Post Partum Back Pain: How To Assess Your Diastasis Recti And Improve Post Pregnancy Back Health With Dr Alli Cain
Welcome to the Back Pain Solutions Podcast – Post Partum Back Pain: How To Assess Your Diastasis Recti And Improve Post Pregnancy Back Health With Dr Alli Cain
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Episode Introduction
Research suggests that up to 50% of women can experience back pain in the first few months following pregnancy which can last between 6 months and a decade! Post partum back pain usually occurs due to pregnancy related changes in the musculoskeletal system that continue after delivery. There are different factors that can contribute to the risk of back pain such as the type of delivery and potential trauma suffered during labour. We have to acknowledge that whilst pregnancy is for the most part a natural process it still has a profound effect on the human body which cannot be underestimated. The effects of pregnancy on the muscles and joints of the back and pelvis vary but a surge in levels of the hormones relaxin, oestrogen, and progesterone results in considerable relaxation of the joints which takes at least 6-8 weeks to return to normal. Given the significant changes that occur during pregnancy it is surprising how little focus is placed on return post pregnancy rehabilitation. If we ever suffer significant trauma then we would always take the appropriate advice before returning to sporting activity yet this is not the case post partum.
In this episode we talk with Dr Alli Cain about post partum rehabilitation and discuss why so little focus is placed on advising women about their musculoskeletal health following birth. As Dr Alli states, the traditional healthcare system provides a better rehab protocol for sprained ankles than mothers after birth! We discuss some of the minimum expectations that that all women should have following pregnancy and some of the key things that should be considered. Ultimately, women should not be expected to pay a lifelong price for a baby’s birth, and with the right advice women do not need to suffer following the birth of their child.
Some of the things you’ll discover…
- The realities of a lack of healthcare for post pregnancy health.
- The realities of the lack of healthcare that is available for post pregnancy health
- Why we need to see post natal health as a recovery from injury like we would with any other trauma
- How there are additional stresses to consider that influence the recovery from pregnancy such as sleep deprivation!
- How labour may last only 24 hours but post partum is for life. Women need the right advice to support this
- How incontinence following birth should NOT be considered a normal result of pregnancy
- Abdominal separation (Diastasis Recti) happens to all women who carry a baby but that it should not be long lasting
- That every women should have a post partum check up at 6 weeks as a minimum.
Episode Highlights
The healthcare system is broken when it comes to post partum healthcare and women should not expect to pay a lifelong price for having children. As a minimum, EVERY women should have a post partum check up that provides a baseline to start their recovery post pregnancy. Key steps in the recovery process include learning how to breath properly and the importance of breathing mechanics as well as learning how to target the traverse abdominals.
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Episode Transcription
Intro 0:00
When we’re young, we move with freedom and confidence with a great resilience to injury. But somewhere along the line we develop poor habits and become more vulnerable to back pain. Back Pain solutions features evidence based and practical advice to help you take back control of your health and get back to the activities you love. This is your guide to better back health through movement. So join us as we demystify some of the commonly held beliefs about back pain and build your confidence to a stronger back the smart way.
Ben James 0:27
Okay, welcome back to the back pain solutions podcast Everybody with me, Ben James, and today we’ve got our special guest, Dr. Ali all the way from Canada, Dr. Ali was raised in Newmarket, Ontario and currently resides within a Catholic community. A love of athletics and passion for health led to obtaining a Bachelor of Kinesiology from Wilfrid Laurier University. While attending university she was a member of the varsity women’s basketball team and varsity cross country team. She went on to pursue graduate studies in sports Business Management before realizing her true passion was to work hands on with individuals as a Doctor of Chiropractic. Throughout her studies, Dr. Ali founded a gym in Newmarket, Ontario worked as a coach and nutrition consultant. In 2016, she helped launch anchor health and fitness center to the Georgina community, a comprehensive facility which features a variety of movement disciplines to satisfy the holistic needs of the human body. In practice, Dr. Ali integrates a combination of diversified chiropractic techniques, myofascial release techniques, rehabilitation exercises and patient education to provide optimal health and wellness. Dr. Ali has a particular interest in the holistic wellness of our patients, treating both musculoskeletal complaints and addressing specific fitness and nutritional needs to help them live and feel the best they can. After giving birth to her son in 2018, Dr. Ali noticed a huge gap in the healthcare system for postpartum women. Inspired she founded groco, a prenota Natal and postpartum rehabilitation and education program and is working to raise the standard of care for postpartum women by helping women strengthen their core, pelvic floor and total body after pregnancy. Dr. Ali now specializes in prenatal and postpartum chiropractic care takes a global approach to musculoskeletal health, including strength training for new and expectant mums. So why is the standard of care for women during pregnancy so thorough, yet following birth? The expectation is that things should simply revert to normal. And what problems is this creating for women that they don’t even realize? Well, which we’ll find out as we join on the show, Dr. Ali? Dr. Ali, welcome. Hello.
Dr Alli Cain 2:41
Thank you so much for having me, man. It’s It’s wonderful to have connected with you and your team.
Ben James 2:45
Yeah, it’s great to be connected. I’ve been following some of your free video content recently, which has been really insightful and interesting, particularly given that my wife and I are expecting our second in three weeks. And yeah, we’ve we’ve got one daughter, who is to in April, and over the last year, she blesser has been in a in a spiker cast. So she she’s had hip complaints. So we’re getting used to the whole children thing, but it’s, it’s, it’s really struck me watching your video content and listen to your information. Just when I reflect on that and my, my wife’s kind of experiences, the kind of the approach to pregnancy and the support. And all of that is so so good. Not necessarily focused on musculoskeletal health, I have to say, but certainly postpartum it’s kind of like, here’s a baby, off you go. And what you what are your What are your thoughts on that? What problems is that creating?
