Understanding diastasis recti – part 2

Mind the gap - understanding diastasis recti

In part 1 we looked at what a diastasis recti is and common things to look out for if you suspect you might have a diastasis. Here in part 2, we will discuss how physiotherapy can help, and common dos and don’ts if you do have a diastasis.

 

Physiotherapy

Unfortunately, there is not a one-size-fits-all set of exercises that can be prescribed to “fix” a diastasis. Treatment for this condition needs to be individually tailored depending on the extent of the issue, how many weeks post-partum you are, whether you’re experiencing concurrent lower back and pelvic pain, and what sports or activities you want to return to.

 

Initial physiotherapy treatment focuses on re-connecting to your core muscles, which include your diaphragm, transversus abdominus, and pelvic floor muscles. Once these muscles are working and co-ordinating together more effectively then you can start to progress exercises to integrate more superficial muscles. The eventual aim is to regain proper function and co-ordination so that you have a reflexive core that can cope with all the physical demands of being a mum, and also any higher impact and more strenuous exercise you might wish to do.

 

Women with a diastasis who return to higher-level abdominal exercises after pregnancy without first working to re-connect to their core muscles are potentially at higher risk of making their diastasis worse. We advise women against doing any sit-ups, crunches, planks, Russian twists, burpees, or similar higher level abdominal exercises until they have been checked by a physio or post-natal specialist personal trainer.

 

Dos and Don’ts

In general, any movement or sustained posture that increases the pressure in the abdomen or places unwanted tension through the linea alba (the connective tissue down the front of the abdomen) is best to avoid.

 

Things to consider:

 

  • Avoid slouching when sitting, standing or nursing your baby – try to use appropriate pillows to support your back and the baby

 

  • In standing you want to keep your hips and pelvis backed up over your ankles, and your ribcage stacked over the pelvis (see photos below). This helps to reduce unwanted sustained tension through the linea alba and helps get your core muscles into a position where they can work more efficiently

  • Avoid movements that create bulging or peaking of the linea alba. Common culprits are getting in and out of bed through a sit-up movement (try rolling onto your side and using your arms instead), and getting up from the sofa from a reclined position whilst holding your baby (again try to use your arms to help you)

 

  • Tightness through the chest, shoulder and hip flexors are also factors that can increase unwanted pressure through the linea alba, as well as constantly sucking your belly in, or straining whilst on the toilet

 

With diastasis recti it’s important to recognize that it is unlikely that one factor will cause harm on its own. It is the accumulation of day-to-day, repetitive, non-optimal loading through the abdomen that can contribute to diastasis recti. But similarly the opposite is true and women can see great improvements in their diastasis by being mindful of how they’re holding themselves, how they’re holding their babies and how they’re moving.

 

If you have any concerns that you may have a diastasis recti please make an appointment to see one of our specialist pre/post-natal specialist physios for a comprehensive assessment – we’re here to help.

 

ACL Reconstruction – They aren’t all the same!

Each orthopedic surgeon has their specific way of doing an Anterior Cruciate Ligament Reconstruction (ACLR). I think it is important to ask your doctors (It is important to get more than one opinion when considering this surgery) the following questions:

How many ACLR’s do you perform annually? 

I think this is an important question because if you are a semi/professional sports person or if you are doing sports that involve pivoting, changing of direction or jumping (soccer, basketball, field hockey, martial arts) you need to give your knee the best chance going forward if you would like to continue with the sport you love and avoid re-injury or chronic pain.

Since I tore my ACL in November 2018, I have consulted with 4 different orthopedic surgeons. The first two doctors I saw told me they only did 20-40 ACLR annually, the third and fourth doctors were doing 100-140 annually. The varying number of surgeries has nothing to do with their expertise but more to do with sporting population size etc. For example, Australia has the highest numbers of ACL reconstructions annually. But Australia is also one of the most active countries in the world, so that makes sense.

Which graft type do you use? 

