Post-Natal Check by an Osteopath
Diastasis recti
- General observation of the abdominal area looking for 'doming' or bulging in the midline
- Contraction of rectus abdominis by asking patient to lift up into a sit up, then an assessment of the distance is noted using fingers width
- Assessment of the contractability of the rectus abdominus and whether this coordinates with the breath
- Assessment of the TLF, as tension here impacts the return of the separation anteriorly
Treatment and management:
- Myofascial release of the rectus abdominus muscle, including attachments
- TLF release
- General osteo work the surrounding areas including the ribs, xiphoid/ sternum, diaphragm, pubis, obliques, TA, PF, lumbar spine etc
- Education and breathing exercises to return to proper breath pattern
- Progressive strength exercises for the abdominal muscles
Prolapse
- Osteo assessment of the hips, pelvis and lumbar spine including imbalances, posture, restrictions which may be affecting the pelvic function
- Observation of perineum in supine position
- Valsalva to assess any bulging or worsening of prolapse
- Internal assessment: to assess pelvic floor muscle strength and function (using PERFECT scoring system and assessing tonus, elasticity, trigger points, scars), assessment of suspension system- ie the pelvic fascia and the ligaments of the uterus
- Assessment of the pressure systems ie the pelvic/ abdominal/ thoracic compartments to see if added pressure is within the pelvic bowl
Treatment
- Osteo treatment to correct any hip, pelvic or spinal imbalances
- Rebalance any pressure differences, including work on the thorax, ribs, diaphragm, hips
- Internal and external work using inhibition on the pelvic floor muscles either to reduce hypertonicity (tension) or oscillations to stimulate the pelvic floor if hypotonic. Stretching and mobility work can be done on scar tissue if found
- Osteopathic techniques like balanced ligamentous tension (BLT) and myofascial work to help rebalance the suspension system of the uterus and the pelvic cavity
- Education on breathing with pelvic floor coordination
- Pelvic floor exercises, tailored to ensure correct activation and relaxation of the muscles
Incontinence
- Osteo assessment of the hips, pelvis and lumbar spine including imbalances, posture especially assessing for a hyperlordotic posture as this can cause more pressure on the bladder, restrictions which may be affecting the pelvic function
- Assessment of the perineum, especially the position of the pelvic floor within the pelvic cavity if it has been stretched or is lower
- Assessment of uterus position, anteversion/ anteflexion of the uterus can put more pressure on the bladder
- Assessment of pelvic floor contraction - looking for drawing in and shortening of perineum
- Internal assessment: to assess pelvic floor muscle strength and function (using PERFECT scoring system), especially focusing on fast contractions- and ensuring patient is able to fully relax pelvic floor in between each contraction
- Assessment of the urethra - rigidity?
- Assessment of the urethra - rigidity?
Treatment
- Internal treatment:
- Internal inhibition and release to the appropriate pelvic floor muscles to ensure there are no hyper/ hypotonic areas so the levator ani can coordinate well together
- Adjustment of cervix and ligaments
- Pelvic fascia release and balance
- Urethra release and tissues around it
- Work on any abdominal tension, including visceral work, especially the small intestine and root of mesentery - to help improve pelvic drainage and function
- Rebalance pressure systems of thorax and pelvic diaphragm
- Work on any imbalances of the hips using mobilisation and soft tissue techniques
Posture
- Assess patients posture from the front, side and posteriorly
- Identify what type of posture the patient has- swayback, hyperlordotic, kyphotic etc and whether they have retained their pregnancy posture
- Assess how their posture is affected by active movements including active spinal movements, squat, breathing etc
- Identify how their posture is contributing to their symptoms
Treatment
- Postural cues given to help improve their posture
- Osteo treatment to certain muscles and areas of the body which can help their posture
- Rehab exercises to help strengthen their postural system
- Integration of an improved breathing pattern to help with their posture