There is a lot of talk on the internet about abdominal corsets and binders, which leaves us with the question: should birthers bind their bellies postpartum? Let’s look at this from an orthopaedic perspective. When dealing with an ankle sprain or torn ACL, it is a no brainer to wrap, tape or brace the injured tissues to give enough external support for the joint to prevent excessive accessory movement and support the surrounding tissues while the ligaments and muscles heal from the injury and restore function with adequate load transfer.
Now, let’s translate this to the postpartum core.
We know that:· 100% of pregnant folks will get a diastasis rectus abdominus (DRA) in their third trimester as measured by an enlarged inter recti distance (Mota et al 2014)
Some people also stretch through the abdominal muscles (Brauman 2008)
Muscles that are lengthened loose contractile strength as seen on the length tension curve as their maximum force generated decreases (Gordon 1966)
45% of birthing folks experience low back pain (LBP) and Pelvic girdle pain (PGP) during pregnancy and 25% postpartum (Wu et al 2004)
Transversus Abdominis (TvA) is inhibited or delayed during and after low back pain is experienced (Hodges et al 2003)
Multifidus (MF) is delayed on the painful side of the LBP group (MacDonald et al 2009)
PGP causes poor synchronization of the deep system (Lee D 2011), especially in PFM and TvA (Bo et al 2009)
The pelvic floor is stretched and/or torn during a vaginal delivery (Sleep et al 1984)
100% of birthing people with a laparoscopic surgery had a DRA (Parker et al 2009)
Spontaneus healing of a DRA (looking at the inter-recti distance) only occurs in the first 8 weeks post partum, beyond that intervention is needed (Coldron et al 2008)
So it stands to reason that just as many cultures around the world have used abdominal binding for centuries, modern day birthers should consider using The Ab System to help restore function to the abdominal wall postpartum. Remembering that an external support to the healing tissues is only temporary and needs to be coupled with restorative exercises to rebuild the internal system.
For those who care, here is a list of some other research we refer to in our work. We are constantly updating this page as we get our hands on more recent research.
Please note, the studies below include gendered language. At bellies inc., we know that there are gestational experiences by those who do not identify as pregnant women and we hope to one day be able to include studies that reflect this experience.
Axer H, Keyserlingk DG, Prescher A. Collagen fibers in linea alba and rectus sheaths. II. Variability and Biomechanical Aspects. J Surg Res. 2001a; 96:127-134.
Beer G, Schuster A, Burkhardt S, et al. The normal width of the linea alba in nulliparous women. Clin Anat. 2009; 22:706-71.
Bo K, Morkved S, Frawley H, et al. Evidence for benefits of tranversus abdominis training alone or in combination with pelvic floor muscle training to treat female urinary incontinence: a systematic review. NeurourolUrodynam. 2009; 28:368-373.
Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther. 1998; (68)7:1082-6
Chiarello CM , Falzone LA , McCaslin KE , Patel MN , Ulery KR. The effects of an exercise program on diastasis recti abdominis in pregnant women . J Womens Health Phys Ther. 2005. 29;11 – 16 .
Coldron Y, Stokes MJ, Newham, DJ et al. Postpartum Characteristics of rectus abdominis on ultrasound imaging. Man Ther. 2008; 13:12-121.
Hodges PW, Cholewski J. 2007. Functional Control of the Spine. Ch: 33 in Movement, Stability and Lumbopelvic Pain. Eds. Vleeming A, Mooney V, Stoeckart R. Elsevier, Edinburgh
Hodges PW, Cresswell AG, Dagfeldt K, et al. In vivo measurement of the effect of intra-abdominal pressure on the human spine. J Biomech. 2001; 34:347-353.
Hodges PW, Sapsford R, Pengel LHM. Postural and Respiratory Functions of the pelvic Floor Muscles. NeurourolUrodynam. 2007; kmp26:362-371.
