& Wellness Center, Inc.
7800 Red Road. Suite 105. South Miami, FL 33143
Are you having back pain?
You might have a Diastasis Recti affecting your spine stabilization.
The Rectus Abdominis (RA) is, like you might guess from its name, one of the abs. In fact, it is your "six pack" muscle. Your RA is made up of two muscle bellies that run down from your ribs to your pubic bone and are held together in the middle by a connective tissue called the Linea Alba. The thinning or separation of the Linea Alba is called Diastasis Rectus Abdominis (DRA). The DRA itself is normally painless, however, it has been linked to changes in breathing, lumbopelvic pain, decreased postural control, pelvic floor dysfunction, altered trunk mechanics, and urinary or bowel problems.
The most common population to experience DRA is pregnant women. The growing fetus puts strain on the abdominal structures and causes a separation of the RA. People lifting heavy weights or those who have gained weight are also at risk of developing DRA.
Thus far in my clinic, I've seen multiple undiagnosed DRAs in men over the age of 50 who complain of low back pain. The DRA is likely an underlying factor. It can be easily overlooked in patients with low back pain, but if identified, can be treated conservatively. If you think you may be experiencing low back pain due to DRA, see a physical therapist before attempting abdominal strengthening exercises, as some exercises may cause a DRA to worsen or exacerbate low back pain.
Would my back pain improve if I strengthen my core?
Yes! Strengthening your core will improve core control, postural awareness and spinal alignment. By activating your Transversus abdominis, relaxing the RA and co-contracting the multifidus, you will be able to turn on your power house, move freely and eliminate pain.
Activation of Transversus Abdominis: Lie on you back with yours knees bent. Take a nice relaxed breath in and then blow all of the air out. As you blow out, start to activate your abdominal wall by palpating with your hands (see picture). Hold the activation for 5 seconds and repeat. Blowing all of the air out relaxes the Rectus Abdominis, preventing the DRA from opening. When you hold air in and activate the abdominal wall, you “Valsalva," creating increased intra-abdominal pressure and back pain.
Co-contracting Multifidus: Lie on you back with yours knees bent. Take a nice relaxed breath in and then blow all of the air out. As you blow out, start to activate your abdominal by tightening the muscles as if you were pushing your belly bottom toward the spine. Maintain your left leg steady as you move your right leg in and out (see picture). Repeat with your other leg. The key is to prevent the pelvis from moving.
Are you having back pain? Part 2
Diagnostic Imaging can be Deceiving
Over the last decade, an overuse of Lumbar imaging (MRI, CT Scan, X-ray) has been reported. This rise in MRI of the lumbar spine can specifically be correlated to, and possibly the cause of, the 2-3 fold increase in surgical interventions.
The American College of Physicians and the American Pain Society make three recommendations regarding the lumbar spine:
1) Do not get imaged frequently.
2) Only get images taken if neurological symptoms are serious or if there is an underlying condition suspected.
3) Only surgical or epidural candidates should receive MRIs or CT-Scans.
These two institutions make these recommendations because there is overwhelming evidence that imaging has no significant positive effect on recovery. Short term recovery actually favors patients who do not get imaging. Multiple studies have found that up to 90% of the asymptomatic population over 60 years old has an MRI that shows degenerative changes even though they have no pain.
One study found that the only 2 MRI findings that predict future low back pain are central canal stenosis and nerve root contact. However, this study also found that a history of depression was a greater predictor than these two MRI findings. Imaging can also have a negative psychological effect on patients since degenerative changes do not alter, but with physical therapy, symptoms of low back pain can be alleviated and controlled (see post on spinal instability). Overall, it may not be in your best interest as someone who suffers from low back pain to receive costly imaging.
For example, pictured are x-rays of a 75yo female with very little back pain who performs Pilates 3x/week!
For more information see: T. Flynn: "Appropriate use of Diagnostic Imaging in Low Back Pain- A Reminder that Unnecessary Imaging may do as Much Harm as Good".