs.
What We Can Learn From Spine Surgery
Patients with lumbar stenosis presumably present for conservative care to improve their quality of life and avoid surgery. However, providing clear guidance to these patients can be difficult for a number of reasons.
Molecular Motors: Tiny Machines Behind the Rhythm of Life
In the clinic, we aim to restore healthy patterns of movement for qi that has gotten trapped or misdirected, or may have even collapsed. We may be focused on freeing stagnation, releasing heat or redirecting counterflow qi, but it often comes down to helping re-establish a flow of sorts.
Assessing Core Stability and ROM: 5 Basic Checks
One of the first steps in addressing core stability is assessing static posture, ranges of motion, and motion of the pelvic bones, sacrum, femurs, lumbar spine and thoracic spine.
A Q & A About Updated Codes
Yes, indeed there was an update to ICD-10 on Oct.1, 2016. This is a regular update to the diagnosis coding system and this type of update will occur every Oct. 1, just as it did when the ICD-9 system was in place.
A First for the Profession: CCE Accredits First Chiropractic Residencies
The Council on Chiropractic Education (CCE) has awarded accreditation to all five chiropractic residency programs currently administered at Veterans Administration facilities, "the first residency programs in the nation ever to be awarded this distinction, a significant advancement in the evolution of chiropractic education," according to a VA press release announcing the milestone.
Dedicated to Defending Chiropractic
Whether you're a veteran DC or a first-trimester student, the name George McAndrews should be part and parcel of your professional vernacular, as familiar as the word chiropractic.
6 Steps to Make 2017 Your Best Year Yet
People often ask me what defines success. Success, for me, is simple: doing exactly what you want to do in life. Whether it's the kind of practice you run, your life at home, your hobbies or something else, it's achieving anything you put your mind to.
August, 2011, Vol. 11, Issue 08
A Common Problem for New Moms and Professional Athletes
By Elaine Stillerman, LMT
The softening, stretching, and weakening of the linea alba of the rectus abdominis and the subsequent lateral widening of the rectus muscles are generally, but not exclusively, considered to be caused by pregnancy.This is the case for nearly 90 percent of the maternal population. As the baby grows, the uterus displaces from a pelvic organ to an abdominal organ resulting in stretched and weakened abdominal muscles. For some pregnant women, the rectus abdominis can stretch longitudinally as much as 115 percent.
The pressure against the connective tissue that connects the two sides of the rectus – the linea alba - by the growing uterus as well as the hormonal influences of relaxin, create a separation of the rectus abdominis along the linea alba called the diastasis recti. "Diastasis" is a Latin word that means separation.
This diastasis does not necessarily heal on its own during postpartum recovery. As a matter of fact, in many instances women have a diastasis for the rest of their lives if they don't do appropriate corrective exercises that will repair the separation (or have them surgically repaired which was the technique used to fix severe separations). The sequelae of a diastasis might be chronic backaches and lumbar instability, and in severe cases, ventral or umbilical hernias for anyone, female or male, with this abdominal weakness.
As the baby grows, the maternal rib cage expands as much as 2-3" anterior and lateral. The rectus, which inserts into the 5-7th ribs, also stretches laterally. The same condition occurs at the pubic symphysis, the origin of the rectus. However, the maladaptive posture of pregnancy – anterior pelvic tilt, exacerbated lordotic curve, protracted neck, hyperextended knees, etc. – and the musculoskeletal discomforts that arise from this posture can be minimized with shorter abdominal muscles and a stronger, more intact abdominal core.
A large diastasis during pregnancy can prolong labor. Since core strength is lax, the uterus bulges forward even more, creating a more pronounced lordotic curve and anterior pelvic placement. This is why a second time mother looks bigger earlier in her pregnancy. The fetal head doesn't align within the pelvis as well as it would if the core were strong and intact, and it is more difficult to engage weak abdominal muscles while pushing, so labor often takes longer.
Not Just A Problem For Moms
But you don't have to be pregnant or a mother to have a diastasis. World class athletes and weekend warriors who do the wrong types of abdominal exercises (i.e. crunches or cross over twists) often develop this separation over time. Even Joseph Pilates, the developer of the popular eponymous exercise system, had a diastasis which got bigger as he got older. While many of his exercises target the core abdominal muscles, many of these exercises can contribute to a diastasis.
Carrying excess abdominal fat also puts pressure against the linea alba and can cause a diastasis for men and women. And people with chronic backaches or back issues fail to recognize that back instability often is caused by weak abdominal muscles and a diastasis recti.
Testing for the presence of a diastasis on your clients or on yourself is easy. You are looking for two conditions: the number of fingers that fit inside the separation and the condition of the connective tissue. The connective tissue will be superficial, moderate or deep. The deeper the connective tissue is, the closer it is to the visceral organs and the longer it will take to close the diastasis.
Have your client lie down on their back and with their knees bent. Place your fingertips in the umbilicus and have your client lift their head (not the shoulders) a few times as you press slightly deeper. Feel for the edges of the rectus muscles coming up. The number of fingers that fit in the space between the edges tells you how wide the separation is. A half a finger width indicates no diastasis. A finger or greater indicates there is one.
