Monday, 28 January 2019

To belly band or not to belly band. That is the question

In the pregnancy and physiotherapy services it was believed that using a belly band in the first 8 weeks post partum would be helpful for “healing” a rectus diastasis. I am the first to admit that I too was recommending this for a period of time. I’ve learned some new information and ever since I have stopped recommending it proactively, but that is not say that in certain circumstances it is not helpful. So I want to share what I have learned.

Firstly using the word healing may be a bit deceiving in the case of a rectus diastasis. Yes we heal postpartum from tears or actual tissue trauma but when it comes to the ab muscles and fascia there is no inflammatory process happening that signals “healing,” like in the case of healing from a wound. Since there is no actual “healing” taking place, a band cannot heal a diastasis. The abdominal wall is actually recovering from a sustained stretch, which is why it is important to rest and allow the body to adjust to the new environment, I.e no baby inside.

One of the leading physiotherapists/educators Diane Lee suggests that using a band can actually prevent the abdominal wall tissues from tightening up. This is because the band puts the muscles/fascia on slack and tension is needed for collagen growth which is what helps muscles and fascia to develop.

We don’t really know why some moms get a smaller separation while others get a large separation. We also don’t really know why some moms regain function and tension in the abdominal wall faster while others don’t. What we do know is that the tissues need to be loaded to rebuild strength and tension.

As I mentioned above, there are some circumstances where using a belly band can be helpful, for example a mom who is experiencing back pain who has a newborn and/or additional kids and needs to get work done around the house or go out for groceries. If the band helps support her in those activities so she can get them done, this is an appropriate time to use it. However, as soon as that activity is done, the band should come off.

I have similar conversations when clients ask about back braces. Braces do the work that the muscles should be doing. There are going to be circumstances when they are needed to get through an activity but I never recommend for constant or permanent use. If the muscles don’t have to work they get weak, often times adding to the problem and creating a reliance on the brace.

Now its important to clarify that if using the band helps with the back pain in the postpartum period it is not because it’s changing the rectus diastasis, it is more because the band provides an increase in intra-abdominal pressure and a wall of support for activity. The same can be true for spanx. It can provide additional support to the back, pelvic and hips with activity but it won’t impact the connective tissue and muscles. So if you are using these to get through some activities by all means, momma’s gotta get work done, but make sure to take it off for most of the time.

Really the only way to address a rectus diastasis is through committed, consistent, hard work. If you read my previous blog on rectus diastasis I was mentioning that we don’t consider a separation a problem in the first 13 weeks post partum. After that if it persists, here are some timelines.

If the ab separation is due to a mechanical issue (meaning a muscle is not activating well or in coordination with other muscles) you can expect to see results from exercise in about 6-8 weeks. However if the fascia/connective tissues needs to re-build, meaning laying down new collagen it could take anywhere between 12-18 months with exercise.

One thing to consider in the time frame is that connective tissue will be impacted by breastfeeding so it can take 4 months after you stopped breastfeeding for the tissue to tighten, hence why it can take 12-18 months.

So the answer.. To band or not to band? Band if you have pain and it helps you get things done, spanx for an evening out but don’t be using this every day, all day as a solution. Make sure to see a physiotherapist.

Information for parts of the blog comes from a presentation done by Diane Lee PT from the Spring/Summer Birth Healing Summit 2018.

The Pelvic Health Lady