Dr Alli Cain 3:46
And that’s it that’s exactly correct. Throughout your pregnancy, you have scheduled appointments, you have an army of medical professionals taking care of you. Once you’ve burst your baby, that baby then undergoes a regular set of checkups throughout the first year of their life and really, throughout their, their entire childhood. Once mom has given birth, there’s not much beyond, here’s a Perry bottle to go home. Come back in six weeks, you know, if you’re bleeding more than you think that you should be, give me a call. And the fact of the matter is, is that there is no health care system for the postnatal woman and birth. And there’s a variety of ways that a woman can give birth whether virtually with no complications, a lot of tearing and a PC oddity or a C section. And all of those can be really looked at when we look at the human body as you and I do as a form of injury. And so, the problem is, is that any other part of the body if a patient came to you and said I sprained my ankle, or I tore my rotator cuff, we have great tests tools. protocols and and treatment plans for those injuries. When it comes to the postnatal women, we’re not looking beyond infection. And we’re not looking beyond the depression scale, at least here in Canada. That’s really what the six week checkup is. And then the woman is truly on her own. As she navigates and, and to go even further there, when somebody does sprained an ankle, then people understand you might use crutches, people are gonna hold the door for you, people are gonna go and run your errands for you. But when you give birth, you’re home and you’re navigating this massive transition transformation. You’re taking care of a newborn, you’re struggling with sleep, and eating and hydration and feeding and all of the challenges that come with being new parents and a new mom. And so that affects your healing too. And so we look at this postpartum time in the fourth trimester, which I’ll call the first 12 weeks after you’ve given birth, but postpartum is forever. And so women are coming to me whether they’re in that fourth trimester, first year postpartum, or even decades after they’ve given birth, with debilitating injuries, back pain, peeing their pants when they cough, laugh or sneeze, even plantar fasciitis, which we can get into later, stemming back to issues that they sustained during pregnancy and childbirth, and postpartum, that are not being looked at or addressed. And so that’s really what my mission is, is to call attention to the fact that we need to provide better rehabilitation for women in this postpartum period, to allow them to feel as good as possible now, but for the rest of their life.
Ben James 6:43
Yeah, sure. I mean, it’s a it’s a it’s a great, it’s a great focus and ambition, isn’t it to make that change? Because it clearly from it, because I look back in practice. And I think that there are women when I first graduated, and I look back now as you do as you reflect in practice, and I think, on what what was, you know, what was causing their issue? And could it have been related to that, you know, exactly as you’re discussing there, this kind of post partum issues that that, for whatever reason seemed to be completely gone under the radar. Why do you think it is that this is just not been a focus or is not more high profile? before?
Dr Alli Cain 7:23
I believe that the focus of the medical system, at least here in Canada, in my experience, is centered around making sure that women and baby survived, right, that is the job of the OB that’s the job of the of the labor and delivery nurses and the midwives. And that is their scope. That’s where they’ve been trained. And they are brilliant at doing that. Thank goodness that they are in that zone of genius, that after baby is born, of course, our attention turns to baby and mom has just been forgotten about because realistically, for those medical professionals, as long as mom doesn’t have an infection isn’t at risk of a postpartum hemorrhage, she will be okay. Right? When it comes to life saving techniques, she will be okay. It’s just that nobody until groco was founded, filled that gap to address the common musculoskeletal complaints that come. And in fact, they’ve really just been under the scope of, of the diagnosis of motherhood, well, you’re peeing your pants when you laugh. Well, you know what, you had a baby, it was your choice. It’s just the price that you’re going to pay. And it’s me and my team standing up and saying, Well, no, there’s plenty of things that you can do. We just look at basic tissue, healing science and basic progressive overload our training techniques, we can do a variety of things to improve and in most cases, fix and resolve these these common but not normal complaints.
Ben James 8:52
Yeah, and I suppose one of the big problems with it is that I mean, certainly from, from my experience with my wife, and obviously, this is an individual thing, but so she’s very, she’s just get on with it, you know, and many women that have children, it’s his baby becomes the focus, obviously. And suddenly, they don’t, they don’t complain about these things. Well, I just put up with it. And then of course, as the beliefs around the incontinence, and that’s just normal. And so it’s, I guess, a lot of the role for you is with with groco is changing, changing those beliefs and an education First of all, to to inform and challenge people that actually, this isn’t normal doesn’t have to be normal. And shouldn’t be, shouldn’t be something you just put up with it. There’s solutions here.
Dr Alli Cain 9:35
Changing the narrative around postpartum healthcare and saying that there is so much that you can do to feel good, strong, confident and empowered in your body after baby You don’t just have to accept this as part of your life now, and that’s really the main focus right now is changing the narrative and letting women know giving them permission to say, hey, I want to take care of me too. To write healthy baby matters, of course, but so does a healthy mother. And in fact, many women are the nucleus of the family. And if they’re not, well, it’s going to stem and creep into every other aspect of the family life. So if we can keep the mother Well, we will keep the entire family. Well, in addition.
Ben James 10:21
Yeah, because of course, it’s not just the physical is it, it’s the, it’s the mental, and it’s the confidence. And it’s the, it’s all of those things that go with these physical kind of issues and problems that are experienced that actually impacts mental health. And then like you say, the impact that it has on baby and on family, and etc, etc. It’s far reaching,
Dr Alli Cain 10:41
Definitely. So if so, if a woman will get into some of the clinical stuff here, but woman has abdominal separation, which happens in 100% of pregnancies, right, that’s a normal part of pregnancy, she gives birth, and that abdominal separation is going to stay there. But if it doesn’t heal, it’s likely going to lend itself to low back pain. And if nothing is done about it, and we just live with it, and we’re lifting babies, and we’re getting back to everyday life, soon that back pain starts to make mom have to take herself out of the things that she loves to do. The the the day to day activities start to become that much more demanding, because of the low back pain, she is suffering. And so if we can just identify that, heal it with a proper core treatment plan, we can prevent or fix that, that part that aspects of her life from occurring, and she can have more joy, she can enjoy more things, she can get back into all of those physical activities that we know lend itself to mental, mental, physical, emotional, and total body health.
