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

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

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

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

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?

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

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

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