When this injury does occur, the athlete has some serious decisions to make including which graft to choose for the reconstruction. Often, people leave that decision up to the orthopedic surgeon without really analyzing if it is best for their lifestyle, age and goals.

Next, I would like to explain the difference between an autograft and an allograft. An autograft is your own tissue. An allograft is the tissue of a cadaver.

The most common choices are a hamstring tendon, patella tendon, quadriceps tendon autograft and a patella tendon allograft. It is important to discuss these options in detail with your surgeon. The research and debate between the hamstring and patella autograft will continue, as there is a lot of research going into the re-injury rates as well as post-surgery pain. I decided to go with the hamstring autograph. Its known to be very painful and it has lived up to that reputation. But with correct management, 8 days post-op I am already off the analgesics.

END.

– Cardeux Nel, Physiotherapist

Watermelon Ginger Hydration Drink

Ingredients

  • 1 cup fresh watermelon, diced or cubed
  • 1½ cups chilled berry flavored tea (herbal or green) such as pomegranate, acai, or raspberry
  • 1 tsp fresh ginger (minced or solid)
  • 1 tsp coconut sugar or Stevia
  • 1 pinch unrefined sea salt

Directions:

1. Combine all ingredients with the basic electrolyte beverage in a blender and blend until smooth.
2. As you pour the liquid into your drinking bottle, strain the pulp with a fine mesh strainer.

Enjoy!

– Katia Kucher, Sports Nutritionist and ultra-runner

Energy Power Muffin Grain-Free & Gluten-Free

Ingredients:

  • 2 cups spinach
  • 1 ripe banana
  • 1 cup apple sauce
  • 1 ½ cups unsweetened almond milk
  • ½ cup Swerve, natural sugar replacement or Stevia to taste
  • ¼ cup coconut oil melted
  • 1 ½ teaspoons vanilla extract
  • 1 ½ cup almond flour
  • 1 cup coconut flour
  • ½ cup tapioca flower
  • 2 scoops protein powder, vanilla or caramel
  • 1 teaspoon baking powder
  • 1 teaspoon baking soda
  • 1 teaspoon ground cinnamon
  • 1 teaspoon sea salt

Instructions:

1) Preheat oven to 180 C° and line a muffin tin with liners.

2) Pulse spinach a few times in a food processor, then add banana, apple sauce, almond milk,

3) Swerve sugar, coconut oil, and vanilla; process until well blended.

4) Add almond flour, coconut flour, tapioca flour, protein powder, baking powder, baking soda, cinnamon and sea salt in a large bowl; whisk.

5) Add wet ingredients and stir until combined.

6) Portion batter into prepared muffin tin.

7) Bake 25 to 30 minutes, or until a toothpick inserted in the center of a muffin comes out clean.

8) Cool muffins completely. Refrigerate in an airtight container for up to 3 days, or freeze.

Enjoy!

– Katia Kucher, Sports Nutritionist and ultra-runner

Quinoa Chia Seeds Vegan Flatbread

Ingredients:

• 1 cup (160 g) uncooked quinoa

• 2 cups (500 mL) plus 3/4 cup (180 mL) water, divided

• 3 tbsp. (30 g) chia seeds

• 2 tbsp. (30 mL) virgin coconut oil or olive oil

• 3/4 tsp. fine sea salt

Directions:

1. Rinse and drain the quinoa and transfer to a medium pot. Add 2 cups of water, stir, and bring it to a low boil. Reduce heat to medium, cover and cook for 13 to 16 minutes until the water is absorbed and the quinoa is fluffy.

2. While the quinoa is cooking, preheat the oven to 180°C and line with a large baking sheet (or 2 medium baking sheets) with parchment paper.

3. Stir the chia seeds, coconut oil (or olive oil, if using), and salt into the cooked quinoa until combined. Now add the remaining 3/4 cup water and stir again. Cool for 2 to 3 minutes.