Ben James 11:48
Yeah, absolutely. And, and of course, baby comes along. And, you know, in contrast to say, someone that doesn’t have children, or guys who you know, live in by themselves, not partner, no children, no babies around and you know, you’ve got an acute back issue. And sometimes we say, right, we got to avoid those activities, the kind of aggravating factors. First of all, let’s do that, first of all, and part of your as part of your management plan, and then we do X, Y, and Z. You can’t stop lifting baby. So actually, then it compounds the issue, because then we’re having to do these things that that are not necessarily healthy for the back, because that’s the ability is not there. And then chronic, further additional problems that we that we see as a result. So…
Dr Alli Cain 12:31
Yeah, that’s absolutely right.
Ben James 12:33
And so what sort of, in your experience, and what sort of percentages are we talking about in terms of women that, obviously, there’s the C section, and there’s different, different ways that babies delivered. But in terms of an average of postpartum women that probably have issues there, whether they really experienced back pain or not, would you say it’s kind of 100% of them could benefit from a kind, of course of exercise, treatment plan, etc, etc.
Dr Alli Cain 13:04
100%, of course, so when you’re pregnant, your uterus goes from two ounces to two pounds, your pelvic floor musculature, which is muscles, just like any other muscles in your body, have to support that rapid shift. So within nine plus months, that amount of growth, the volume, the abdominal contents, grows so substantially, and then in a flash, well, maybe depending on the labor, you’ve given birth, and your body starts to shift anatomically, once again, that is a lot for somebody to go through in a very short period of time. So I believe every birthing person should have an assessment, which includes palpation, of their abdominal musculature, their glute musculature, looking at their postural muscles as well. And, and as you know, from having kids like sitting and feeding baby can be really hard on the shoulders and the neck body assessment to identify at the very least a baseline. So baseline of where mom is at within that first six weeks, and then how monitoring how she heals over the course of that first year, similar to the way that your baby has those regular checkups that they’re going in and making sure they’re hitting their milestones, coming back to diastasis recti, or abdominal separation. If a patient comes into me within those first six weeks postpartum, they’re likely going to still have a diastasis and that’s okay. But if they’re not coming in at three months postpartum and that hasn’t healed six months, 12 months, then we know that there is core dysfunction going on and core dysfunction being a whole myriad of things that we need to then determine right diastasis recti is a symptom of core dysfunction. It alerts the practitioner and the mom that something isn’t right. Let’s do a deep dive and figure out so definitely anybody would benefit from a very specific post Natal core pelvic floor and total body program unique to them based off of metrics, like how they birthed and how they’re healing any other comorbidities or underlying conditions as well
Ben James 15:13
Sure. And I guess the follow up question to that is, would would women benefit from it, we get, we always kind of discussed getting fit for sport rather than using sport to get fit. And in a kind of similar way. We want to almost prepare for women for pregnancy, and that would surely be a beneficial thing. Is that something that you’ve you found as, as impacted the postpartum in those women that have kind of undertaken and being proactive in taking that approach?
Dr Alli Cain 15:43
So, yes, and no. And I’ll give you the spectrum of the answer. So absolutely having a higher degree of cardiorespiratory fitness having a higher amount of muscle mass on your body is going to lend itself to having a better buffer, in that postpartum period, and also having the endurance throughout childbirth. That being said, there’s been some studies done in this in this one study that is called to me, was focused on CrossFit athletes, and they actually determined they looked at CrossFit athletes and sedentary women, and there was no difference in their pelvic floor strength. So what that study concluded was that you need a dedicated pelvic floor strengthening program, which as an athlete, myself, I was like, ah, darn all that work I’ve been putting in for years and years, didn’t lend itself to an improved pelvic floor. But as I alluded to earlier, your pelvic floor has been through a lot. Just because you’re a high level athlete doesn’t mean that you’re not susceptible to an ACL injury. That being said, when we look at overall health, and we look at health, say on a spectrum, with sickness over here, wellness in the middle, and fitness, on the one end, we want to push people as far away from sickness as possible, right, so the more we push the needle towards fitness, the better buffer we’re going to have. And in that postpartum period, then if you are as fit as can be, and now you’re navigating, sleep deprivation and healing from childbirth, you’re going to fall to wellness, right, you’re going to be well, but if you were only well, or worse, you were you were sick, and you didn’t take care of yourself, in that prenatal period, you are going to experience more detrimental things during that postpartum period, because you’re going to fall towards sickness. So that’s why we definitely want to focus on having mom train for birth being as strong as possible, but then also say, the postpartum period is really, really critical that we are employing the right dose of movement for you.
Ben James 17:44
Yeah, it’s it’s not just a generic, it’s, it’s got to be an individualized approach. And it’s interesting what you say about the CrossFit actually, because I would say there’s an argument that that everybody whether male or female, pregnancy, you know, pregnant or non pregnant could almost benefit from that pre conditioning work ready for CrossFit There seems to be a lot of sedentary people going into CrossFit as the solution but actually, you know, even for men, I guess, you know, pelvic floor is important because there’s a lot of heavy lifting in, in CrossFit that maybe we’re not conditioned or ready for. And so actually taking a step back and conditioning first and being patient and progressive with the with the exercise plan, and then you can do CrossFit makes kind of makes sense.