Now feel how deep your fingers go. If you feel a pulse, the connective tissue is deep and weak. Test three inches above and below the umbilicus, along the linea alba. When you test yourself, assume the same back-lying position and place your fingers pointing down toward your feet. Test at all three areas.
A brief review of abdominal muscle anatomy is important to understand how the action of one muscle affects the others. We have three layers of abdominal muscles: the outermost rectus abdominis, the deeper internal and external obliques, and the deepest abdominal muscle, the transverse abdominis (TVA). The rectus abdominis originates at the crest of the pubis and symphysis pubis and inserts into the costal cartilage of 5th -7th ribs and the side of the xiphoid process. It has two halves that are usually inch apart and are connected by the fibrous linea alba. Relaxing, forward pressure, and the growing uterus cause the linea alba to relax (allowing the muscles to move aside for fetal growth), stretch sideways, and become thinner. This is the diastasis.
The action of the rectus abdominis is trunk flexion, but when standing, it supports the visceral organs, holds the rib cage and pubis together and gives anterior support to the lumbar spine. Along with the gluteus maximus and hamstrings, it prevents an anterior pelvic tilt. Since this muscle is so compromised during pregnancy, it is easy to see how weakness in this muscle affects the entire core support and initiates the maladaptive posture associated with pregnancy.
The obliques are the middle layers of the abdominal core. The anterior division of the external obliques originates on the anterior surfaces of the 5th-8th ribs and inserts at the linea alba (as a broad abdominal aponeurosis). The lateral division of the external obliques originates at the lateral anterior surfaces of ribs 9-12 and inserts into the iliac crest along the outer lip. This group, along with the internal obliques, aids in trunk flexion and, when working unilaterally, rotates the trunk and flexes the trunk laterally. Since they attach to the rectus via the linea alba, it is easy to see how a rotational force pulls on the linea alba and stretches it even more. That is why cross-over abdominals do more harm than good.
The internal obliques cross in the opposite direction. The anterior division of the internal obliques originates in the inguinal ligament and medial lip of the pelvic crest and runs up and inserts at the crest of the pubis and linea alba (by the aponeurosis). The lateral division originates at the middle 1/3 of the iliac crest and inserts at the inferior borders of ribs 10-12.
The deepest abdominal muscle, the transverse abdominis, wraps around the abdomen and back like a belt or a girdle. It originates at the lateral 1/3 of the inguinal ligament, anterior 3/4 of the internal edge of the iliac crest, lumbodorsal fascia and the inner edges of the lower six ribs. It inserts into the – wait for it! – linea alba aponeurosis which passes behind the rectus abdominis. It functions to increase intra-abdominal pressure, assists in forced expiration, defecation, and during labor, stabilizes the lumbar spine and stabilizes the linea alba.
Based upon this anatomy, it makes perfect sense – and anatomical logic – that exercises that recruit the TVA are the ones that will make the diastasis smaller. This is even more apparent when you consider that the largest measurement of the diastasis usually is at the umbilicus and the muscle that works the rectus from the middle is the TVA.
The exercises that specifically target the TVA and shrink the diastasis are based upon a system of exercises called the Tupler Technique. The Tupler Technique is a four-step research-based program that includes: 1) specific exercises that isolate and work the TVA; 2) wearing and holding a splint. This splint does much more than the over-the-counter drug store splints or girdles. This specifically designed splint compresses the abdomen and approximates the rectus abdominis, making the exercises more efficient and repositioning the muscle to its correct position; 3) using the TVA with all activities; and, 4) using proper body mechanics when getting up and down from a back-lying position (no jack-knifes allowed).
The position you start in is very important, since the TVA is affected by gravity. The optimum way to begin these core strengthening exercises is in a seated or standing position. The head lifts of the Tupler Technique are only performed once the diastasis starts to heal. Belly breathing puts the TVA in the correct starting and ending position. If you imagine a horizontal elevator, the first floor is a neutral abdomen, the fifth floor is bringing the TVA all the way to the spine, and the sixth floor is an isometric contraction 'out the back'.
It is impossible to engage the TVA to fifth floor and hold it there if you are on your back and your shoulders come off the floor. That is why crunches and sit-ups don't work; they actually cause the abdomen to protrude and make the diastasis larger, the antithesis of what they are supposed to do.
When doing the head lifts of the Tupler Technique, the head comes up with the chin tucked in, as in a nod. And all cross-over exercises and sports (tennis, golf, etc) should be avoided when a diastasis is present because as we saw with the obliques, these forceful movements pull on the linea alba and further sheer it laterally.
The TVA is the missing link in core integrity – whether your client is pregnant, has a mommy pouch, is recovering from abdominal surgery, has a large belly or suffers from back pain and instability. Doing the Tupler Technique, regardless of how long the diastasis is there, will repair the diastasis and create a strong, integrated core.
Click here for previous articles by Elaine Stillerman, LMT.
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