4. Spoon this mixture into a large food processor and process for about 30 seconds (allowing steam to escape) until the quinoa is 50% broken down. There should still be some texture to the dough, and it’ll look like a thick, sticky paste with bits of quinoa throughout.

5. Scoop 1/4-cup mounds of dough onto the prepared baking sheet(s) several inches apart. You should have 9 portions. Lightly oil your hands (to prevent sticking) and press down on each ball with the palm of your hand until the dough forms a small round shape, approximately 13cm in diameter and no more than 2cm thick.

6. Transfer the baking sheet(s) to the preheated oven and bake for 20 to 23 minutes until the edges are lightly firm to the touch. Using a spatula, carefully transfer each to a cooling rack where they’ll firm as they cool. Add your desired toppings

Storing: You can refrigerate leftover flatbread in a sealed bag for 3 to 4 days or store in the freezer for up to 1 month.

Enjoy!

– Katia Kucher, Sports Nutritionist and ultra-runner

Joseph March
Founder and Physiotherapist

After graduating from university in Australia, Joseph had solid exposure in a wide range of areas including professional sports, neurological, pediatrics, gerontology, and rehabilitation.

Joseph has over a decade of experience in Hong Kong, specializing in rehabilitation of musculoskeletal and sports injuries. He has treated issues related to pregnancy, desk jobs, as well as the unique injuries that come with a variety of athletic pursuits.

He has partnered with the Hong Kong Football Club as the performance squad physiotherapist, as well as the Hong Kong Ballet as the consulting physiotherapist.

Joseph’s hobby outside of work is the pursuit of a better functioning body. This has led him to delve deeply into many types of exercise and performance training. He has years of experience in Olympic weight lifting, movement training, powerlifting, yoga, pilates and strength, and conditioning. Through his own journey, Joseph has positioned himself well to understand other bodies and across a wide range of exercise and sport.

In the past Joseph competed at a high level in football and long distance running.

Cardeux Nel
Senior Physiotherapist

Cardeux represented South Africa and attained her first karate world championship medals at the age of 11. Cardeux’s other sport of interest is field hockey, which she has also played at a national level. From a young age, she attended physiotherapy to enhance performance and recovery. Understanding the importance of this stimulated her to pursue a career in helping others.

After graduating from The University of The Free State in South Africa, Cardeux spent a few years working in private practice as well as gaining experience in sports physiotherapy. She assisted with the Springboks in the lead up to the 2015 Rugby World Cup and worked at the Comrades Marathon for 4 consecutive years.

Cardeux’s treatment is focused on exercise, education, and a holistic therapy approach. As a keen trail runner, she specializes in performing full running assessments, both clinical and video. She has also completed her post-graduate course in Dry Needling which she provides as part of her treatments.

Cardeux spends her time off continuing to pursue sports-related endeavors. She is captain of the Valley Premier women’s field hockey team, coaches running, and manages the Hong Kong Sports Clinic running team. She also extends her passion for the sport by giving back, as a member of WISE HK – Helping empower, educate, and connect women and girls through sport in Hong Kong.

 

Pronouns: she/her

Elaine Leung
Principle Chiropractor

Elaine completed her chiropractic training at Macquarie University in Sydney, Australia with a Bachelor’s degree in Chiropractic Science and Master’s degree in Chiropractic. She then moved to Hong Kong to pursue her career and to promote the importance of health and the work-life balance.

Coming from a family of martial artist and traditional Chinese lion dancers, Elaine also developed an interest in Muay Thai, BJJ and weight training. This of course also comes with some injuries which have always been managed with chiropractic.

Her long interest and love for animals have then lead her to complete a Certificate in Animal Chiropractic in the USA to enable her to provide care for animals as she does for people. She is passionate about getting people (and animals) out of pain and living their lives to the fullest.