Dr Alli Cain 18:28
And and and taking that extrapolating it and putting it into the postpartum time. And here is one of the main issues then that I see because we’re just starting to talk about postnatal rehabilitation. Oftentimes, after women are given that six week clearance, which once again, to be very clear, it’s a clearance of no infection, no postpartum hemorrhage, and you’ve passed this postnatal depression scale, the first people they’re often going to see is their coach. So you might have a woman who gave birth six weeks ago, has significant tearing through the parent isn’t going to see their CrossFit coach and having no guidance and the coaches Of course, aren’t educated and in this area, and just getting back to fitness, and that is an improper dose and improper volume and improper intensity. So we want to employ this postnatal rehab this preconditioning like you said, to empower them to get back to whatever their favorite fitness class is, with a really good baseline so that they can progressively grow without sustaining any more injuries. Because that’s that’s the biggest thing is is that if they’re doing too much too soon, too fast, just like any other injury in the body, they’re more susceptible.
Ben James 19:41
Yeah, and naturally for a lot of women that you know, once they given birth, they’re like, right, I want to I want to get back my kind of, there’s a self esteem thing. There’s a confidence thing I want to get my body back. So Ryan can just start running and actually that That in itself great and proactive but could be a Problem. Yeah, getting that getting that balance, right, isn’t it?
Dr Alli Cain 20:05
Yeah. And I definitely never want to tell somebody not to do something because I value physical activity so much, but in the right dose. And so we know with running running is a really good example. It’s an impact exercise. So if you have just given birth, and let’s say you’re still holding excess weight, like every single woman is going to after she’s given birth, she goes out to run, she goes out to run on a core that is not fully rehabilitated, so muscle fibers aren’t torn, she goes out to run with a pelvic floor that has muscle fibers that have not fully healed, every step she takes, she’s putting one and a half to two and a half times her body weight through her body. And a core that is not ready doesn’t have the prerequisites to handle that load, she is doing more damage as good as it might feel to run. And with the goals of feeling good and empowered in her skin, she’s actually going to make things worse, and it won’t be long before the pain increases, she can’t run and she’s worse off in terms of her per musculoskeletal health than she was when she gave birth. So we like to look at the the soonest that somebody is getting back to any type of impact exercise is a minimum of three months postpartum. And that would be if you had a vaginal birth with no tearing at all, no stitches, you healed very well, minimal bleeding, like bleeding dropped off at four or five weeks postpartum. And then we’ll start you back gradually, right? It’s not way out for that five k run continuously, you’re going to start and see what 500 meters feels like or you’re going to go out, you’re going to see what one minute feels like. Because it’s likely that you’re going to wake up the next day and feel like you got hit by a truck because your body is still healing. Now, when we look at birth methods, like a C section, which is major abdominal surgery, it’s an incision through seven layers of your abdomen right down to your uterus, and, or significant tearing, like an episiotomy, which is a surgical incision, then from the vagina to anus or significant tearing where women are having hundreds and hundreds of stitches, hundreds of stitches. And we’re not getting them back to impact exercise until closer to six months postpartum. And, and we have to make sure they’ve undergone that proper rehabilitative program, but prior to.
Ben James 22:21
Yeah, absolutely. And, and the way your, your kind of business works, do you have kind of a gym element that people can pay a membership to go into the gym? And the reason I asked that is I’m interested that any women that that are kind of members, let’s say and fairly independent in that gym setting? Do you kind of try and stop them prevent them? How do you balance that just in terms of Look guys, too much too soon, let’s take a step back. Got must be……
Dr Alli Cain 22:50
So the gym aspect of anchor is all class based. So every single person who is a member comes in and does a class with a coach. And you better believe that all of my coaches know that as soon as a woman announces her pregnancy, that they’re coming to see me whether it’s a conversation or booking an appointment. And and I would say 99% of our members understand and and have been influenced by what I talked about, it makes a lot of sense. So they’re coming to see me and not only am I taking care of them through that prenatal period, but I’m also educating them on things that they should be doing. And the next part about it being class based, is that we have a daily workout. So I know exactly what’s on the menu for that day’s workout. And I can say, okay, Ollie, today, there’s box jumps, but you’re 34 weeks pregnant. And you said to me that when you cough, you’re peeing your pants. So we’re going to modify those to a lower box setup. But if you step up, but if you feel this, this and this, then you need to change it right away to squats. And so they’re being guided and empowered. I’m not saying hey, you’re pregnant, you’re fragile, don’t do anything, I’m saying do this, but do it with a smart approach. And then because within Ankur they’ve been under my care throughout their the prenatal period, they’re well aware of when they need to be seeing me after they’ve given birth and, and we’re a smaller community. So usually I’ll see on the Instagram while babies arrive. So I’ll reach out to them to make sure that they know I’m here to support them. And then the second part to to answer your question is we run group based rehabilitative program. So I wanted to reduce the barrier to care and and one on one care as you know, it’s expensive and luckily here a lot of people have access to a nice bonus from their company, they have their benefits plan, but if they’re on that leave that their their finances have shifted a little bit. So what we do is they’ll come in for their initial post Natal assessment so I can look at their entire body build their program, but I’ll lead twice a week for an hour, an entire post Natal rehabilitation program. So it’s at a fraction of the cost because we have between four 810 people in these programs, all in this fourth trimester or forestier, postpartum. And we’re we’re providing the rehabilitation under the care of either myself or one of my other postnatal doctors. And women can come in and not only rehabilitate, but rehabilitate properly, because we’re showing them how to do it. They’re getting the time and this is pre COVID. But to connect with other women going through the same things, we’ve really addressed the the holistic approach to postnatal wellness by doing this, we have had fantastic results because our patients know, okay, I need to go do grow call for one or two sessions, four to eight weeks, before I’m going back to my Pilates class, my yoga class, my CrossFit class, my spinning, because I need to build the foundation. So it’s been a really wonderful addition to our methodology at anchor and really, with how we work is we now have have healthcare practitioners who are doing this around the world as well.