Huge BS, Colby LA. Women’s health: obstetrics and pelvic floor. In, Kisner C, Lobly LA. Therapeutic Exercise. Foundations and Techniques, 5th ed. FA Davis, Philadelphia 2007.
Keeler J, Albrecht M, Eberhardt L et al. Diastasis recti abdominis: a survey of women’s health specialists for current physical therapy clinical practise for postpartum women. J Women’s Health Phys Ther. 2012; 36:131-142.
Lee DG. 2011. The Pelvic Girdle-An integration of clinical practise and research. 4th edition. Elsevier, Edinburgh
Lee DG, Lee LJ, McLaughlin L. Stability, continence and breathing. J Bodywork MvmtTher. 2008;12:333-348.
Lee DG, Lee LJ. 2008a. Integrated, multimodal approach to the treatment of pelvic girdle pain and dysfunction. In: Magee DJ, Zachazewski J E, Quillen W S (eds) Pathology and intervention in musculoskeletal rehabilitation Saunders, Elsevier p473
Liaw LJ, Hsu MJ, Liao CF et al. The relationship between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study. J OrthopSpors Phys Ther. 2011; 41:435-443.
Lilios S, Young J. The effects of core and lower extremity strengthening on pregnancy-related low back and pelvic girdle pain: a systematic review. J Womens Health Phys Ther. 2012; 36:116-124.
Macarthur. Urinary incontinence persisting after childbirth: extent, delivery history, and effects in a 12–year longitudinal cohort study – MacArthur – 2015 – BJOG: An International Journal of Obstetrics & Gynaecology – Wiley Online Library
Mattox, TF, Lucente, V, McIntyre P, et al. Abnormal spinal curvature and its relationship to pelvic organ prolapse. Am J Obstet Gynecol. 2000;183:1381-1384.
Mendes Da, Nahas FX, Veiga DF, et al. Ultrasonography for measuring rectus abdominis muscle diastasis. ActaCirúrgicaBrasileira. 2007; 22:182-186.
Mens JMA, Vleeming A, Snijders CJ et al. Validity of the active straight leg raise test for measuring disease severity in patients with posterior pelvic pain after pregnancy. Spine. 2002; 27:196-200.
Neumann P, Gill V. Pelvic floor and abdominal muscle interaction: EMG activity and intra-abdominal pressure. Inter Urogyn J. 2002; 13:125-132.
Lo T, Candido G, Janssen P. 1999. Diastasis of the recti abdominis in pregnancy: risk factors and treatment . Physiotherapy Canada 51(1):32 – 37 .
Mens JMA, Vleeming A, Snijders CJ, Stam HJ, Ginai AZ 1999. The active straight leg raising test and mobility of the pelvic joints. European Spine 8:468.
Parker MA, Miller LA, Dugan SA. Diastasis rectus abdominis and lumbo-pelvic pain and dysfunction: are they related?. J Womens Health Phys Ther. 2009; 33:15-22.
Sahrmann SA. Daignosis and treatment of movement impairment syndromes. St. Louis:Mosby; 2001
Sapsford RR, Hodges PW, Richardson CA et al. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. NeurourolDynam. 2001; 20:31-42.
Sapsford RR, Hodges PW. Contraction of the pelvic floor muscles during abdominal maneuvers. Arch Phys Medil Rehab 2001. 82; 1081-8.
Sherburne M, Murphy CA, Carroll S et al. Investigation of transabdominal real-time ultrasound to visualize the muscles of the pelvic floor. Aust J Physiother. 2005; 51:167-170.
Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Urogynecol J Pelvic Floor Dysfunt. 2007; 18:321-8.
Tuttle, Lori J. PT, PhD; DeLozier, Elizabeth R. SPTet al. The Role of the Obturator Internus Muscle in Pelvic Floor Function. Journal of Women’s Health Physical Therapy:January/April 2016 – Volume 40 – Issue 1 – p 15–19