Emma Piachaud
Senior Physiotherapist

Emma returned ‘home’ to Hong Kong in 2011 after having spent her childhood here. She completed her Bachelor’s Degree (Hons) in Physiotherapy in the UK and has subsequently worked in the UK, France, and Hong Kong in a variety of settings, including the National Health Service, private hospitals and clinics, and a ski resort.

Emma is a keen sportswoman, which has led to a natural interest in sports injury rehabilitation and exercise-based therapy where she has completed many postgraduate courses specialising in manual therapy and core stability retraining. These have been in areas such as the lumbopelvic complex and thoracic rib cage and their combined effects on the musculoskeletal system. She has used this knowledge when treating clients, from elite athletes with chronic overuse injuries to postnatal women returning to sport.

Emma is available to assess and manage all musculoskeletal conditions including neck and back pain, sports injuries, thoracic and ribcage issues, and post-surgical rehabilitation. In addition, Emma has a specialist interest in treating specific problems related to ante and post-natal women, including pelvic girdle pain, rectus diastasis, mastitis, and assisting in return to sport and fitness.

Katia Kucher
Principle Nutritionist

Katia is a nutritionist with a Precision Nutrition certification and NASM Sports nutrition certification. Katia has also been a fitness, road, and trail running coach for many years. Her focus is on finding the ideal personalized diet plan to maintain a healthy lifestyle. Her other certifications include NASM Personal Trainer, PTA Global Personal Trainer. She also does corporate talks and presentations about nutrition and fitness.

As a nutritionist, her goal is to create a personalized nutrition plan and diet to help clients reach their health and fitness goals, or resolve any health issues. The key is to find a healthy, balanced, life sustainable diet that is adaptable to the client’s body type, metabolism, and lifestyle. For athletes, she creates nutrition programs to improve their performance, strength and endurance levels, and promote faster recovery.

Her background also includes helping clients dealing with injuries, by recommending a diet and specific foods that follow the healing phases to help with the healing quality and speed.

If you find it challenging to find a proper diet that will help you reach any of your goals, Katia can help you achieve your goals or help with any health issues, by recommending a diet you will enjoy and be able to maintain.

Taras Makarenko
Principle Osteopath

Taras is the Principal Osteopath with the Hong Kong Sports Clinic, where he specialises in mechanical pain associated with sports injuries, “desk-bound” related back pain, and nerve entrapment syndromes, like sciatica pain.

He has post-graduate training in both pre and postnatal as well as infant and newborn treatments. His experience includes over 6 years as an independent osteopath, working with multi-disciplinary fields alongside general practitioners, sports doctors, and physiotherapists to provide a higher level of effective recovery for his patients. He has engaged with high-level athletes in the field of tennis, soccer, rugby, field hockey, basketball, dance, ballet, trail-running, and triathletes.

To achieve long-lasting results, Taras strongly believes that structure and function have to be considered equally. His methodology includes an emphasis on educating patients about their pain, and to consider that effective recovery and treatment extends beyond the therapy room. Education is a key component to treatments when walking with patients for their road to recovery, with a mixture of in-clinic and home exercises (stretches and strength focused) as keys factors to improve symptoms.

A French national, he enjoys the fast-paced environment of Hong Kong, with his two kids and wife his loves alongside a keen interest in tennis and running.

Hamish Dickie
Senior Physiotherapist

Hamish originally undertook a Sports Science degree at Otago University and followed this up completing a physiotherapy degree at the Auckland University of Technology. A proud Kiwi, Hamish has worked with a number of high-performance teams and individuals and was part of the New Zealand Olympic team in 2018 where the team won 2 medals.

The first NZ Winter Olympics medals in 26 years. Hamish is still involved with the New Zealand Olympic program and physiotherapist for the Hong Kong Rugby men’s team. In 2018, Hamish’s wife Alex gave birth to the couple’s first child Charlie who has quickly become the apple of his father’s eye.