Ben James 26:07
Yeah, amazing. Amazing. I think like you say that the great side of that, is that the community element as well, because that’s the other that’s the other side of it. That’s, you know, about having having children, there’s, there’s no course you go on beforehand, and it’s like his baby, and how do I how do I keep keep this channel alive? And it’s quite isolating if, if a partner is going back to work fairly quickly, and particularly in this environment, it’s, you know, that is challenging, obviously, which is, which is a difficult thing to manage. But that community aspect, and again, back to the mental health, it’s all a package, isn’t it of wellness and health and support. Right, not again, just the just the physical. So I think that’s a that that’s a great, that’s a great approach to give it to give the access to people, which is fantastic. So back to, you talked about the the abdominal separation that that, like you say is happening with every everyone because, again, I’ve heard in the gym and places, women talking about diastasis recti. And or, you know, will that happen to me? Will it not? And it will, because you’ve got this baby grown inside you it’s going to happen? How many? How many of how many women that you see or have you? Have you seen any research in terms of percentages of of that being a problem for a longer period of time for certain women? And why? Why is why is that for some and not others? I guess.
Dr Alli Cain 27:30
So within my own practice, I would say 50% of women resolve within the first month in terms of just the the diastasis, which is just one aspect, right? So So having a diastasis yes or no doesn’t doesn’t doesn’t mean there aren’t other issues going on. But it’s a really apparent clue. And it’s also something that a woman can do at home, especially as we record this in here in Canada in Ontario, specifically, we’re locked down on empowering women who don’t feel comfortable coming to the clinic to do it themselves so that we can determine what the next steps need to be. So 50% are resolving within the timeframe that for me is is eight weeks postpartum, I want to see it back to medically normal, which medically normal is 2.7 centimeters, but it’s difficult to measure. So we just do less than two finger breaths. Not only the width, but also the depth. The other 50% are not resolving. So for me and my colleagues, we need to put on our little protective hats and be like, figure out okay, we know diastasis is a symptom of core dysfunction, it’s typically due to improperly managed intra abdominal pressure. So then we look at breathing mechanics, then we look at postural complaints, are they locked in an anterior pelvic tilt or posterior pelvic tilt? Did they have a traumatic birth where they did have major abdominal surgery as a C section, or an episiotomy or significant tearing and are those is that scar tissue or the adhesions that are forming, they’re causing a reduced mobility through somewhere in their body and therefore their core hasn’t healed appropriately. There’s all sorts of different things that we need to be looking at. And typically, I would say out of that 50% of women who come in and their diastasis isn’t healing properly, I’d say 40% of them. So most of them, we are able to heal within a 12 week program. The other subset have other issues going on where we’re looking at perhaps sending them to for a surgical console, but But again, we want to look at the overall function. So some people can have a functional diastasis and then called with a patient who’s given me permission to share this but 10 years postpartum came in, she’d been doing a deadlift in the gym, injured her low back and we found a substantial diastasis recti we healed her core. We resolved the pain, it’s now been four or five years, she still has a large gap, but it’s functional, she can engage her deep core, her transverse abdominus, she can engage and she has really, really strong, like 360 degrees of her core. So again, in that particular case, we weren’t necessarily worried about closing the gap, we were more concerned about a reducing pain, and then the improving function.
Ben James 30:26
Okay. Sure. And so a good question. I guess, as a follow up to that, if if someone has got a cease that that is years, you know, as in this case, if the functions Okay, we’re not worried about the you know, that separation. But can you get that separation back after all that time?
Dr Alli Cain 30:46
Yeah, in many cases, I have had a number of clients who come in in their 50s. And so they’re their youngest child is 23 years old. So they’re 23 years postpartum, they have had a diastasis for over two decades. And in one particular case, and once again, permission to share this. Her low back pain was so significant autobackup she was a high level athlete, she was a varsity. She ran for her university as a track and field athlete. Part of her family dynamic was going for hikes and they loved being outside. And once she hit menopause, it all fell apart. Her low back pain was so debilitating that she actually had to take a leave of absence for her work, her relationship suffered because now her pelvic, her pelvic floor, there was so much pain when she was having intercourse. So every aspect of her of her life was impacted, and I was her last resort, she had gone to medical doctors, and she had gone to physio therapists, and not one person has performed a diastasis recti check. So we did. And she had a significant diastasis, which I knew based on her low back pain based on the fact that all of these symptoms would come up right around menopause, where a drop in estrogen causes a laxity of a lot of ligaments. I said to her, it’s going to be more challenging, because it’s been over two decades that you’ve had this diastasis. But let’s try, give me 12 weeks, let’s see what we can do. And within 12 weeks, she had improved like you could just see it when she came in to see me Her eyes were Breyer, I got four I went for a walk around the block with no pain, Dr. alley, six or seven weeks into into treatment, I think I’m going to go back and try a really low impact workout class at my favorite gym just to see what happens. I did it with no pain. And I saw over the course of these three months of working together, how she felt empowered by taking control of her health and having an answer as to why she had felt like that for so long. And in her particular case, yes, we did see it close, it didn’t go back to what we looked for as, as I mentioned, medically normal, but we saw a significant closure in that gap. And best of all, zero back pain, improved function of her pelvic floor and her ability to re engage with all of those aspects of life that that she had had to take herself out. So that for me, yeah, it is amazing, right? When and when you see the impact that this lack of doing what I’ll call a simple check, like if we could just check all of our moms and and monitor them in that first year postpartum, we would ward off so many of these debilitating issues that crop up later in life. But the fact is bad, like what we can get away with in our 20s and our 30s. As we age if we’re not an active participant in our healthcare, meaning that we’re warding off age related muscle mass loss sarcopenia, it will come back to bite us in the butt. So yeah, that’s what I’m trying to do by changing the narrative is say yes, I know you don’t want to picture yourself as a little old lady in your 50s with pelvic organ prolapse. But let’s talk about right now getting your core strong and feeling good and getting rid of the mom pooch. And I know that by doing that, that you will be less likely to have the severe quality of life impacting complaints later on later on in life.
