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19/11 Optimal Nutrition For Post Natal Recovery and Healing The Rectus Abdominus Module 2: The Post Natal Core – Structure, Function,Trauma and Healing Tutor: Jenny Burrell BSc (Hons), Dip SMRT, Founder of Burrell Education. © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). Internal and External Obliques Transversus Abdominus Anterior Division Origin – Inguinal ligament and the anterior iliac crest. Inser)on – Crest of the pubis and the linea alba by it’s aponeurosis Ac)on -‐ RotaCon of the trunk and lateral flexion. Supports and compresses the abdominal viscera and assists in forced expiraCon. Lateral Division Origin – Iliac crest and TCF Inser)on – Inferior boarders of 10th – 12th ribs. Ac)on – rotaCon and flexion of the trunk. © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). Origin – 5th to 12th ribs. Inser)on -‐ into the Linea Alba via the broad abdominal aponeuros from the ribs to the crest of the pubis, inguinal ligament and the anterior half of the iliac crest along the outer lip. Ac)on -‐ RotaCon and flexion, anterior stabilizaCon of the pelvis and increases forced expiraCon. Origins – Inguinal ligament, iliac crest and TCF and the inner edges of the lower 6 costal carClages. Inser)on – The Linea Alba by its aponeurosis. Ac)on: Compression and assisCng forced expiraCon. © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). 19/11 Anatomy of the Abdominal Wall Video – ESSENTIAL VIEWING! Defining Diastasis © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). Anterior Abdominal Wall A & P Key Diastasis Points © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). What’s happened? The abdominal wall has lost tensegrity – TENSION & INTEGRITY -‐ the opCmal synergy between the soX Cssue and the bony structures that allows the transfer of load/force and the mangements of intra-‐ abdominal pressure. SomeCmes this is temporary and some Cme it’s not and the woman requires clinical intervenCon to create ‘false force closure’ via tummy tucks etc., • A Whole Body & Lifestyle approach is required. • P o s t u r e , n u t r i t i o n , b r e a t h i n g s t r a t e g y, h y d r a t i o n , h o r m o n a l b a l a n c e , s t r e s s management all have a vital place in a restorative programme for Core Restore. • The inter-recti distance doesn’t define function. • C a p a c i t y t o t r a n s f e r l o a d a n d w i t h s t a n d I A P, c o n t i n e n c e u n d e r d u r e s s a r e m o r e viable definitions of ‘function’. • N e v e r j u d g e a b o o k b y i t s c o v e r. • W h a t y o u d o n ’ t a s k , t h e c l i e n t i s l e s s l i k e l y t o r e p o r t – s c r e e n e x t e n s i v e l y. • T h e P F, A b Wa l l , B r e a t h – Tr i u m v i r a t e ! T h e I n n e r U n i t n e e d s t o r e t u r n t o synergistic function. • The Inner Unit connects to the Outer Unit & ultimately reintegration is required for full functionality to be restored. • Some Diastases and Pelvic Floor/Continence issues are corrected via ‘conservative’ programmes and some require clinical interventions. • NEVER GIVE UP ON SOFT TISSUE! © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). 19/11 The Global / Thomas Myers’ 12 Line Myofascial Meridian System Key Line For Core Restoration - The Superficial Front Line © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). Key Line for Core Restoration - Front Functional Line • Lower Pectoralis Major • Lateral Rectus Abdominis and Abdominal Aponeurosis • Adductor Longus • Extensor Digitorum Longus and Brevis • Tibialis Anterior • Patellar Tendon • Quadriceps (including the Rectus Femoris) • Rectus Abdominis • Sternalis • Sternocleidomastoid © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). Key Line for Core Restoration - Spiral Line Anterior View • Splenius capitus • Rhomboids • Serratus anterior • External oblique • Rectus sheath • Internal oblique • Tensor fascia latae • ITB • Tibialis anterior © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). Posterior View • Peroneus longus • Biceps femoris S/L head • Sacrotuberous ligament • Spinae erectors 19/11 The ‘Triumvirate’ of the Pelvic Floor, Abdominal Wall & The Respiratory System Pelvic Floor Anatomy & Function – ESSENTIAL VIEWING! • Are you asking the questions that will give you the answers so that you can provide solutions? • Lifestyle, current and past history, major nutrition habits, general health and pelvic health. © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). Post Birth Pelvic Health & Abdominal Wall Issues - Bladder, Prolapse, Levator Avulsion C-Section & Vaginal Birth Videos – ESSENTIAL VIEWING – Please view the links in your Resources……. • You have a separate presentation which covers these topics………. © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). 19/11 Trauma to the Pelvic Floor Degrees of Tears During Birthing Tears are described in ‘degrees’ which indicate their size and effect: • Episiotomy • Ventous • Forceps • Perineal & Pelvic Floor Tears • 1st degree – This involves the skin of the perineum and the back of the vagina. These tears are often so small they don’t need stitching, and in fact they heal better naturally. • 2nd degree – This is when the skin and back of the vagina plus the muscles of the perineum are torn. These tears need to be stitched closed. • 3rd degree – This involves the skin, back of the vagina, muscles of the perineum and extends partially or completely through the anal sphincter. Stitches are needed to close these tears. • 4th degree – This is the same as the third degree tear, but extends into the rectum. Stitches are needed to close these tears, too. • Occasionally a tear may occur at the top of the vagina. This is known as a periurethral laceration. These tears are often quite small and require only a few stitches, if any. © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). Degrees of Perineal Tear What are muscles, tendons, ligaments, fascia made of? • Mostly C OLLAGEN! The main constituent of Collagen are Amino Acids which are found in protein foods. © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). 19/11 The 4 Phases of Wound Healing The 4 Phases Of Wound Healing © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s). © Burrell Education 2014. Do not copy, duplicate or transmit electronically without full permission from the author(s).