Prior to Hong Kong, Hamish and Alex spent a number of years in beautiful Queenstown, New Zealand where he developed the regions first high-performance youth sports academy to progress talented athletes. Hamish has worked in other high-performance programs including the New Zealand Baseball team and has worked at major tournaments such as the New Zealand Golf Open.

He has also worked in house at CrossFit boxes and is enjoying working with the CrossFit and weightlifting community in Hong Kong. Hamish was the physiotherapist for the Hong Kong Cricket Club rugby section in 2016/17 and is an active member of the cricket section where he captains the Optimists Sunday premier league team. An avid fitness enthusiast, Hamish loves all the running options that Hong Kong offers and is an avid runner on the wonderful trails.

Needless to say, Hamish understands sports and has a special interest in biomechanics and strength and conditioning components of rehabilitation. Hamish is also a qualified dry needling technician and uses a number of mobilizations, soft tissue and active release techniques to enhance the recovery process. Whether you’re a weekend warrior, youth athlete trying to reach the pinnacle of your sport or an international athlete Hamish is the right physio for you.

Charles Wang
Senior Physiotherapist

Charles completed his Physiotherapy degree at the University of Sydney, Australia. Charles has a particular interest in the link between biomechanics and injury, especially in the lumbopelvic area and lower limb. As such his treatment approach incorporates manual therapies and exercises prescription to optimise movement patterns and to recover from and prevent recurring injuries.

Joe Zhang
Physiotherapist

Joe graduated from the University of Sydney and has worked with a variety of athletes and programs, particularly at the Olympic and Professional level. He was a physiotherapist at the NSW Institute of Sport, working across all the programs in particular the Cycling, Hockey and Wheelchair Basketball programs.

Joe was also a team physiotherapist at the NSW Waratahs Super Rugby team and Sydney FC’s W-League team. He worked also as a state program physiotherapist in gymnastics and netball.

Joe’s treatment approach incorporates soft tissue release, dry needling, mobilisations and exercise prescription to speed up recovery, optimise movement patterns, and prevent injuries from recurring.

Joe has played representative basketball, and was also involved in weightlifting.

Dereck Fu

Physiotherapist

 

Dereck completed his physiotherapy training at the Hong Kong Polytechnic University. After graduation, he started practicing in a public hospital where he had extensive experience in treating different musculoskeletal, orthopedics, and sports conditions. He recognizes the complex contribution to pain and musculoskeletal injuries and is keen on using a wide range of skill sets such as exercise therapy, manual therapy, and acupuncture tailored to individual conditions.

Before joining HKSC, Dereck completed his Master of Clinical Physiotherapy (Musculoskeletal Physiotherapy) and accreditation in Level 1 strength and conditioning coach under the Australian Strength and Conditioning Association (ASCA). These exposures enriched his practice, considering the psychosocial, biomechanical, and training load aspect of the clients’ story.

He has a particular interest in treating sports-related injuries and desk job conditions, assisting clients on their way back to function, and prevent recurring injuries.

Dereck has been a sports enthusiast since his teenage years. He is a keen football (soccer) and badminton player who treasures the enjoyment and satisfaction brought by both team and individual sports.

Icy Bo Lin

Head of Mobility

Icy has spent thousands of hours studying yoga, stretching and mobility through a broad range of in-depth courses. She has more than 7 years of experience teaching group and 1-on-1 classes to people ranging from athletes, pregnant ladies and new mums, children and especially the average Joe’s.

Icy is passionate about helping people move better, recover well and get pain free.

She believes it takes a combination of tools to help build a healthy body and has therefore spent substantial time practising strengthening and conditioning as well

Her passion for her craft is demonstrated through a focus and attention to detail with her clients.

Icy is a mother, experienced former banker and we are proud to have such an accomplished person on our team.

Below is a list of her completed training:

Leslie T. Evangelista

Head of Strength and Conditioning

Leslie’s athletic achievements speak for themselves. She is a true world class power lifter and continues to compete at the highest level. She has reached the pinnacle of her sport, medalling in a number of international powerlifting federation events. She has been Asia’s best lifter and holds a number of national records.