Ben James 34:18
Yeah, absolutely. And it’s a it’s again, back to the education and and understanding and then taking that as an individual proactive approach to to your health, postpartum. Even that’s a long way down the road, because I’m guessing I know the answer that I’m going to get from this question. Any any woman that comes to see you that you know, of any age that comes to see with backout problems? I’m assuming you’re going to do those those checks and look at that, particularly, obviously if they’ve had had children, of those individuals that come to you with back pain that maybe are, you know, have given birth even 1020 years previously. Are you seeing a lot of those even at that point, a lot of a big percentage of Those people, there’s some kind of issue there that that is kind of pelvic pregnancy related.
Dr Alli Cain 35:14
So am I seeing issues in the majority of women who are giving who have given birth and coming to me later in life? I’d say once again, like 50% of people and 50. Now, but and educating them, because if you’ve given birth, I want to know your birth method, because we know that if there has been significant tearing, or in a PC on me that you are more likely to have pelvic organ prolapse. So if a patient comes in, and I don’t think that their low back pain is, the root cause can be linked back to their pregnancy and giving birth, I’m still going to say to them, if you feel these common complaints, so like heaviness and your pelvic floor or your incontinence gets worse over the next four or five years, that is an indication of pelvic organ prolapse, which is when your uterus, your bladder, your rectum start to travel down in the vaginal canal, and in some cases actually protrude. And so I want you to come see me, because there’s things that we can do. And in fact, if you, if you can think back and you’ve had any of those symptoms, we should get started ahead of the game right now. Because we know that after menopause, that there’s a higher likelihood, likelihood of pelvic organ prolapse. So while not every single person that comes in, we’re going to, you know, attribute it to an issue in postpartum, we’re certainly going to educate, because even if that patient that I give that spiel to doesn’t have that she’s talking to her sister, or a friend or a colleague, and they mentioned those symptoms, now she is empowered to tell them that there is things that they can do. And that’s how we change the narrative benefits by coming on podcasts like this and sharing information, and empowering women to step up and say, Okay, this doesn’t feel good. I don’t feel normal. What can I do? Where can I go? And now they know, okay, you can go to go go?
Ben James 37:08
Absolutely, yeah. And there’s no, there’s no negative impact of working on a pelvic floor, that that isn’t necessarily a primary cause of, you know, of a back problem or anything else, you know, because it it’s part of the core people see the the abdominal wall, or the kind of six pack. That’s my, that’s my call, but actually, no, guys, you know, there’s a lot more to it than that.
Dr Alli Cain 37:30
Yeah. And we talked about the inner unit. And the big pieces that we can see in any patient, male, female, postpartum, no children is, especially with with work from home, which I know a lot of people are likely doing right now is if your posture is impacted, impacted, so two is your pelvic floor, because your diaphragm and your pelvic floor have this beautiful synergistic relationship. And so we often think that, okay, if you’ve given birth, your pelvic floor is probably too too loose. But that’s not always the case. And in fact, in the majority of people who have incontinence issues, so they’re peeing, when they laugh, or cough or sneeze, they often will have a pelvic floor that is too tight. And this stems in many cases, to the fact that they’re not getting a full breath cycle, because they’re breathing up here in their chest, they probably have an upper cross syndrome as well. And so with every inhalation, when the pelvic floor when the diaphragm rather moves down, the pelvic floor has to stretch. And then as you exhale in the diaphragm moves back up, it has to contract slightly. So we want that proper stretch and contract cycle with every single breath for a proper healthy, functional, pelvic floor. But in a lot of cases, people aren’t getting that. And so they’re, they’re contributing to a worsening or less functional pelvic floor over the course of their lifetime by not doing work to it. And again, that’s male or female, because males can have a diastasis too.
Ben James 39:01
Yeah, sure, yeah, I was gonna say that, that’s another common misconception that this is just, you know, female predominant. And so for the, for the people listening for particularly, those, those women that have given birth recently, one of the things that they can do themselves as a bit of a self kind of test that anything they can do from a check in digestive system cells at whatever that period of time postpartum, and, and the kind of breathing mechanics that you talk a lot about, what are the things that they can do to kind of assess that or kind of do a bit of a self assessment, I guess, just to get a bit of baseline a bit of insight.
Dr Alli Cain 39:37
Okay, so so two pieces, and this is the podcast, so I can’t show you so if they can head to to Instagram at groco dot rehab, I have a few posts on how to do a self diastasis recti. Check. It’s it’s simple in the sense that you lie down, you go into a bit of a crunch, you lift your head off the ground and you feel down the midline. Have your core, and I guide you through what you should be looking for. But in a sense, if you can sink down, and you can fit two or more fingers in the gap in the midline, that is a clue that you should go find somebody who is trained in diastasis recti checks or is a postnatal specialist practitioner, and I get a further investigation done. The second thing you can do, and if whether your family planning if you’re expecting, if you’ve given birth is I want you to learn how to breathe properly. Because if you can engage your deep core and your pelvic floor and reestablish that neurological connection that has shifted through a pregnancy because of the massive changes that occur and atomically and neural neurologically, then you’ll be better served to actually strengthen those muscles when time comes if that’s what is needed in that case. So a proper deep breath is the belly actually expanding out as you inhale, the pelvic floor actually relaxing, and a cue I use because you’re not really thinking about your pelvic floor when you’re breathing, right, we’re just we’re just breathing each and every day, but a cue that I use. So for people listening right now, you might laugh, but I think for a lot of people, it really helps to imagine a flower actually blooming through their vagina as they take a deep breath into relax the pelvic floor. And when you get good at you can feel it. So deep breath in, everything relaxes flower blooms, exhale. And then we want to actually lift up through the pelvic floor and in through the deep core. And so it sounds simple, but this is often the most difficult piece to postnatal rehab. And without mastering that component, any other core exercise that you do a dead bug a bird dog, a side plank is not going to be as effective. So we need to establish that neurological control over our deep core, our TV and our pelvic floor before we do anything. So like anything, if you haven’t ever thought about your breathing mechanics, or somebody has said, Hey, I think that you’re not actually breathing properly, you should improve your breath mechanics, got to do the reps, you got to do the work just like training your biceps, the more the more you do it on a dedicated program, the better you’re going to do it and it has to be conscious at first for it to then become part of your normal day to day.
Ben James 42:33
Yeah, I often talk to patients about making the conscious subconscious. And it’s only get that through practice. But But it’s interesting because from a from a spine stability, spine health point of view, I talk a lot to patients about you know, control of breathing and being able to control that core because invariably, a lot of patients I see a good percentage, and we’re not talking just postpartum women here with we’re talking everybody struggle with that. And there’s there’s no doubt and I’m guessing from a from a women with postpartum, they’re struggling with the breathing. Letting Go and relaxing is is probably one of the big challenges because they’re so fearful of letting it go because of the concerns about incontinence, I’m guessing?
Dr Alli Cain 43:15
You’ve got a bed and also it’s a stressful it’s a stressful time. And if you’re you’re not thinking about yourself, especially in those first few months postpartum where you’re just trying to survive and you’re your focus is on baby. So while we have grown called the in person sessions, what I just talked about the deep core and pelvic floor work, it is something that you can do while you’re holding baby while you’re brushing your teeth, to have a massive impact on your overall health and healing. Which is nice because most most new moms don’t have 10 3060 minutes to grab for themselves. And even just the thought, okay, baby’s asleep. I want to have a nap to shake a lion head, do three deep belly breaths, and then have your and then have your nap and know that you’ve done. You put in the reps to make the improvement.
Ben James 44:07
Repetition, repetition, repetition. Yeah… absolutely.
Dr Alli Cain 44:09
Got it.
Ben James 44:11
So check it out for diastasis, breathing is a key thing. Where do you go from there?
Dr Alli Cain 44:18
Where do you go from there. So once you establish and really mastered that foundation, the key exercises that I like to do have to do with targeting the TvA. So my favorite exercise is the dead bug. And it’s the dead bug because we can progress it so well and see amazing results. And the first thing and again, if you’re listening and you’ve recently given birth, just lying on your back with your hands and legs in the air and trying to do those deep diaphragmatic breaths. It’s going to be challenging, you’ll likely see a shake to your core because once again, we’re just in this place. This process of reestablishing neurological connection and healing those muscle fibers. Once you can do that without once you can do that and show me really good core stability. So that means no shifting of the ribs or the hips or lifting of the low back in that position, then we start to move the limbs, whether it’s just the legs, just the arms, or both. And we do that in a contra lateral motion, so the opposite leg in the opposite arm. And the goal of this then is to challenge the course, I don’t care how far you can move your leg or your arm, I care that you can show me true core stability and control. And so that would be my absolute number one favorite exercise to do for the majority of people because we’re linking the breath with every single Rep. And then we’re challenging core and pelvic floor. So we’re really hitting it from all angles. And quite honestly, if you only focused on doing the dead bug exercise for for the first 12 weeks, you would see massive improvements and, and even extrapolating that exercise and that inner core unit focus, if you had your Olympic weightlifters or your runners or really any high level athletes actually do a dedicated core program that focused on the deep core pelvic floor integrated, you would see massive results, because as we know, that’s your power transfer zone. That’s how you, you transfer load through the body before you even lift your arm. Like let’s say you’re serving a volleyball or you’re playing tennis, your TVA is bracing, pre activating before you do that motion. And so you can see how if you don’t have a proper functioning deep core, how everything is going to be compromised. And similarly how if you have an awesome functioning deep core that everything is going to feel better, you’re going to look better, and you’re going to perform better as well.
Ben James 46:57
Yeah, it’s interesting that that kind of core core stiffness, core stability, distal kind of mobility, digital performance, and they just relaying a case that I’ve been seeing a guy with tennis elbow, but he’s generating all his power, just, it’s all through the arm, it’s all through the arm, we’ve talked a lot about get that call, right? Get that shoulder stability, right? It’s that kind of kinematic chain, that now you’re going to be better off from a technique and a power point of view. But you’re always going to be healthy, you know, and it’s exactly again, that, you know, it’s it that core is just so important. And it’s so undervalued under, under focused, I guess other than the classic setups that people do that they’ve been sitting in a chair all day, and then they go to the gym and do setups and, you know,
Dr Alli Cain 47:44
Precisely… it…. you painted such a great picture where you as an astute clinician figured out that okay, yes, your elbow hurts, okay, let’s look at your shoulder. Okay, let’s look at your core. And you’ve been able to properly rehabilitate this elbow tendinitis patient, because you did a full comprehensive analysis. And so what we’re doing with posting a rehabilitation is not reinventing the wheel. There’s no magic to this, we’re just saying, hey, let’s look at women who have given birth. Like we look at any other patient that comes through our doors, knowing that they’ve been through this event, and do a full assessment and prescribe proper rehab. It really comes down to just basic tissue healing science having a keen eye as a clinician, and and the prescription of rehabilitation and not just chalking up issues that women experience after they’ve given birth to the inevitable inevitable side effects of having having children.