As impressive as it is, Leslie’s athletic resume pales in comparison to her passion, knowledge and dedication to the science of physical human performance. She is a student and expert of strength and conditioning, working in the industry as a coach and consultant for 10 years. We are very glad to have her on our team as her technical knowledge of compound movements and training methodology helps us bridge the gap between injury and a better you.

Leslie takes most pleasure in teaching the average person. Leslie’s deep knowledge and experience means she can build you from the bottom up or take you to a level beyond your expectations. Whether you are a mother or a mother to be, an office worker wanting to learn how to keep strong, or a youth wanting to learn the essentials of training, she is the expert for you.

Leslie is available as a consultant for long or short-term basis if you are serious about improving your health. She is an invaluable asset to have on anyone’s team.

Hideo “Harry” Loasby

Head Running Coach, Founder of BuffCo

Harry discovered running at 16, and quickly rose through the ranks in Hong Kong and became a national champion over 1500m when he was 17. He represented Hong Kong at the Asian Schools Championships and won several gold medals in cross country and track. Harry’s performances earned him a place on the Loyola Marymount University cross country and track team.

Towards the end of his university career, Harry became increasingly interested in studying various training methods and running philosophies. After moving back home, and knowing first hand the gap in grass roots development in Hong Kong, he set up Buffalo Running Company (BuffCo) in the hopes of changing that for the better. While coaching full time, Harry has remained competitive in the local scene, winning the 2020 China Coast Marathon by over 8 minutes. During the absence of races, he coached himself to personal bests in solo road time trials in the 10k and half marathon, running 31:38 and 70:30 respectively.

After running and now coaching in Hong Kong for the majority of his running career, Harry builds his coaching and training philosophy around the context of the city and what it means to be a runner here. He enjoys hunting for excellence in every level of runner, because he knows what Hong Kong’s running scene has to offer despite the tough conditions. From complete beginner to aspiring college athlete, on any surface over any distance, Harry is keen to help you with your running journey.

Harry is available as a consultant for any race you have on the calendar, but he is particularly passionate in developing runners over several years and building a sustainable relationship with all aspects of the sport, so that you can enjoy a lifetime of healthy, happy running.

May Lee
Sports Massage Therapist and Sports Scientist

May is an Internationally experienced Sports Massage Therapist, she focuses on deep tissue massaging to aid recovery, optimise performance but also general health and well-being. Throughout her years of training and watching others train, May has found that many people neglect the recovery process. The recovery process is fundamental for muscles to grow and develop and more importantly to reduce injury in the long term. Deep tissue massage helps to smooth out those little aches and pains you experience in normal day to day activities.

May has studied Sports Science at degree level and has completed her Level 4 Diploma in Sports Massage Therapy in the UK as well as being qualified in Dry Needling, Myofascial Release, Trigger point therapy and Pre-Hospital immediate care in sport.

She has previously worked a ski season in Niseko followed by working in clinical practice in Tokyo before deciding to move to Hong Kong to pursue her career further.

May has always had a keen interest in sports, training and exercise which has allowed her to pursue a successful career within sports and exercise rehabilitation.

Lizemari Marais
Physiotherapist and Pilates Instructor

Liz is a Physiotherapist and Pilates Instructor from South Africa. Her greatest passion is health education and empowerment, which is why she flourishes in the corporate wellness setting. She’s good at analysing corporate settings to determine risk factors to individual health as well as employee productivity. She will not just remind your employees to sit up straight – she will walk a path with your company to encourage healthy lifestyles and happy employees.

Liz’s approach to rehabilitation is grounded in the balance between mobility and foundation strength. She explores this in her calisthenics, yoga and pilates. She believes that with the right foundation and training, the human body can do anything.

Liz values independence and wishes to equip her patients with everything they would need to maximise their body’s potential, allowing them to pursue independent lives.

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