Ben James 48:47
Yeah, absolutely. And I think the other the other part of the job that for me is so important. It’s not just the, like you said, the exercise prescription, it’s the coaching around it, you know, they’re, they’re just doing a dead bug or a bird dog. That’s no good if you’re not doing if the form is not right. And often people just yeah, I’ve done the repetitions, but the quality is poor. It’s not about the reps. It’s the quality of movement. And I think that’s it that’s so so important as well.
Dr Alli Cain 49:13
You are absolutely correct. And it is why we don’t just write three sets of five dead bugs, go home and do this to a new mom, because we know she’s not going to do it. And we know she’s likely not going to do it properly. So the implementation of group based rehabilitation makes me and I feel so lucky, as a clinician, I can have my eyes on my patient, I can make sure she’s doing it and doing it properly. And it is so empowering for mom to know that she’s doing it right because how often have you heard if you have prescribed to a patient go home and do this exercise? I didn’t get to it or I don’t know if I was doing it right. So this really solves both of those problems, and really the overarching problem which is that women aren’t getting the care that they need.
Ben James 50:00
Yeah, absolutely, absolutely. And I think I think that’s a really not just from a postpartum women point of view, but from an accessibility for, for, for a lot of people suffering from back pain, whether they’re athletes or whether they’re just, you know, office workers that don’t go to the gym, that that kind of evolution of care from passive hands on with a few exercises, but almost, you know, looking at the group, that kind of hybrid model you’ve got, that gets people not just out of pain, but functioning better performing better and, and far more resilient. And I think confident with it. I think that really is the pinnacle of where, where practice needs to go from, from a personal point of view. So it’s, it’s, it’s great that you’ve got the, it’s great that you’ve got that kind of system and setup in place. But I guess the unfortunate thing is not everybody’s got a adopted ollie on the doorstep from a postpartum women point of view. So tell us a little bit more about groco and, and the kind of community and the professional network you’re developing there?
Dr Alli Cain 51:03
Well, I can’t raise the standard of postnatal care by myself. And I also recognized and you may have found this to in your education that this really isn’t taught to clinicians, we’re not taught more than to ask our postnatal patients Did you have your six week clearance, and then we go about things within our within our scope of education. And so it’s three years ago now I launched the groco health professional seminar so that I could teach other health professionals chiropractors, physiotherapists, rmts, osteopath, etc. What they should be looking for what we needed to do as a collective to raise the standard of care postpartum, and get better outcomes. And something as simple as we’ve talked about, then as adding a diastasis, recti, check which, in my education, my almost a decade of studying the human body, intensely, was never taught that by in a formal setting. So that’s what we have done. And then I invite any healthcare professional, who has completed the seminar to join me as what I call an ambassador. And so they use the groco name, but they run route based rehabilitation for postnatal women, whether in person or virtually now, and for their patients so that we can provide access, I was having people drive to me from hours and hours away, and I was flattered, thank you for thinking of me, but we have to find somebody within you know, your region that you can go and see. And that is satisfied. That issue now we have health care professionals who have this specialty, stationed largely within Canada, but starting around the world and is what needs to happen so that we can match the patient with the proper professional.
Ben James 52:50
Yeah, amazing, amazing. And no one has to give you any work. But if you’ve got ambitions to try and get it on to educational programs and things in terms of that progression of of training, because it’s still it’s still when I think great, great training where I I studied at the ACC in Bournemouth, but very kind of chiropractic moving away from that, but still very kind of passive, that kind of approach. And they were starting to do a lot more rehab, which was great, really insightful. But clearly there’s a there’s a gap for this kind of postnatal care ambitions there?
Dr Alli Cain 53:26
I’ve thought about it actually just the there’s one chiropractic school within all of Canada and and lucky for me, it’s just about an hour away and they contacted me to come do a talk there. So this level of care is definitely being noticed people, especially once they get into practice or recognizing that they don’t feel as empowered as they could provide the level of care that they want. So they’re they’re reaching out the the impact has started to become global. Certainly, do I have ambitions of becoming a professor and a lecturer? I love seeing my patients so much. And I have two young kids at home. So that’s not not my aspirations. But I would love to see this level of care start to become part of the curriculum for all healthcare professionals who will be working with women, which is everybody.
Ben James 54:16
Yeah, no Amazing, amazing and I think, you know, credit to you that not only have you identified the need and an issue there, but you’ve taken action to to really look at the the the ways of solving that problem and building that network to grow it and reach a wider audience. So it’s absolutely fantastic, hugely insightful, some great content there for the listeners to to take action today, you know, which is fantastic. And of course we’ll share all the information the links in the show notes for regarding groco for any professionals listening that want to look at the courses and the content. I’ve been consuming a lot of the videos and the free kind of video content you’ve been putting out there which has been which has been great and high value. So look forward to following more information that for to get in the podcast. out there to people so that we can do a little bit to share, share your message. And I really appreciate you coming on the show. And it’s been it’s been great and I look forward to staying in touch and and maybe get you back on at some some future point.
Dr Alli Cain 55:16
Thanks so much Ben. It’s opportunities like this that truly do raise the standard of care for postnatal women. So thank you so much for having me on.
Transcribed by https://otter.ai